AUTHOR=Voltan Glauber , Marques-Júnior Wilson , Santana Jaci Maria , Lincoln Silva Claudia Maria , Leite Marcel Nani , De Paula Natália Aparecida , Bernardes Filho Fred , Barreto Josafá Gonçalves , Da Silva Moises Batista , Conde Guilherme , Salgado Claudio Guedes , Frade Marco Andrey Cipriani 

TITLE=Silent peripheral neuropathy determined by high-resolution ultrasound among contacts of patients with Hansen's disease

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.1059448

DOI=10.3389/fmed.2022.1059448

ISSN=2296-858X

ABSTRACT=Abstract: Introduction: Hansen disease (HD) primarily infects peripheral nerves, with no HD- patients being free of peripheral nerve damage. Household contacts of HD-patients (HHC) are at a 5 to 10 times higher risk of HD than the general population. Neural thickening is one of the three cardinal signs that define a case of HD according to WHO guidelines, exclusively considering palpation examination which is subjective and may not detect the condition in the earliest cases even when performed by well-trained professionals. High resolution ultrasound (HRUS) can evaluate most peripheral nerves, a validated technique with good reproducibility allowing detailed and accurate examination. Objective: To use the peripheral nerve HRUS test according to the HD-protocol as a diagnostic method for neuropathy comparing HHC with healthy volunteers (HVs) and HD-patients. Material and methods: In municipalities from different regions of Brazil we selected at random 83 HHC to be submitted to peripheral nerve ultrasound and compared to 49 HVs and 176 HD-patients. Results: HHC assessed by HRUS showed higher median and mean absolute peripheral nerve cross-sectional area (CSA) values and greater asymmetries (∆CSA) compared to HVs at the same points. Median and mean absolute peripheral nerve CSA values were higher in HD-patients compared to HCCs at almost all points, while ∆CSA values were equal at all points. Mean±SD focality (∆TpT) values for HHC and HD-patients, respectively, were 2.7±2.2/2.6 ± 2.2 for the median nerve, 2.9±2.7/3.3± 2.9 for the common fibular nerve (p>0.05), and 1.3±1.3/2.2±3.9 for the ulnar nerve (p<0.0001). Conclusions: Considering HRUS findings for HHCs, asymmetric multiple mononeuropathy signs (thickening or asymmetry) in at least 20% of the nerves evaluated already indicates evidence of HD-neuropathy. Thus, if more nerve points are assessed in HHCs (14 instead of 10), the contacts become more like HD-patients according to nerve thickening determined by HRUS, which should be a cutting-edge tool for an early diagnosis of leprosy cases.