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Follow-up assessment of patients with Pure Neural Leprosy in a reference center in Rio de Janeiro—Brazil

INTRODUCTION: Pure Neural Leprosy (PNL) is a rare clinical form of leprosy in which patients do not present with the classical skin lesions but have a high burden of the disability associated with the disease. Clinical characteristics and follow up of patients in PNL are still poorly described in th...

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Autores principales: Pitta, Izabela Jardim Rodrigues, Hacker, Mariana de Andrea Vilas-Boas, Andrade, Ligia Rocha, Spitz, Clarissa Neves, Vital, Robson Teixeira, Sales, Anna Maria, Antunes, Sergio Luiz Gomes, Sarno, Euzenir Nunes, Jardim, Marcia Rodrigues
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8752023/
https://www.ncbi.nlm.nih.gov/pubmed/35015773
http://dx.doi.org/10.1371/journal.pntd.0010070
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author Pitta, Izabela Jardim Rodrigues
Hacker, Mariana de Andrea Vilas-Boas
Andrade, Ligia Rocha
Spitz, Clarissa Neves
Vital, Robson Teixeira
Sales, Anna Maria
Antunes, Sergio Luiz Gomes
Sarno, Euzenir Nunes
Jardim, Marcia Rodrigues
author_facet Pitta, Izabela Jardim Rodrigues
Hacker, Mariana de Andrea Vilas-Boas
Andrade, Ligia Rocha
Spitz, Clarissa Neves
Vital, Robson Teixeira
Sales, Anna Maria
Antunes, Sergio Luiz Gomes
Sarno, Euzenir Nunes
Jardim, Marcia Rodrigues
author_sort Pitta, Izabela Jardim Rodrigues
collection PubMed
description INTRODUCTION: Pure Neural Leprosy (PNL) is a rare clinical form of leprosy in which patients do not present with the classical skin lesions but have a high burden of the disability associated with the disease. Clinical characteristics and follow up of patients in PNL are still poorly described in the literature. OBJECTIVE: This paper aims to describe the clinical, electrophysiological and histopathological characteristics of PNL patients, as well as their evolution after multidrug therapy (MDT). METHODS: Fifty-two PNL patients were selected. Clinical, nerve conduction studies (NCS), histopathological and anti-PGL-1serology were evaluated. Patients were also assessed monthly during the MDT. At the end of the MDT, all of the patients had a new neurological examination and 44 were submitted to another NCS. RESULTS: Paresthesia was the complaint most frequently reported by patients, and in the neurological examination the most common pattern observed was impairment in sensory and motor examination and a mononeuropathy multiplex. Painful nerve enlargement, a classical symptom of leprosy neuropathy, was observed in a minority of patients and in the motor NCS axonal injuries, alone or in combination with demyelinating features, were the most commonly observed. 88% of the patients did not present any leprosy reaction during MDT. There was no statistically significant difference between the neurological examinations, nor the NCS pattern, performed before and after the MDT. DISCUSSION: The classical hallmarks of leprosy neuropathy are not always present in PNL making the diagnosis even more challenging. Nerve biopsy is an important tool for PNL diagnosis as it may guide therapeutic decisions. This paper highlights unique characteristics of PNL in the spectrum of leprosy in an attempt to facilitate the diagnosis and management of these patients.
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spelling pubmed-87520232022-01-12 Follow-up assessment of patients with Pure Neural Leprosy in a reference center in Rio de Janeiro—Brazil Pitta, Izabela Jardim Rodrigues Hacker, Mariana de Andrea Vilas-Boas Andrade, Ligia Rocha Spitz, Clarissa Neves Vital, Robson Teixeira Sales, Anna Maria Antunes, Sergio Luiz Gomes Sarno, Euzenir Nunes Jardim, Marcia Rodrigues PLoS Negl Trop Dis Research Article INTRODUCTION: Pure Neural Leprosy (PNL) is a rare clinical form of leprosy in which patients do not present with the classical skin lesions but have a high burden of the disability associated with the disease. Clinical characteristics and follow up of patients in PNL are still poorly described in the literature. OBJECTIVE: This paper aims to describe the clinical, electrophysiological and histopathological characteristics of PNL patients, as well as their evolution after multidrug therapy (MDT). METHODS: Fifty-two PNL patients were selected. Clinical, nerve conduction studies (NCS), histopathological and anti-PGL-1serology were evaluated. Patients were also assessed monthly during the MDT. At the end of the MDT, all of the patients had a new neurological examination and 44 were submitted to another NCS. RESULTS: Paresthesia was the complaint most frequently reported by patients, and in the neurological examination the most common pattern observed was impairment in sensory and motor examination and a mononeuropathy multiplex. Painful nerve enlargement, a classical symptom of leprosy neuropathy, was observed in a minority of patients and in the motor NCS axonal injuries, alone or in combination with demyelinating features, were the most commonly observed. 88% of the patients did not present any leprosy reaction during MDT. There was no statistically significant difference between the neurological examinations, nor the NCS pattern, performed before and after the MDT. DISCUSSION: The classical hallmarks of leprosy neuropathy are not always present in PNL making the diagnosis even more challenging. Nerve biopsy is an important tool for PNL diagnosis as it may guide therapeutic decisions. This paper highlights unique characteristics of PNL in the spectrum of leprosy in an attempt to facilitate the diagnosis and management of these patients. Public Library of Science 2022-01-11 /pmc/articles/PMC8752023/ /pubmed/35015773 http://dx.doi.org/10.1371/journal.pntd.0010070 Text en © 2022 Pitta et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Pitta, Izabela Jardim Rodrigues
Hacker, Mariana de Andrea Vilas-Boas
Andrade, Ligia Rocha
Spitz, Clarissa Neves
Vital, Robson Teixeira
Sales, Anna Maria
Antunes, Sergio Luiz Gomes
Sarno, Euzenir Nunes
Jardim, Marcia Rodrigues
Follow-up assessment of patients with Pure Neural Leprosy in a reference center in Rio de Janeiro—Brazil
title Follow-up assessment of patients with Pure Neural Leprosy in a reference center in Rio de Janeiro—Brazil
title_full Follow-up assessment of patients with Pure Neural Leprosy in a reference center in Rio de Janeiro—Brazil
title_fullStr Follow-up assessment of patients with Pure Neural Leprosy in a reference center in Rio de Janeiro—Brazil
title_full_unstemmed Follow-up assessment of patients with Pure Neural Leprosy in a reference center in Rio de Janeiro—Brazil
title_short Follow-up assessment of patients with Pure Neural Leprosy in a reference center in Rio de Janeiro—Brazil
title_sort follow-up assessment of patients with pure neural leprosy in a reference center in rio de janeiro—brazil
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8752023/
https://www.ncbi.nlm.nih.gov/pubmed/35015773
http://dx.doi.org/10.1371/journal.pntd.0010070
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