Ultrasound as a Diagnostic Modality for the Involvement of Peripheral Nerves in Leprosy

Leprosy is a major infectious cause of serious deformities which affects skin, nerves, eyes and limbs. In this study we have attempted to incorporate ultrasonography as an objective tool for the detection of early nerve thickening compared to healthy controls.A case control study was performed with 35 patients with leprosy as cases and 30 healthy controls. Clinical evaluation of bilateral ulnar, median and common peroneal nerves respectivelywas performed by two observers and they reached a consensus whether the nerve was thickened or not.Ultrasonography of these nerves was conducted and dimensions like cross sectional area and circumference was noted and compared with those of healthy subjects. Receiveroperator characteristics and area under curve method was used to determine cut off values for nerve thickness of each nerve. All six examined nerves showed significant thickening in leprosy patients compared to controls. Nerve involvement was more common among males at 72.4%. Around 62.8% patients belonged to the Borderline spectrum followed by lepromatous, pure neural and tuberculoid at 17.1%, 11.4% and 5.7% respectively. One patient had histoid type of lepromatous leprosy with nodular lesions. Patients with leprosy had significantly higher number of thickened nerves with p value <0.001. Asymmetric nerve thickness was noted in 54.6%. Among 210 nerve points examined 86 were found to be clinically thickened and 138 were found to be thickened ultrasonographically (p<0.001). The most common sonographic finding was focal thickening (83.3%) followed by hypoechoicity (63%). Using receiveroperator characteristics, nerve cross sectional area above 0.08cm sq. was found to be a predictor of nerve thickness.Ultrasound is a noninvasive modality that acts as an effective and objective marker of nerve thickening in leprosy. Besides detection of nerve thickening in leprosy, it can be used to identify structural changes in the nerve such as focal thickening and inflammation.

Leprosy scenario in southern part of Dakshina Kannada district, Karnataka, after 16 years of control work.

This article examines the changes that occurred in epidemiological indices over a period of 16 years following the introduction of MDT in Ullal town, south of Mangalore city, having a population of 130,000. The analysis indicates that new case-detection rates and prevalence rates showed a declining trend due to shorter duration of treatment with MDT. There was a ten-fold reduction in the prevalence rate during the first 6 years, from 23 in 1987 (230 cases) to 2.76 per 10,000 (29 cases) at the end of 16 years. The number of nmultibacillary cases among the newly detected cases showed a downtrend (from 28 cases in 1987 to 5 in 2001). The number of newly detected cases presenting with single lesion also showed a declining trend.

Giant lesions in histoid leprosy--an unusual presentation.

A forty-year-old man presented with multiple, asymptomatic, raised lesions of one-year duration. Well-defined, non-tender papules and nodules were seen on the normal looking skin. Few giant lesions were seen over the lower legs and feet. Diffuse infiltration of the face and ears was present. Bilateral ulnar, radial cutaneous, sural and right superficial peroneal nerves were thickened. Slit-skin smear from a nodule had a BI of 6+. Biopsy showed features of histoid leprosy. The lesions had developed de novo, without previous dapsone monotherapy.

A clinical study of vitiligo.

A clinical study of one hundred patients having vitiligo revealed the incidence among new patients to be 1.84%. The male/female ratio was 1:1.22. Family history of vitiligo was available in 8% of our patients. The different morphological pattern consisted of vitiligo vulgaris (39 cases), focal vitiligo (27 cases), acrofacial vitiligo (18 cases), lip-tip vitiligo (7 cases), lip vitiligo (5 cases), segmental vitiligo (3 cases) and universal vitiligo (1 case). Associated diseases include atopic dermatitis (2 cases), Hansen's disease (2 cases), alopecia areata (1 case), halo naevus (1 case), chronic urticaria (1 case), lichen planus (1 case), diabetes mellitus (9 cases), hypertension (4 cases), hypothyroidism (2 cases), epilepsy (1 case) and IHD (1 case).