“Cytological needle aspiration" for the diagnosis of primary neural leprosy

Leprosy Mailing List – February 4th, 2011

Ref.:   “Cytological needle aspiration" for the diagnosis of primary neural leprosy

From: Warren G, Sydney , Australia

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Dear Dr Noto,

I am very interested in Dr Theuvenet’s recent letters. Herewith I comment on the one about the needle biopsy to diagnose primary neural leprosy (Jan 25^th, 2011).

The needle biopsy sounds excellent if you have the laboratory to do it.  The needle biopsy will not be destroying many fibres, though I guess some fibres may be sucked up.  I wonder what one actually sees under the microscope is it just fluid and hopefully bacteria or does the clinician actually suck up some nerve tissue in which the pathology can be identified.

Also if the nerves are large enough and the clinician experienced enough to do the needle biopsy, but the majority of cases I have seen are missed because they were never suspected.  I am afraid that for the endemic areas we need to accent the necessity of ”Think of the possibility of leprosy” and teach the clinicians that they must be aware of its possibility and frequency.  So the first thing in saving nerves is to teach clinicians general medicine not just the leprology ones, to “Think leprosy”.  If in doubt treat as leprosy for a minimum of 6 months full MDT, then reassess.

 With best wishes for good salvage work!

Grace Warren

Previously adviser in Leprosy and reconstructive surgery for The Leprosy Mission in Asia ( 1975-1995)