Keywords

adverse effects Chronic inflammatory demyelinating polyneuropathy COVID-19 dapsone decompression delay in diagnosis distorted fascicular architecture employment Fedis folP1 Gene Hansen disease Hansen’s disease histopathology household contact hypervascularity leprosy Leprosy Leprosy reactions M. leprae M. leprae infection MDT median nerve motor mouse foot pad Mycobacterium leprae mycobacterium leprae nasal carriage nerve conduction study nerve enlargement neural leprosy patient compliance PCR peripheral nerves poverty prednisolone pure neuritic leprosy Relapse sensory steroids Sudan Type 1 lepra reaction

Volume - 92, Issue - 3

editorial
Page 201
Editorial
Pages 202 - 206
Original Papers
Pages 207 - 217
  • Sonographic characteristics of median nerve neuropathy in Hansen’s disease: a case-control study

    • Y. Muralidhar Reddy
    • Jagarlapudi M. K. Murthy
    • Lalitha Pidaparthi
    • Shyam K. Jaiswal
    • E. S. S. Kiran
    • Anusha Penneru
    • Ravi Nukala
    • Sudhir Kumar
    Volume 92, Issue 3

    | Published on September 2021

    Background and objectives

    High-resolution ultrasonography (HRUS) has become a vital imaging tool in the management of leprosy. This case-control study analyzed the sonographic data on median nerves in leprosy and healthy controls to identify the features characteristic of leprosy.

    Methods

    Newly diagnosed and treatment naïve Hansen’s patients of both sexes and aged >16 years were included in the study. The control group included prospectively enrolled healthy subjects. Nerve conduction studies were performed in all. HRUS of the median nerve was performed using a Philips HD15 machine. HRUS parameters studied included cross-sectional area (CSA) of the nerve, fascicular architecture and abnormal blood flow (by colour Doppler). CSA was measured at the wrist (S1), 5 cm above the wrist (S2), 10 cm above the wrist (S3), mid-forearm (S4) and at the elbow (S5).

    Results

    30 median nerves from 22 cases of leprosy and 30 nerves from 15 healthy subjects were compared. Among cases, 8 were borderline tuberculoid, 9 borderline lepromatous, 3 lepromatous leprosy, and 2 indeterminate leprosy. Abnormal motor (76.7%) and sensory conduction (96.7%) was noted in the patient group. The mean CSA was 18.5 mm2 at S1, 20.3 mm2 at S2, 14.1 mm2 at S3, 9.1 mm2 at S4, and 8.1 mm2 at S5. The CSA at S1 and S2 were significantly higher compared to other sites. CSA values were significantly higher in patients compared to controls. The fascicular architecture was distorted in patients - grade II (33.3%), III (40.0%) and IV (20%), and hypervascularity was noted in 26.6%.

    Conclusion

    HRUS depicted characteristic features of the median nerve in leprosy - maximum enlargement in the distal forearm with distorted fascicular architecture.

Original Papers
Pages 218 - 224
  • The carpal tunnel syndrome in leprosy: a long term follow up of steroids versus surgical decompression for median nerve neuritis in leprosy

    • Imran Sajid
    • Mamta Arora
    • Etisha Nawani
    • Kameshwar Nath Mishra
    Volume 92, Issue 3

    | Published on September 2021

    Leprosy is a stigmatizing and neglected tropical disease still prevalent in various countries of the world. According to WHO reports from 159 countries, 208,619 new leprosy cases were reported globally in 2018, of which Brazil, India, and Indonesia accounted for 79.6%. With the preference of M. leprae for cooler areas, peripheral nephropathy of the hand and feet are commonly seen in leprosy patients. Peripheral nerve involvement may result in the development of deformities. The ulnar nerve is commonly involved followed by median nerve, common peroneal nerve, facial nerve and the radial nerve in descending order. High doses of steroids are commonly given in peripheral neuropathies, but 70–75% cases still develop deformity with this treatment. Surgical decompression of involved nerves, though not so common, is another modality attempted for nerve damage prevention. In the present study, we compared steroid therapy alone with steroids plus surgical decompression, for carpal tunnel syndrome in leprosy cases.

    Methods

    52 patients with involvement of 70 median nerves (18 bilateral) were enrolled. They had palpable median nerves, along with sensory and motor loss. 16 patients were lost to follow up by 2 years, so that 36 patients with 50 median nerves (14 bilateral) remained for review. These cases were randomly divided into two groups: one group was given steroids while the second group was given steroids along with surgical nerve decompression. The results were evaluated for improvement or deterioration of the sensory and motor symptoms, along with pain.

    Conclusion

    The results support the proposition that surgical decompression of the nerve together with steroid treatment, is a better option to prevent the progression of deformities due to median nerve involvement, than steroids alone. 

Original Papers
Pages 225 - 235
  • A clinicopathological and electrophysiological study of nerve involvement in leprosy in a tertiary care centre in South India

    • M. I. Celine
    • Ameena Jaleel
    • Seena Palakkal
    • Beena Vasanthi
    • K. Sobhanakumari
    • M. S. Sadeep
    Volume 92, Issue 3

    | Published on September 2021

    Objectives and Methods

    To correlate the clinical spectrum of Hansen’s disease with the histopathological spectrum in skin and nerve and to study the electrophysiological changes in peripheral nerves in Hansen’s disease. Thirty-five consecutive attendees with leprosy were recruited for the study from a tertiary dermatology clinic.

    Results

    Clinically, borderline tuberculoid (BT) classification was the commonest subtype with 34% cases, followed by borderline lepromatous (BL) and lepromatous (LL). The incidence of multibacillary (MB) cases was high (83%) and grade 2 disability was seen in 23% cases. Concordance between clinical diagnosis and skin histopathology was 75.8%, while between clinical diagnosis and nerve histopathology was 68%. Skin and nerve histopathology were in concordance in 60% of cases. Electrophysiological assessment revealed derangement in 88.5% of cases with sensory nerve conduction parameters being the commonest and earliest to be affected. Analysis revealed a significant association between deranged parameters and thickness of the superficial peroneal nerve, sural and common peroneal nerves. Subclinical involvement was high in most nerves studied. Cases at the tuberculoid end of the spectrum showed more of segmental demyelination, whereas lepromatous cases showed a mixture of axonal and demyelinating changes.

    Conclusion

    A high degree of concordance was seen between dermal and nerve histopathologies, especially towards the poles of the leprosy spectrum. With an increasing trend towards MB cases and grade 2 disability, our study validates nerve conduction study to be a very sensitive screening tool to detect Hansen’s disease in its early stages and also to identify the type of nerve degeneration. Nerve histopathology may be considered as the gold standard for confirmation of the diagnosis of leprosy.

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