Evaluate of leprosy affected nerves using high resolution ultrasonography and color doppler

Abstract

Introduction: Leprosy is the most common treatable peripheral nerve disorder worldwide with periods of acute neuritis leading to functional impairment of limbs, ulcer formation and stigmatizing deformities. Since the hallmarks of leprosy are nerve enlargement and inflammation, we used high-resolution sonography and color Doppler imaging to demonstrate nerve enlargement and inflammation. Aims: To evaluate leprosy affected nerves using High Resolution Ultrasonography and Color Doppler and possibility of prediction of Reactions using High Resolution Ultrasonography and Color Doppler. Materials and methods: This is a prospective study for a period of 2 years includes 30 healthy controls and 30 patients of both genders with aged between 17 to 58 years (mean 33+ /-10) with cross- sectional areas (CSAs) of the MN, UN, lateral popliteal (LP) and PT nerves. 30 leprosy patients, diagnosed as per Ridley- Jopling classification, who were in different stages of therapy with WHO multi-drug therapy, were included for evaluation. Results: 1 patient had TT, 12 patients had borderline tuberculoid, 1 had Borderline borderline, 6 patients had Border line lepromatous and 4 lepromatous leprosy, 6 Pure Neuritic leprosy. 4 had type 1 reaction and 2 patients had type 2 reactions, which was associated with neuritis. Skin smears were positive in 12 patients. Clinical thickening, ranging from grade 1 to 3, was observed in 193 nerves of the 240 examined nerves (72% ). Significant correlation was observed between clinical parameters of grade of thickening, sensory loss and muscle weakness and US abnormalities of cross- sectional areas, echotexture, endoneural flow (p, 0.001). Increased color doppler was observed in multiple nerves in 3 out of 4 patients undergoing type 1 reaction, which is considered to be localized to the dermal lesions and the neighbouring nerves. In patients with a type 2 reaction, blood flow signals in multiple nerves was seen in 2 out of 2 patients. Conclusion: The clinical and ultrasonographic changes of leprosy affected nerves is well correlated so help us to predict the possible occurrence of the reactions in thickened nerves on periodic examination.