Tags

Type your tag names separated by a space and hit enter

Leprous neuropathy.
Handb Clin Neurol 2013; 115:499-514HC

Abstract

Leprous neuropathy, which is due to infection of nerve cells by Mycobacterium leprae, still affects millions of people in many developing countries. The clinical and pathological manifestations are determined by the natural resistance of the host to invasion of M. Leprae. Failure of early detection of leprosy often leads to severe disability in spite of eradication of mycobacterium at a later date. In the lepromatous type, bacilli are easily found in the skin and in nerve cells including Schwann cells, endothelial cells, and macrophages. In the tuberculoid type, a strong cell-mediated immune reaction leads to formation of granulomas and destruction of cells harboring bacilli and neighboring nerve fibers. In many cases, treatment of patients with the multibacillary leprosy is complicated by reversal reaction and further nerve damage. Nerve lesions lead to a symmetrical, pseudo-polyneuritic pattern in most cases of lepromatous leprosy, which is usually associated with typical skin lesions, but pure neuritic forms occur in up to 10% of patients with lepromatous leprosy. In the pure neuropathic cases, only nerve biopsy permits diagnosis. The multifocal pattern is more common in tuberculoid leprosy. Treatment is currently based on multidrug therapy with dapsone, rifampicin, and clofazimine. The use of corticosteroids can reduce or prevent nerve damage in reversal reactions. It is important to remember that sequelae, especially sensory loss, are extremely common, which can lead to secondary trophic changes due to repeated trauma in painless areas.

Authors+Show Affiliations

Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Niterói, Brazil. Electronic address: mgdefreitas@outlook.com.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

23931798

Citation

de Freitas, Marcos R G., and Gérard Said. "Leprous Neuropathy." Handbook of Clinical Neurology, vol. 115, 2013, pp. 499-514.
de Freitas MR, Said G. Leprous neuropathy. Handb Clin Neurol. 2013;115:499-514.
de Freitas, M. R., & Said, G. (2013). Leprous neuropathy. Handbook of Clinical Neurology, 115, pp. 499-514. doi:10.1016/B978-0-444-52902-2.00028-X.
de Freitas MR, Said G. Leprous Neuropathy. Handb Clin Neurol. 2013;115:499-514. PubMed PMID: 23931798.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Leprous neuropathy. AU - de Freitas,Marcos R G, AU - Said,Gérard, PY - 2013/8/13/entrez PY - 2013/8/13/pubmed PY - 2014/4/2/medline KW - Mycobacterium leprae KW - leprosy KW - leprous neuropathy KW - nerve biopsy KW - pure neural leprosy SP - 499 EP - 514 JF - Handbook of clinical neurology JO - Handb Clin Neurol VL - 115 N2 - Leprous neuropathy, which is due to infection of nerve cells by Mycobacterium leprae, still affects millions of people in many developing countries. The clinical and pathological manifestations are determined by the natural resistance of the host to invasion of M. Leprae. Failure of early detection of leprosy often leads to severe disability in spite of eradication of mycobacterium at a later date. In the lepromatous type, bacilli are easily found in the skin and in nerve cells including Schwann cells, endothelial cells, and macrophages. In the tuberculoid type, a strong cell-mediated immune reaction leads to formation of granulomas and destruction of cells harboring bacilli and neighboring nerve fibers. In many cases, treatment of patients with the multibacillary leprosy is complicated by reversal reaction and further nerve damage. Nerve lesions lead to a symmetrical, pseudo-polyneuritic pattern in most cases of lepromatous leprosy, which is usually associated with typical skin lesions, but pure neuritic forms occur in up to 10% of patients with lepromatous leprosy. In the pure neuropathic cases, only nerve biopsy permits diagnosis. The multifocal pattern is more common in tuberculoid leprosy. Treatment is currently based on multidrug therapy with dapsone, rifampicin, and clofazimine. The use of corticosteroids can reduce or prevent nerve damage in reversal reactions. It is important to remember that sequelae, especially sensory loss, are extremely common, which can lead to secondary trophic changes due to repeated trauma in painless areas. SN - 0072-9752 UR - https://www.unboundmedicine.com/medline/citation/23931798/Leprous_neuropathy L2 - https://linkinghub.elsevier.com/retrieve/pii/B978-0-444-52902-2.00028-X DB - PRIME DP - Unbound Medicine ER -