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    Molecular, immunological and neurophysiological evaluations for early diagnosis of neural impairment in seropositive leprosy household contacts.
    PLoS Negl Trop Dis 2018 May 21;12(5):e0006494. Epub 2018 May 21.
    National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil.
    Background: Household contacts constitute the highest risk group for leprosy development, and despite significant progress in the disease control, early diagnosis remains the primary goals for leprosy management programs.

    Methods: We have recruited 175 seropositive and 35 seronegative household contacts from 2014 to 2016, who were subjected to an extensive protocol that included clinical, molecular (peripheral blood qPCR, slit-skin smear qPCR, skin biopsy qPCR) and electroneuromyographic evaluations.

    Results/principal Findings: The positivity of peripheral blood qPCR of seropositive contacts was 40. Read More

    Neuropathic pain in leprosy: symptom profile characterization and comparison with neuropathic pain of other etiologies.
    Pain Rep 2018 Mar 23;3(2):e638. Epub 2018 Feb 23.
    Neurology Departament, Pain Center, University of Sao Paulo, Brazil.
    Introduction: Previous studies reported a high prevalence of neuropathic pain in leprosy, being especially present in "pharmacologically cured" patients. The presence of neuropathic pain in leprosy poses a supplementary burden in patient's quality of life, daily activities, and mood.

    Objectives: The aim of this study was to assess whether neuropathic pain in leprosy has similar symptom profile as neuropathic pain of other etiologies and to retrospectively assess the efficacy of neuropathic pain medications regularly prescribed to leprosy. Read More

    Clinical spectrum and quality of life in patients with chronic polyneuropathy: A cross-sectional study.
    J Peripher Nerv Syst 2018 Apr 23. Epub 2018 Apr 23.
    Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
    Chronic polyneuropathy is a disabling condition of the peripheral nerves, characterized by symmetrical sensory motor symptoms and signs. There is paucity of studies on the etiological spectrum of polyneuropathy and its impact on quality of life (QoL). The present cross-sectional study in a referral based tertiary care center in North India found diabetic neuropathy as the commonest cause (25. Read More

    Genetic variants, structural, and functional changes of Myelin Protein Zero and Mannose-Binding Lectin 2 protein involved in immune response and its allelic transmission in families of patients with leprosy in Colombia.
    Infect Genet Evol 2018 Jul 5;61:215-223. Epub 2018 Apr 5.
    Colombian Institute of Tropical Medicine (ICMT), CES University, Cra. 43 A # 52 Sur 99, Sabaneta, Antioquia, Colombia; School of Medicine, CES University, Cl. 10 #22 - 04, Medellín, Antioquia, Colombia; Graduate School, CES University, Cl. 10 #22 - 04, Medellín, Antioquia, Colombia. Electronic address:
    Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Genetic factors associated with immune response contribute to infection development and disease. M. Read More

    Clinical and Neurophysiological Features of Leprosy Patients with Neuropathic Pain.
    Am J Trop Med Hyg 2018 04 2. Epub 2018 Apr 2.
    Department of Neurology, Pedro Ernesto University Hospital/Rio de Janeiro State University, Rio de Janeiro, Brazil.
    Neural pain is a frequent symptom in leprosy disease. There is a paucity of data regarding neural pain diagnostics resulting in common prescriptive errors when neuritis is confused with neuropathic or mixed nociceptive-neuropathic pain. The present study identified important demographic, clinical, and neurophysiological features of 42 leprosy neuropathy patients presenting neuropathic pain (NP). Read More

    Cutaneous manifestations of diabetic peripheral neuropathy.
    Dermatoendocrinol 2017 6;9(1):e1395537. Epub 2017 Dec 6.
    Department of Dermatology, Venereology and Leprosy, Department of Endocrinology, Diabetes and Metabolism, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamilnadu, India.
    There is a rise in number of people diagnosed with Diabetes Mellitus. The incidence is rising in modern Indian society because of Industrial development and drastically changing lifestyles. Diabetic neuropathies are microvascular disorders that are usually associated with the duration of Diabetes. Read More

    Association between the Rosén and Lundborg Score and the Screening Activity Limitation and Safety Awareness scale in hand functional evaluation of patients with leprosy diagnosis.
    Disabil Rehabil 2018 Jan 30:1-6. Epub 2018 Jan 30.
    b Department of Applied Physical Therapy , Federal University of Triângulo Mineiro , Uberaba , Brazil.
    Purpose: To evaluate the association of results from the Rosén and Lundborg Score and the screening activity limitation and Safety Awareness scale for the assessment of hand in patients diagnosed with leprosy.

    Method: An association between the Rosén and Lundborg Score and the Screening Activity Limitation and Safety Awareness scale for hand was evaluated in a cross-section study with 25 people of a mean age of 51 years old (SD 14), undergoing drug treatment for leprosy.

    Results: The mean quantitative score in the Screening Activity Limitation and Safety Awareness scale was 27. Read More

    Revisiting primary neural leprosy: Clinical, serological, molecular, and neurophysiological aspects.
    PLoS Negl Trop Dis 2017 Nov 27;11(11):e0006086. Epub 2017 Nov 27.
    National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil.
    Background: Leprosy neuropathy is considered the most common peripheral neuropathy of infectious etiology worldwide, representing a public health problem. Clinical diagnosis of primary neural leprosy (PNL) is challenging, since no skin lesions are found and the slit skin smear bacilloscopy is negative. However, there are still controversial concepts regarding the primary-neural versus pure-neural leprosy definition, which will be explored by using multiple clinical-laboratory analyses in this study. Read More

    Peripheral Nerve Stimulation for Painful Mononeuropathy Secondary to Leprosy: A 12-Month Follow-Up Study.
    Neuromodulation 2018 Apr 29;21(3):310-316. Epub 2017 Oct 29.
    Department of Endocrinology, University Hospital of Brasília, Brasilia, Brazil.
    Objective: Leprosy affects approximately 10-15 million patients worldwide and remains a relevant public health issue. Chronic pain secondary to leprosy is a primary cause of morbidity, and its treatment remains a challenge. We evaluated the feasibility and safety of peripheral nerve stimulation (PNS) for painful mononeuropathy secondary to leprosy that is refractory to pharmacological therapy and surgical intervention (decompression). Read More

    Mycobacterium lepromatosis Lepromatous Leprosy in US Citizen Who Traveled to Disease-Endemic Areas.
    Emerg Infect Dis 2017 11;23(11):1864-1866
    We report Mycobacterium lepromatosis infection in a US-born person with an extensive international travel history. Clinical symptoms, histopathology, and management are similar to those of infections caused by M. leprae. Read More

    Diseases of the peripheral nerves.
    Handb Clin Neurol 2017 ;145:453-474
    Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany. Electronic address:
    This chapter reviews the diseases of the peripheral nerves from a neuropathologic point of view, with a special focus on specific morphologic changes, and includes a summary of the histopathologic methods available for their diagnosis. As the rate of obesity and the prevalence of type 2 diabetes increase, diabetic neuropathy is the most common cause of peripheral neuropathy. Many systemic disorders with metabolic origin, like amyloidosis, hepatic failure, vitamin deficiencies, uremia, lipid metabolism disorders, and others, can also cause axonal or myelin alterations in the peripheral nervous system. Read More

    Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial.
    PLoS Negl Trop Dis 2017 Oct 4;11(10):e0005952. Epub 2017 Oct 4.
    Dept. of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
    Background: While prednisolone is commonly used to treat recent nerve function impairment (NFI) in leprosy patients, the optimal treatment duration has not yet been established. In this "Treatment of Early Neuropathy in Leprosy" (TENLEP) trial, we evaluated whether a 32-week prednisolone course is more effective than a 20-week course in restoring and improving nerve function.

    Methods: In this multi-centre, triple-blind, randomized controlled trial, leprosy patients who had recently developed clinical NFI (<6 months) were allocated to a prednisolone treatment regimen of either 20 weeks or 32 weeks. Read More

    Evaluation of polymerase chain reaction in nerve biopsy specimens of patients with Hansen's disease.
    J Neurol Sci 2017 Sep 27;380:187-190. Epub 2017 Jul 27.
    Department of Neurology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India. Electronic address:
    Background: Pure neuritic variety of leprosy (PNL) presents as peripheral neuropathy with absent skin lesions and negative skin smears. Diagnosing PNL is an uphill task as most of these patients have nonspecific changes on nerve biopsy. In such circumstances, additional molecular diagnostic tools like polymerase chain reaction (PCR) has proven to be useful in diagnosing leprosy. Read More

    Early detection of neuropathy in leprosy: a comparison of five tests for field settings.
    Infect Dis Poverty 2017 Sep 1;6(1):115. Epub 2017 Sep 1.
    Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
    Background: Early detection and treatment of neuropathy in leprosy is important to prevent disabilities. A recent study showed that the Nerve Conduction Studies (NCS) and Warm Detection Thresholds (WDT) tests can detect leprosy neuropathy the earliest. These two tests are not practical under field conditions, however, because they require climate-controlled rooms and highly trained staff and are expensive. Read More

    A Macrophage Response to Mycobacterium leprae Phenolic Glycolipid Initiates Nerve Damage in Leprosy.
    Cell 2017 Aug;170(5):973-985.e10
    Department of Microbiology, University of Washington, Seattle, WA 98195, USA; Department of Immunology, University of Washington, Seattle, WA 98195, USA; Department of Medicine, University of Washington, Seattle, WA 98195, USA; MRC Laboratory of Molecular Biology, Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge CB2 OQH, UK. Electronic address:
    Mycobacterium leprae causes leprosy and is unique among mycobacterial diseases in producing peripheral neuropathy. This debilitating morbidity is attributed to axon demyelination resulting from direct interaction of the M. leprae-specific phenolic glycolipid 1 (PGL-1) with myelinating glia and their subsequent infection. Read More

    Extensive sonographic ulnar nerve enlargement above the medial epicondyle is a characteristic sign in Hansen's neuropathy.
    PLoS Negl Trop Dis 2017 Jul 28;11(7):e0005766. Epub 2017 Jul 28.
    Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
    Objective: Earlier studies have shown sonographic enlargement of the ulnar nerve in patients with Hansen's neuropathy. The present study was performed to determine whether sonography or electrophysiological studies can detect the specific site of ulnar nerve pathology in leprosy.

    Methods: Eighteen patients (thirty arms) with Hansen's disease and an ulnar neuropathy of whom 66% had borderline tuberculoid (BT), 27% lepromatous leprosy (LL) and 7% mid-borderline (BB) leprosy were included in the study. Read More

    Infectious diseases causing autonomic dysfunction.
    Clin Auton Res 2018 Feb 20;28(1):67-81. Epub 2017 Jul 20.
    Neurology Department, Raigmore Hospital, Inverness, UK.
    Objectives: To review infectious diseases that may cause autonomic dysfunction.

    Methods: Review of published papers indexed in medline/embase.

    Results: Autonomic dysfunction has been reported in retrovirus (human immunodeficiency virus (HIV), human T-lymphotropic virus), herpes viruses, flavivirus, enterovirus 71 and lyssavirus infections. Read More

    Multidrug therapy for leprosy: a game changer on the path to elimination.
    Lancet Infect Dis 2017 Sep 7;17(9):e293-e297. Epub 2017 Jul 7.
    Instituto Lauro de Souza Lima, Bauru, Brazil.
    Leprosy is present in more than 100 countries, where it remains a major cause of peripheral neuropathy and disability. Attempts to eliminate the disease have faced various obstacles, including characteristics of the causative bacillus Mycobacterium leprae: the long incubation period, limited knowledge about its mode of transmission, and its poor growth on culture media. Fortunately, the leprosy bacillus is sensitive to several antibiotics. Read More

    Anticeramide antibody and butyrylcholinesterase in peripheral neuropathies.
    J Clin Neurosci 2017 Aug 30;42:204-208. Epub 2017 May 30.
    Nireekshana-ACET/CODEWEL, Hyderabad, Telangana 500029, India. Electronic address:
    Ceramide is a glycosphingolipid, a component of nerve and non neuronal cell membrane and plays a role in maintaining the integrity of neuronal tissue. Butyrylcholinesterase (BChE) is a multifunctional enzyme, its involvement in neurodegenerative diseases has been well established. Anticeramide antibody (Ab-Cer) and enzyme BChE have been implicated in peripheral neuropathies. Read More

    Is Ross Syndrome an Autoimmune Entity? A Case Series of 11 Patients.
    Can J Neurol Sci 2017 May;44(3):318-321
    3Department of Neurology,Christian Medical College,Vellore,Tamil Nadu,India.
    Background: Ross syndrome is diagnosed by the presence of segmental anhidrosis, areflexia, and tonic pupils. Fewer than 60 cases have been described in literature so far. There have been reports of presence of antibodies in such patients, suggesting an autoimmune pathogenesis. Read More

    Ultrasound elastography assessment of the median nerve in leprosy patients.
    Muscle Nerve 2017 Sep 4;56(3):393-398. Epub 2017 Mar 4.
    Physics Department, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, University of São Paulo, Brazil.
    Introduction: We sought to compare median nerve elasticity between leprosy patients (LPs) and healthy volunteers (HVs) using ultrasound elastography (UE).

    Methods: Two radiologists independently measured the strain ratio of the median nerve/flexor digitorum superficialis muscle (MN/FDSM) of 18 LP and 18 HV using real-time freehand UE. Statistical analysis included intra-class correlation coefficients (ICC) and Mann-Whitney test. Read More

    A large-scale genome-wide association and meta-analysis identified four novel susceptibility loci for leprosy.
    Nat Commun 2016 Dec 15;7:13760. Epub 2016 Dec 15.
    Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong 250000, China.
    Leprosy, a chronic infectious disease, results from the uncultivable pathogen Mycobacterium leprae (M. leprae), and usually progresses to peripheral neuropathy and permanent progressive deformity if not treated. Previously published genetic studies have identified 18 gene/loci significantly associated with leprosy at the genome-wide significant level. Read More

    Leprosy in a patient infected with HIV.
    Pract Neurol 2017 Apr 9;17(2):135-139. Epub 2016 Dec 9.
    St George's University Hospitals, London, UK.
    A 60-year-old Nigerian man, who had lived in Europe for 30 years but had returned home frequently, presented with right frontalis muscle weakness and right ulnar nerve palsy, without skin lesions. Neurophysiology showed a generalised neuropathy with demyelinating features. Blood tests were positive for HIV, with a normal CD4 count. Read More

    Ultrasonography of Leprosy Neuropathy: A Longitudinal Prospective Study.
    PLoS Negl Trop Dis 2016 11 16;10(11):e0005111. Epub 2016 Nov 16.
    Radiology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo Ribeirão Preto, São Paulo, Brazil.
    Background: Previous studies have shown that leprosy multi-drug therapy (MDT) does not stop the progression of nerve function impairment. There are no prospective studies investigating the evolution of nerve anatomic abnormalities after treatment. We examined leprosy patients aiming to investigate the evolution of nerve ultrasonography (US) abnormalities and the risk factors for poor outcomes after MDT. Read More

    Clin Rheumatol 2017 Jan 29;36(1):9-14. Epub 2016 Oct 29.
    Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41 110, Larissa, Greece.
    Acro-osteolysis is an osteolysis of the distal phalanges of the hands and feet and can affect the terminal tuft or the shaft of the distal phalanx (transverse or band acro-osteolysis). It is often associated with distal digital ischemia, digital calcinosis, or severe sensory neuropathy. Acro-osteolysis has been associated with a heterogeneous group of disorders, including occupational activities, infections, rheumatic disorders (systemic sclerosis, psoriatic arthritis), endocrinopathies, genetic disorders, and lysosomal storage disorders. Read More

    Evaluation of rheumatoid factor and anti-citrullinated peptide antibodies in relation to rheumatological manifestations in patients with leprosy from Southern Brazil.
    Int J Rheum Dis 2016 Oct 6;19(10):1024-1031. Epub 2015 Aug 6.
    Laboratório de Imunopatologia, Departamento de Patologia Médica, Clinical Hospital of Federal University of Parana, Curitiba, Brazil.
    Background: Leprosy patients may present several osteoarticular complaints, which require further evaluation of inflammatory diseases, such as rheumatoid arthritis (RA). Therefore, an adequate clinical assessment in addition to testing for rheumatoid factors (RF) and anticyclic citrullinated peptide antibodies (anti-CCP), can be useful in order to establish the correct diagnosis.

    Method: In this study, the relation of RF and anti-CCP with rheumatological manifestations was evaluated in 97 leprosy patients from Southern Brazil. Read More

    Leprosy with ulnar nerve abscess: ultrasound findings in a child.
    Skeletal Radiol 2017 Jan 27;46(1):137-140. Epub 2016 Oct 27.
    Radiology Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
    We report the ultrasound findings of a typical case of nerve abscess due to leprosy in an 11-year-old boy. The patient had previously undergone pediatric multibacillary leprosy multidrug therapy (MDT) in accordance with World Health Organization guidelines. He presented to our service with bilateral ulnar neuritis with no response to prednisone (1 mg/kg). Read More

    Evaluation of peripheral nerve lesions with high-resolution ultrasonography and color Doppler.
    Neurol India 2016 Sep-Oct;64(5):1002-9
    Department of Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
    Purpose: Traditionally, peripheral nerve lesions are diagnosed on the basis of clinical history, physical examination, and electrophysiological studies, and the role of imaging studies has been limited. The purpose of the study was to assess the usefulness of sonography in diagnosing peripheral nerve lesions.

    Materials And Methods: Thirty adult patients with peripheral nerve lesion/s and 30 healthy adult volunteers were included in the study, and sonography of the relevant peripheral nerve/s was done. Read More

    [Pure neural leprosy. Diagnostic aspects of a clinical case].
    Rev Neurol 2016 Sep;63(6):257-61
    Complejo Hospitalario Universitario de Albacete, Albacete, Espana.
    Introduction: Leprosy is an infectious disease caused by the bacteria Mycobacterium leprae. It is particularly prone to affect the skin and the nerve trunks and, in fact, both are compromised in most infected patients. It is transmitted by exposure to those with the disease and sometimes by reactivation. Read More

    Subversion of Schwann Cell Glucose Metabolism by Mycobacterium leprae.
    J Biol Chem 2016 Oct 23;291(41):21375-21387. Epub 2016 Aug 23.
    From the Laboratório de Microbiologia Celular,
    Mycobacterium leprae, the intracellular etiological agent of leprosy, infects Schwann promoting irreversible physical disabilities and deformities. These cells are responsible for myelination and maintenance of axonal energy metabolism through export of metabolites, such as lactate and pyruvate. In the present work, we observed that infected Schwann cells increase glucose uptake with a concomitant increase in glucose-6-phosphate dehydrogenase (G6PDH) activity, the key enzyme of the oxidative pentose pathway. Read More

    Minocycline in leprosy patients with recent onset clinical nerve function impairment.
    Dermatol Ther 2017 Jan 23;30(1). Epub 2016 Aug 23.
    Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
    Nerve function impairment (NFI) in leprosy may occur and progress despite multidrug therapy alone or in combination with corticosteroids. We observed improvement in neuritis when minocycline was administered in patients with type 2 lepra reaction. This prompted us to investigate the role of minocycline in recent onset NFI, especially in corticosteroid unresponsive leprosy patients. Read More

    The role of primary infection of Schwann cells in the aetiology of infective inflammatory neuropathies.
    J Infect 2016 Nov 18;73(5):402-418. Epub 2016 Aug 18.
    Laboratoire d'Immunologie Clinique et Expérimentale de l'OI (LICE-OI), Centre recherche Immuno-clinique des agents pathogènes de l'OI (CRIC-AP OI) Pôle Biologie Santé, Hôpital Félix Guyon, CHU de la Réunion, Reunion. Electronic address:
    Numerous different pathogens are responsible for infective peripheral neuropathies and this is generally the result of the indirect effects of pathogen infection, namely anti pathogen antibodies cross reacting with epitopes on peripheral nerve, auto reactive T cells attacking myelin, circulating immune complexes and complement fixation. Primary infection of Schwann cells (SC) associated with peripheral nerve inflammation is rare requiring pathogens to cross the Blood Peripheral Nerve Barrier (BPNB) evade anti-pathogen innate immune pathways and invade the SC. Spirochetes Borrelia bourgdorferi and Trepomema pallidum are highly invasive, express surface lipo proteins, but despite this SC are rarely infected. Read More

    Renal amyloidosis in leprosy, an infrequent cause of nephrotic syndrome in Europe.
    BMJ Case Rep 2016 Aug 3;2016. Epub 2016 Aug 3.
    Department of Nephrologist, Hospital Universitario Principe de Asturias, Alcala de Henares, Spain.
    Leprosy is a chronic infectious disease caused by Mycobacterium leprae The main clinical manifestations involve the skin and the peripheral nervous system. Several types of nephropathy have been described in leprosy. One frequent form of renal involvement is amyloidosis, especially in patients with lepromatous leprosy. Read More

    Thermographic analysis and autonomic response in the hands of patients with leprosy.
    An Bras Dermatol 2016 May-Jun;91(3):274-83
    Universidade Federal de Uberlândia (UFU) - Uberlândia (MG), Brazil.
    Background: Low temperatures and slow blood flow may result from peripheral neuropathy caused by leprosy, and the simple detection of cold fingers could already be a preliminary classification for these patients.

    Objective: To investigate whether infrared thermography would be able to measure this change in temperature in the hands of people with leprosy.

    Method: The study assessed 17 leprosy patients who were under treatment at the National Reference Center for Sanitary Dermatology and Leprosy, Uberlândia/MG, and 15 people without leprosy for the control group. Read More

    Comprehensive electrophysiology in leprous neuropathy - Is there a clinico-electrophysiological dissociation?
    Clin Neurophysiol 2016 08 17;127(8):2747-55. Epub 2016 May 17.
    Department of Neurology, King George's Medical University, U.P., Lucknow 226003, India. Electronic address:
    Objective: The diagnosis of leprous neuropathy is mostly empirical and electrophysiological studies may not truly represent the clinical findings. This study comprehensively evaluates the neuroelectrophysiology and looks at clinico-electrophysiological dissociation.

    Methods: Conventional electrophysiological recording included evaluation of median, ulnar, radial, tibial, and common peroneal nerve; an extended protocol included great auricular, phrenic, and facial nerves, along with sympathetic skin response and blink reflex. Read More

    Regional Anaesthesia Management in a Patient with Leprosy: Rare Case with Rare Application.
    Turk J Anaesthesiol Reanim 2016 Feb 1;44(1):37-9. Epub 2016 Feb 1.
    Department of Anaesthesiology, İnönü University School of Medicine, Malatya, Turkey.
    Leprosy is a chronic infectious disease that is caused by Mycobacterium leprae and affects the skin and nerves. Patients with leprosy having related peripheral neuropathy and involvement of other organs may have cardiac, respiratory dysautonomia and autonomic dysfunctions. There are very few studies regarding anaesthetic management of patients suffering from leprosy. Read More

    Treatment of Peripheral Neuropathy in Leprosy: The Case for Nerve Decompression.
    Plast Reconstr Surg Glob Open 2016 Mar 17;4(3):e637. Epub 2016 Mar 17.
    Department of Plastic Surgery, Johns Hopkins University, Baltimore, MD; Department of Plastic Surgery, Luis Vernaza Hospital, Guayaquil, Ecuador; and Damien House Organization, Guayaquil, Ecuador.
    Plastic surgery has a tradition of caring for patients with facial deformity and hand deformity related to leprosy. The approach, however, to the progressive deformity and disability related to chronic nerve compression is underappreciated in the world today. A cohort of patients with leprous neuropathy from an indigenous area of leprosy in Ecuador was evaluated for the presence of chronic peripheral nerve compression, and 12 patients were chosen for simultaneous upper and lower extremity, unilateral, nerve decompression at multiple levels along the course of each nerve. Read More

    Correlation between clinical tests and electroneuromyography for the diagnosis of leprosy neuropathy.
    Lepr Rev 2016 Mar;87(1):60-70
    Background: In leprosy, sensory function of nerves is evaluated with monofilaments test and the motor function with voluntary muscle test, however electroneuromyography is considered as the gold-standard tool.

    Objectives: This study aimed: i) to evaluate the correlation between clinical tests and electroneuromyography for the diagnosis of leprosy neuropathy; and ii) to identify the prevalence of leprosy neuropathy and the most compromised peripheral nerves in leprosy.

    Methods: We analysed the data from a nested case-control study that identified 166 patients diagnosed with leprosy neuropathy confirmed by electromyography. Read More

    Corticosteroids for treating nerve damage in leprosy.
    Cochrane Database Syst Rev 2016 May 23(5):CD005491. Epub 2016 May 23.
    Department of Public Health, Erasmus Medical Center, PO Box 2040, Rotterdam, Netherlands, 3000 CA.
    Background: Leprosy causes nerve damage that can result in nerve function impairment and disability. Corticosteroids are commonly used for treating nerve damage, although their long-term effect is uncertain. This is an update of a review first published in 2007, and previously updated in 2009 and 2011. Read More

    Delayed Diagnosis, Leprosy Reactions, and Nerve Injury Among Individuals With Hansen's Disease Seen at a United States Clinic.
    Open Forum Infect Dis 2016 Mar 25;3(2):ofw063. Epub 2016 Mar 25.
    Division of Infectious Diseases, Department of Medicine , Emory University School of Medicine.
    Background.  Hansen's disease (HD), or leprosy, is uncommon in the United States. We sought to describe the characteristics of patients with HD in a US clinic, including an assessment of delays in diagnosis and HD reactions, which have both been associated with nerve damage. Read More

    Combination chemoprophylaxis and immunoprophylaxis in reducing the incidence of leprosy.
    Risk Manag Healthc Policy 2016 27;9:43-53. Epub 2016 Apr 27.
    Cebu Skin Clinic, Leonard Wood Memorial Center for Leprosy Research, Cebu City, the Philippines.
    Leprosy is a complex infectious disease caused by Mycobacterium leprae that is a leading cause of nontraumatic peripheral neuropathy. Current control strategies, with a goal of early diagnosis and treatment in the form of multidrug therapy, have maintained new case reports at ~225,000 per year. Diagnostic capabilities are limited and even with revisions to multidrug therapy regimen, treatment can still require up to a year of daily drug intake. Read More

    Nerve biopsy in Indian patients with mononeuropathy multiplex of undetermined etiology.
    Muscle Nerve 2017 01 13;55(1):23-27. Epub 2016 Oct 13.
    Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Gomtinagar, Lucknow, Uttar Pradesh, India.
    Introduction: A diagnosis of mononeuropathy multiplex (MM) requires detailed evaluation to determine etiology. We performed nerve biopsy on patients with MM in whom the etiology could not be established via other investigations.

    Methods: Sixty-eight patients with MM seen between January 2013 and June 2014 underwent detailed diagnostic evaluation. Read More

    Prevalence of leprous neuropathy determined by neurosensory testing in an endemic zone in Ecuador: Development of an algorithm to identify patients benefiting from early neurolysis.
    J Plast Reconstr Aesthet Surg 2016 Jul 7;69(7):966-71. Epub 2016 Apr 7.
    The Dellon Institutes for Peripheral Nerve Surgery, Towson, MD, USA. Electronic address:
    The success of a microneurosurgical intervention in leprous neuropathy (LN) depends on the diagnosis of chronic compression before irreversible paralysis and digital loss occurs. In order to determine the effectiveness of a different approach for early identification of LN, neurosensory testing with the Pressure-Specified Sensory Device™ (PSSD), a validated and sensitive test, was performed in an endemic zone for leprosy. A cross-sectional study was conducted to analyze a patient sample meeting the World Health Organization (WHO) criteria for Hansen's disease. Read More

    Field-Friendly Test for Monitoring Multiple Immune Response Markers during Onset and Treatment of Exacerbated Immunity in Leprosy.
    Clin Vaccine Immunol 2016 06 6;23(6):515-519. Epub 2016 Jun 6.
    Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
    Acute inflammatory reactions represent the major cause of irreversible neuropathy in leprosy. These tissue-destroying episodes have considerable overlap with acute immunological complications (flares) in several chronic (autoimmune) diseases that similarly warrant early detection. However, the lack of diagnostic tests impedes early diagnosis of these reactions. Read More

    Multiple Crush Concept Applied to Multiple Nerves in Leprous Neuropathy.
    Clin Podiatr Med Surg 2016 Apr 29;33(2):203-17. Epub 2016 Jan 29.
    Johns Hopkins University, Baltimore, MD, USA. Electronic address:
    There is a large reservoir of leprosy patients, no longer contagious, due to multidrug therapy, who are considered cured and are becoming increasingly disabled due to progressive chronic nerve entrapment in the upper and lower extremities. After a review of the history of understanding leprous neuropathy, an approach is outlined based on the approach taken to relieve pain and restore sensation that prevents ulcers and amputations in diabetics with neuropathy and superimposed nerve compressions. The results of the first application of this approach in an indigenous area for leprosy, Guayaquil, Ecuador, is discussed with implications for international care of this neglected patient population. Read More

    Tangier's disease: An uncommon cause of facial weakness and non-length dependent demyelinating neuropathy.
    Ann Indian Acad Neurol 2016 Jan-Mar;19(1):137-9
    Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
    Tangier disease is an autosomal recessive disorder characterized by an abnormal accumulation of cholesterol esters in various organs secondary to adenotriphosphate binding cassette transporter A-1 (ABCA-1) transporter deficiency and disrupted reverse cholesterol transport. It causes neuropathy in half of the affected individuals. We present the clinical, electrophysiological, and histopathological findings in a middle aged gentleman of Tangier disease who was initially misdiagnosed leprosy and treated with antileprosy drugs. Read More

    Painless Ulcers and Fissures of Toes: Hereditary Sensory Neuropathy, Not Leprosy.
    Indian J Dermatol 2016 Jan-Feb;61(1):121
    Department of Dermatology, SVS Medical College, Mahbubnagar, Telangana, India.
    Hereditary sensory neuropathies (HSN) are rare genetically determined neuropathies. They often manifest as painless injuries in children. We present HSN in a 5-year-old boy who presented with recurrent fissuring and ulceration involving both great toes. Read More

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