Fw: (LML) d.d. pure neuritic leprosy and diabetic neuropathy

Leprosy Mailing List – February 15,  2021

 

Ref.:  (LML) d.d. pure neuritic leprosy and diabetic neuropathy

 

From:  Joel Almeida, Mumbai and London

 

 

 

Dear Pieter and colleagues,

 

Interesting question from Dr. G.Suryanarayan Rao (LML, February 13, 2021)! And a useful response from Dr. Theuvenet (LML, February 14, 2021).

 

Of course, the diseases can also co-exist. Confirmation of one does not rule out the other. 

 

The standard panel of tests for diabetes or pre-diabetes can be used to rule out diabetes. The presence of acid-fast bacilli in skin smears or tissue biopsies does not rule out diabetes.

 

Along with good clinical examination and the usual skin smears / tissue biopsies, serology can be uniquely useful where bilateral peripheral neuropathy is possibly due to BL HD. This can happen without marked enlargement of nerves or skin patches, and even false negative skin smears. However, absence of IgM antibodies, to specific antigens, has high negative predictive value, over 90%.(1) It comes very close to ruling out MB HD. Serological tests using PGL1 or NDO-LID antigens are particularly useful in such situations..

Positive serology, on the other hand, is not diagnostic of current or future clinical HD. Nor, of course, does it rule out diabetes as the cause of peripheral neuropathy. Only the panel of tests for diabetes can do that.

Of course peripheral neuropathy can have causes other than HD or diabetes. The permanence of peripheral neuropathy, after a certain duration, makes a trial of treatment somewhat unreliable as a means of ruling out HD. It is useful to rule out nutritional and other causes, especially in low income areas. No harm giving water soluble vitamins, for example.

 

Best,

 

Joel Almeida

 

References

 

1. Leturiondo AL, Noronha AB, Oliveira do Nascimento MO et al. Performance of serological tests PGL1 and NDO-LID in the diagnosis of leprosy in a reference Center in Brazil. BMC Infectious Diseases volume 19, Article number: 22 (2019)

 

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

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