DOI: http://dx.doi.org/10.18203/issn.2454-2156.IntJSciRep20202567

Clinical study of nerve function impairment in newly diagnosed leprosy patients at a tertiary care center in Shahjahanpur district

Amar Singh, Astha Pant

Abstract


Background: In leprosy nerve function impairment may result from pathological and immunological processes that take place in peripheral nerves. Prevalence rate of leprosy in India is 0.81 per 10,000 populations. The study was undertaken to determine the status of nerve function impairment at the time of registration for therapy in new leprosy patients.

Methods: History of the patients was taken and clinical examinations were performed and they were assisted for nerve function impairment by performing sensory test and voluntary muscle power.

Results: The most commonly affected nerve by function impairment was the posterior tibial, followed by the ulnar nerve. In the present study 29% patients had grade 1 disability and 10% had grade 2 disabilities.

Conclusions: The loss of nerve function and incapacitating deformities occurring in a small proportion of leprosy patients result in serious social and psychological impact in their quality of life. Therefore, early detection of nerve function impairment is needed to avoid complications and better management of leprosy.


Keywords


Nerve function impairment, Neuropathy, Disability

Full Text:

PDF

References


Lastória JC, Abreu MA. Leprosy: review of the epidemiological, clinical, and etiopathogenic aspects - part 1. An Bras Dermatol. 2014;89(2):205‐18.

Kumar B, Rai R, Kaur I. Systemic involvement in leprosy and its significance. Indian J Lepr. 2000;72(1):123‐42.

Lockwood DN, Saunderson PR. Nerve damage in leprosy: a continuing challenge to scientists, clinicians and service providers. Int Health. 2012;4(2):77‐85.

Leon KE, Jacob JT, Franco-Paredes C, Kozarsky PE, Wu HF, Fairley JK. Delayed Diagnosis, Leprosy Reactions, and Nerve Injury Among Individuals With Hansen's Disease Seen at a United States Clinic. Open Forum Infect Dis. 2016;3(2):ofw063.

Kumar V. Emerging Concept on Peripheral Nerve damage in Leprosy. Int J Res Studies Med Health Sci. 2017;2(7):8-18.

Kar S, Krishnan A, Singh N, Singh R, Pawar S. Nerve damage in leprosy: An electrophysiological evaluation of ulnar and median nerves in patients with clinical neural deficits: A pilot study. Indian Dermatol Online J. 2013;4(2):97‐101.

W.H.O. Global leprosy situation. Weekly epidemiological record. 2013;35:365-80.

McDougall AC. The clinical examination of peripheral nerves in leprosy. Indian J Lepr. 1996;68(4):378‐80.

Rambukkana A, Zanazzi G, Tapinos N, Sazer JL. Contact-dependent demyelination by Mycobacterium leprae in the absence of immune cells. Science. 2002;296:78-82.

Scollard DM, Adams LB, Gilis TP, Krahenbuhl JL, Truman RW, Williams DL. The Continuing Challenges of Leprosy. Clin Microbiol Rev. 2006;19:338-81.

Job CK. Pathology of leprosy. In: Hastings RC (ed). Leprosy, 2nd edition. Edinburgh: Churchill Livingstone; 1994: 193-234.

Ooi WW, Srinivasan J. Leprosy and peripheral nervous system: Basic and clinical aspects. Muscle Nerve. 2004;30:393-409.

Van Brakel WH, Khawas IB. Nerve damage in leprosy: an epidemiological and clinical study of 396 patients in west Nepal- part1. Definition, method and frequencies. Lepr Rev. 1994;65:204-21.

Croft RP, Nicholls PG, Steyerberg EW, Richardus JH, Smith WCS. A clinical prediction rule for nerve-function impairment in leprosy patients. The Lancet. 2000;355:1603-6.

Croft RP, Richards JH, Nicholls PG, Smith WC. Nerve function impairment in leprosy: design, methodology, and intake status of a prospective cohort study of 2664 new leprosy cases in Bangladesh (The Bangladesh Acute Nerve Damage Study). Lepr Rev. 1999;70:140-59.

Alberts CJ, Smith WC, Meima A, Wang L, Richardus JH. Potential effect of the World Health Organization's 2011-2015 global leprosy strategy on the prevalence of grade 2 disability: a trend analysis. Bull World Health Organ. 2011;89(7):487‐95.

Anderson AM, van Brakel WH. Age specific normal thresholds for sensibility testing with monofilaments in a Nepali population. Int J Lepr, 1998;66:69.

John J. Grading of muscle power: comparison of MRC and analogue scales by physiotherapists. Int J Rehabil Res.1984;7(2):173-81.

Van Brakel WH. Peripheral neuropathy in leprosy and its consequences. Lepr Rev. 2000;71:146-53.

Robertson LM, Nicholls PG, Butlin CR. Delay in presentation and start of treatment in leprosy: experience in an out-patient clinic in Nepal. Lepr Rev. 2000;71:511-6.

Sardana K. A study of leprosy in children, from a tertiary pediatric hospital in India. Leprosy Rev. 2006;77:160-2.

Silva S, Cacilda DA, Bacha Juliana Totti. Delayed diagnosis of leprosy and the potential role of education activities in Brazil. Lepr Rev. 2003;74:249-58.

NLEP Annual Report 2015-2016. Central Leprosy Division, Directorate General of Health Services, Ministry of Health and Family Welfare Government of India, Nirman Bhavan, New Delhi. 2016.

Magora A, Sheskin J, Sagher F, Gonen B. The condition of the peripheral nerve in leprosy under various forms of treatment. Int J Lepr. 1970;38:149-63.

Brown TR, Kovindha A, Wathanadilokkol U, Smith T, Kraft GH. Leprosy neuropathy: correlation of clinical and electrophysiological tests. Indian J Lepr. 1996;68(1):1-14.

Brunel W, Schecter WP, Schecter G. Hand deformity and sensory loss due to Hansen’s disease in American Samoa. J Hand Surg. 1988;13:279-83.

Becx-Bleumink M, Berhe D. Occurrence of reactions, their diagnosis and management in leprosy patients treated with multidrug therapy; experience in the Leprosy Control Program of the All Africa Leprosy and Rehabilitation Training Centre (ALERT) in Ethiopia. Int J Lepr. 1992;60:173-84.

Meima A, Saunderson PR, Gebre S, Desta K, Van Oortmarssen GJ, Habbema JDF. Factors associated with impairments in newly leprosy patients: the AMFES Cohort. Lepr Rev. 1999;70:189-203.

De Oliveira CR, De Alencar Marie DJF, De Sena Neto SA, Lehman LF, Schreuder PAM. Impairments and Hansen’s disease control in Rondonia State, Amazon region of Brazil. Lepr Rev. 2003;74:337-48.

Nicholls PG, Croft RP, Richardus JH, Withington SG, Smith WCS. Delay in presentation, an indicator for nerve function status at registration and for treatment outcome-the experience of the Bangladesh acute nerve damage study cohort. Lepr Rev. 2003;74:349-56.