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Penna PS, Pitta IJR, Vital RT, Hacker MAVB, Salles AM, Pinheiro RO, Antunes SLG, Sarno EN, Jardim MR. Progressive neuropathy in patients with lepromatous leprosy after multidrug therapy. Mem Inst Oswaldo Cruz 2023; 117:e220150. [PMID: 36651454 PMCID: PMC9870262 DOI: 10.1590/0074-02760220150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 11/17/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The lepromatous pole is a stigmatising prototype for patients with leprosy. Generally, these patients have little or no symptoms of peripheral nerve involvement at the time of their diagnosis. However, signs of advanced peripheral neuropathy would be visible during the initial neurological evaluation and could worsen during and after multidrug therapy (MDT). Disabilities caused by peripheral nerve injuries greatly affect these patients' lives, and the pathophysiological mechanisms underlying nerve damage remain unclear. OBJECTIVES To evaluate the outcome of peripheral neuropathy in patients with lepromatous leprosy (LL) and persistent neuropathic symptoms years after completing MDT. METHODS We evaluated the medical records of 14 patients with LL who underwent nerve biopsies due to worsening neuropathy at least four years after MDT. FINDINGS Neuropathic pain developed in 64.3% of the patients, and a neurological examination showed that most patients had alterations in the medium- and large-caliber fibers at the beginning of treatment. Neurological symptoms and signs deteriorated despite complete MDT and prednisone or thalidomide use for years. Nerve conduction studies showed that sensory nerves were the most affected. MAIN CONCLUSIONS Patients with LL can develop progressive peripheral neuropathy, which continues to develop even when they are on long-term anti-inflammatory and immunosuppressive therapy.
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Affiliation(s)
- Patricia Sola Penna
- Universidade Federal do Estado do Rio de Janeiro, Programa de Pós-Graduação em Neurologia, Rio de Janeiro, RJ, Brasil,+ Corresponding author:
| | - Izabela Jardim Rodrigues Pitta
- Universidade Federal do Estado do Rio de Janeiro, Programa de Pós-Graduação em Neurologia, Rio de Janeiro, RJ, Brasil,Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Departamento de Hanseníase, Rio de Janeiro, RJ, Brasil,Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | | | - Ana Maria Salles
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Departamento de Hanseníase, Rio de Janeiro, RJ, Brasil
| | - Roberta Olmo Pinheiro
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Departamento de Hanseníase, Rio de Janeiro, RJ, Brasil
| | - Sergio Luiz Gomes Antunes
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Departamento de Hanseníase, Rio de Janeiro, RJ, Brasil
| | - Euzenir Nunes Sarno
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Departamento de Hanseníase, Rio de Janeiro, RJ, Brasil
| | - Márcia Rodrigues Jardim
- Universidade Federal do Estado do Rio de Janeiro, Programa de Pós-Graduação em Neurologia, Rio de Janeiro, RJ, Brasil,Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Departamento de Hanseníase, Rio de Janeiro, RJ, Brasil,Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Pitta IJR, Hacker MA, Vital RT, Andrade LR, Spitz CN, Sales AM, Antunes SLG, Sarno EN, Jardim MR. Leprosy Reactions and Neuropathic Pain in Pure Neural Leprosy in a Reference Center in Rio de Janeiro - Brazil. Front Med (Lausanne) 2022; 9:865485. [PMID: 35402428 PMCID: PMC8992651 DOI: 10.3389/fmed.2022.865485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Leprosy reactions are complications that can occur before, during, or after multidrug therapy (MDT) and are considered a major cause of nerve damage. Neuritis is an inflammatory process that causes nerve function impairment associated with pain and tenderness along the nerve. Neuritis can be found in both type 1 and type 2 reactions and may also be the sole manifestation of a leprosy reaction. The objective of this study is to describe the incidence of leprosy reactions and its association with neuropathic pain in pure neural leprosy (PNL) patients. Methods We selected 52 patients diagnosed with PNL and 67 patients with other clinical forms of leprosy. During the MDT the patients visited the clinic monthly to take their supervised dose. The patients were instructed to return immediately if any new neurological deficit or skin lesions occurred during or after the MDT. Results Of the PNL patients, 23.1% had a leprosy reaction during or after the MDT, while this was 59.7% for patients with the other clinical forms of leprosy. There was an association between having PNL and not having any reaction during and after the MDT, as well as having PNL and having neuritis after the MDT.There was also an association between having previous neuritis and having neuropathic pain in the other clinical forms of leprosy group, although this association was not present in the PNL group. Discussion Our data suggest that PNL is a different form of the disease, which is immunologically more stable. In addition, PNL patients have more neuritis than the classical leprosy skin reactions. In PNL there was no association between acute neuritis and neuropathic pain, suggesting that these patients may have had silent neuritis. Understanding and identifying neuritis is essential to reduce disability and the impact on public health.
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Affiliation(s)
- Izabela Jardim Rodrigues Pitta
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.,Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Neurology, Antonio Pedro University Hospital/ Fluminense Federal University, Niteroi, Brazil
| | | | - Robson Teixeira Vital
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.,Department of Neurology, Pedro Ernesto University Hospital/ Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ligia Rocha Andrade
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.,Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Clarissa Neves Spitz
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.,Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anna Maria Sales
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | | | | | - Marcia Rodrigues Jardim
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.,Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Neurology, Pedro Ernesto University Hospital/ Rio de Janeiro State University, Rio de Janeiro, Brazil
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Ribeiro-Guimarães ML, Tempone AJ, Amaral JJ, Nery JA, Gomes Antunes SL, Pessolani MCV. Expression analysis of proteases of Mycobacterium leprae in human skin lesions. Microb Pathog 2007; 43:249-54. [PMID: 17624714 DOI: 10.1016/j.micpath.2007.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Revised: 05/05/2007] [Accepted: 05/12/2007] [Indexed: 11/28/2022]
Abstract
Proteases are commonly involved in bacterial pathogenesis and their inhibition has represented a successful therapeutic approach to treat infectious diseases. However, there is little information on the role of proteases in the pathogenesis of Mycobacteria. Five of these genes, three coding for putative secreted proteases, were selected in the present study to investigate their expression in Mycobacterium leprae isolated from skin biopsies of multibacillary leprosy patients. Via nested-PCR, it was demonstrated that mycP1 or ML0041, htrA2 or ML0176, htrA4 or ML2659, gcp or ML0379 and clpC or ML0235 are transcribed in vivo during the course of human infection. Moreover, the expression of Gcp in leprosy lesions was further confirmed by immunohistochemistry using a specific hyperimmune serum. This observation reinforces the potential role of mycobacterial proteases in the context of leprosy pathogenesis.
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Affiliation(s)
- Michelle Lopes Ribeiro-Guimarães
- Laboratory of Cellular Microbiology, Department of Mycobacterioses-Oswaldo Cruz Institute, Oswaldo Cruz Foundation, FIOCRUZ, Av. Brasil 4365, Manguinhos, 21040-900 Rio de Janeiro, RJ, Brazil
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Antunes SLG, Chimelli LM, Rabello ET, Valentim VC, Corte-Real S, Sarno EN, Jardim MR. An immunohistochemical, clinical and electroneuromyographic correlative study of the neural markers in the neuritic form of leprosy. Braz J Med Biol Res 2006; 39:1071-81. [PMID: 16906282 DOI: 10.1590/s0100-879x2006000800010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 04/20/2006] [Indexed: 11/21/2022] Open
Abstract
The nerve biopsies of 11 patients with pure neuritic leprosy were submitted to routine diagnostic procedures and immunoperoxidase staining with antibodies against axonal (neurofilament, nerve growth factor receptor (NGFr), and protein gene product (PGP) 9.5) and Schwann cell (myelin basic protein, S-100 protein, and NGFr) markers. Two pairs of non-adjacent histological cross-sections of the peripheral nerve were removed for quantification. All the fascicles of the nerve were examined with a 10X-ocular and 40X-objective lens. The immunohistochemistry results were compared to the results of semithin section analysis and clinical and electroneuromyographic data. Neurofilament staining was reduced in 100% of the neuritic biopsies. NGFr positivity was also reduced in 81.8%, PGP staining in 100% of the affected nerves, S100 positivity in 90.9%, and myelin basic protein immunoreactivity in 90.9%. Hypoesthesia was associated with decreased NGFr (81.8%) and PGP staining (90.9%). Reduced potential amplitudes (electroneuromyographic data) were found to be associated with reduced PGP 9.5 (63.6%) and nerve fiber neurofilament staining (45.4%) by immunohistochemistry and with loss of myelinated fibers (100%) by semithin section analysis. On the other hand, the small fibers (immunoreactive dots) seen amid inflammatory cells continued to be present even after 40% of the larger myelinated fibers had disappeared. The present study shows an in-depth view of the destructive effects of leprosy upon the expression of neural markers and the integrity of nerve fiber. The association of these structural changes with the clinical and electroneuromyographic manifestations of leprosy peripheral neuropathy was also discussed.
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Affiliation(s)
- S L G Antunes
- Laboratório de Hanseníase, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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