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Appropriately Selected Nerve in Suspected Leprous Neuropathy Yields High Positive Results for Mycobacterium leprae DNA by Polymerase Chain Reaction Method.
Am J Trop Med Hyg. 2020 07; 103(1):209-213.AJ

Abstract

Identification of Mycobacterium leprae DNA by polymerase chain reaction (PCR) is a reliable and an affordable method to confirm leprosy. DNA from 87 nerve samples (61 from paraffin blocks and 26 fresh samples) was extracted. Mycobacterium leprae DNA was amplified by PCR from 80/87 (92%) specimens. Patients were seen over a period of 11 years (2007-2019), and leprosy was diagnosed based on clinical and characteristic histopathology findings. The clinical diagnostic possibilities were as follows: leprous neuropathy in 73/80 (91.3%), mononeuritis multiplex of unknown etiology in four (5.0%), vasculitic neuropathy in two (2.5%), and distal symmetric sensory motor neuropathy in one (1.3%). The biopsied nerves were as follows: superficial radial = 34 (42.6%), dorsal cutaneous branch of ulnar = 19 (23.8%), sural = 18 (22.5%), and superficial peroneal = 9 (11.3%), and corresponding neurological deficits were recorded in 77 (96.3%) cases. The histopathological diagnoses in total group were as follows: (borderline tuberculoid (BT) = 52, tuberculoid (TT) = 8, borderline lepromatous (BL) = 8, borderline borderline (BB) = 3, nonspecific inflammation = 3, healed/fibrosed = 4, and axonopathy = 2). Acid fast bacilli (AFB) was demonstrated in 11 (13.7%) samples. For comparison, 31 clinically and histopathologically defined non-leprous disease control nerves (inherited neuropathy = 20, vasculitis = 8, and nutritional neuropathy = 3) subjected to PCR were negative for M. leprae DNA. In most instances, there are multiple thickened peripheral nerves in suspected cases of leprosy, but neurological deficits pertaining to the thickened nerve are not as widespread. The current findings emphasize the importance of selecting the most appropriate nerve for biopsy to obtain a positive PCR result. We infer that clinical, histopathological, and PCR tests complement each other to help achieve a definitive diagnosis of leprosy particularly in pure neuritic leprosy and in leprous neuropathy with negative skin smears/biopsy.

Authors+Show Affiliations

Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.Stanley Browne Research Laboratory, TLM Community Hospital, New Delhi, India.Stanley Browne Research Laboratory, TLM Community Hospital, New Delhi, India.Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India.Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India.Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India.Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India.Department of Neurology, St John's Medical College, Bangalore, India.Stanley Browne Research Laboratory, TLM Community Hospital, New Delhi, India.Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32285768

Citation

Vengalil, Seena, et al. "Appropriately Selected Nerve in Suspected Leprous Neuropathy Yields High Positive Results for Mycobacterium Leprae DNA By Polymerase Chain Reaction Method." The American Journal of Tropical Medicine and Hygiene, vol. 103, no. 1, 2020, pp. 209-213.
Vengalil S, Lavania M, Singh I, et al. Appropriately Selected Nerve in Suspected Leprous Neuropathy Yields High Positive Results for Mycobacterium leprae DNA by Polymerase Chain Reaction Method. Am J Trop Med Hyg. 2020;103(1):209-213.
Vengalil, S., Lavania, M., Singh, I., Nashi, S., Preethish-Kumar, V., Polavarapu, K., Mahajan, N. P., Raju, S., Pradeep-Chandra-Reddy, C., Keerthipriya, M., Mahadevan, A., Yasha, T. C., Nandeesh, B., Gnanakumar, K., Parry, G. J., Sengupta, U., & Nalini, A. (2020). Appropriately Selected Nerve in Suspected Leprous Neuropathy Yields High Positive Results for Mycobacterium leprae DNA by Polymerase Chain Reaction Method. The American Journal of Tropical Medicine and Hygiene, 103(1), 209-213. https://doi.org/10.4269/ajtmh.19-0746
Vengalil S, et al. Appropriately Selected Nerve in Suspected Leprous Neuropathy Yields High Positive Results for Mycobacterium Leprae DNA By Polymerase Chain Reaction Method. Am J Trop Med Hyg. 2020;103(1):209-213. PubMed PMID: 32285768.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Appropriately Selected Nerve in Suspected Leprous Neuropathy Yields High Positive Results for Mycobacterium leprae DNA by Polymerase Chain Reaction Method. AU - Vengalil,Seena, AU - Lavania,Mallika, AU - Singh,Itu, AU - Nashi,Saraswati, AU - Preethish-Kumar,Veeramani, AU - Polavarapu,Kiran, AU - Mahajan,Niranjan Prakash, AU - Raju,Sanita, AU - Pradeep-Chandra-Reddy,Chevula, AU - Keerthipriya,Muddasu, AU - Mahadevan,Anita, AU - Yasha,Tagadur Chickabasaviah, AU - Nandeesh,Bevinahalli, AU - Gnanakumar,Krishnamurthy, AU - Parry,Gareth J, AU - Sengupta,Utpal, AU - Nalini,Atchayaram, Y1 - 2020/04/09/ PY - 2021/07/01/pmc-release PY - 2020/4/15/pubmed PY - 2020/9/1/medline PY - 2020/4/15/entrez SP - 209 EP - 213 JF - The American journal of tropical medicine and hygiene JO - Am J Trop Med Hyg VL - 103 IS - 1 N2 - Identification of Mycobacterium leprae DNA by polymerase chain reaction (PCR) is a reliable and an affordable method to confirm leprosy. DNA from 87 nerve samples (61 from paraffin blocks and 26 fresh samples) was extracted. Mycobacterium leprae DNA was amplified by PCR from 80/87 (92%) specimens. Patients were seen over a period of 11 years (2007-2019), and leprosy was diagnosed based on clinical and characteristic histopathology findings. The clinical diagnostic possibilities were as follows: leprous neuropathy in 73/80 (91.3%), mononeuritis multiplex of unknown etiology in four (5.0%), vasculitic neuropathy in two (2.5%), and distal symmetric sensory motor neuropathy in one (1.3%). The biopsied nerves were as follows: superficial radial = 34 (42.6%), dorsal cutaneous branch of ulnar = 19 (23.8%), sural = 18 (22.5%), and superficial peroneal = 9 (11.3%), and corresponding neurological deficits were recorded in 77 (96.3%) cases. The histopathological diagnoses in total group were as follows: (borderline tuberculoid (BT) = 52, tuberculoid (TT) = 8, borderline lepromatous (BL) = 8, borderline borderline (BB) = 3, nonspecific inflammation = 3, healed/fibrosed = 4, and axonopathy = 2). Acid fast bacilli (AFB) was demonstrated in 11 (13.7%) samples. For comparison, 31 clinically and histopathologically defined non-leprous disease control nerves (inherited neuropathy = 20, vasculitis = 8, and nutritional neuropathy = 3) subjected to PCR were negative for M. leprae DNA. In most instances, there are multiple thickened peripheral nerves in suspected cases of leprosy, but neurological deficits pertaining to the thickened nerve are not as widespread. The current findings emphasize the importance of selecting the most appropriate nerve for biopsy to obtain a positive PCR result. We infer that clinical, histopathological, and PCR tests complement each other to help achieve a definitive diagnosis of leprosy particularly in pure neuritic leprosy and in leprous neuropathy with negative skin smears/biopsy. SN - 1476-1645 UR - https://www.unboundmedicine.com/medline/citation/32285768/Appropriately_Selected_Nerve_in_Suspected_Leprous_Neuropathy_Yields_High_Positive_Results_for_Mycobacterium_leprae_DNA_by_Polymerase_Chain_Reaction_Method_ L2 - https://ajtmh.org/doi/10.4269/ajtmh.19-0746 DB - PRIME DP - Unbound Medicine ER -