Neural leprosy new threat, can be undetected – Nat’l Leprosy Prog. Head

GINA, GUYANA, Wednesday, March 22, 2017

Neural Leprosy can now be identified as one of the new public health threats if not properly diagnosed and treated efficiently. This type of leprosy mainly affects the nerves and may lie dormant for years without evidence of transmission.

Primary neural leprosy, pure neural leprosy, or neuritic leprosy is an unclassified diagnosis which is often missed if not suspected by a doctor or physician.

Director of the National Leprosy Programme, Ministry of Public Health, Dr. Nikita McKenzie said this type of Leprosy is not classified by the World Health Organisation (WHO) which recognises Paucibacillary or Multibacillary type leprosy.

Dr. McKenzie explained that, “This goes without being detected because of its presentation because this type of Leprosy does not have any lesions on the skin neither when you send the patient for a smear will it always show.”

Leprosy can be classified on the basis of clinical manifestations and skin smear results. In the classification based on skin smears, patients showing negative smears at all sites are grouped as paucibacillary leprosy, while those showing positive smears at any site are grouped as having multibacillary leprosy.

In Neural Leprosy, the main causes of these neuropathies are entrapments, metabolic, traumatic, hereditary, infectious, and nerve tumors.

Dr. McKenzie pointed out that, “the nerves are what give you this type of leprosy, but when you check the nerves on patients they thicken or enlarge, as well as they can be tender so when we would examine patients and their contacts you will often find that the patients would show lesions or some impairment of leprosy but then when you check their relatives you see no lesions on the skin, but when you check and examine the nerves you will find the enlargements.”

The Director of the National Leprosy programme said that enlarged nerves can be diagnosed as a number of other diseases. Enlarged nerves can be diagnosed as leprosy, refsum (an autosomal recessive neurological disease that results from the over-accumulation of phytanic acid in cells and tissues), Schwannoma (a tumour of the tissue that covers nerves, called the nerve sheath) and amyloidosis (caused by accumulation of proteins in the form of abnormal, insoluble fibres, known as amyloid fibrils, within the extracellular space in the tissues of the body) just to name a few.

The only sign of Neural Leprosy may be painful and visibly enlarged nerves. The most commonly affected nerves include the posterior tibial, peroneal, ulnar and median nerves. One way of diagnosing this type of leprosy is by a nerve biopsy, but concerns remain that a nerve biopsy may misdiagnose a patient. More research is being done to efficiently identify patients in Guyana with Neural leprosy.

For further information on leprosy and other related skin diseases, Dr. Mc Kenzie can be found at the skin clinic at the Palms geriatric home on Brickdam or can contact the clinic on 225 – 4711.

By: Delicia Haynes