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Predicting neuropathy and reactions in leprosy at diagnosis and before incident events. Results from the INFIR cohort study

Predicting neuropathy and reactions in leprosy at diagnosis and before incident events. Results from the INFIR cohort study
Predicting neuropathy and reactions in leprosy at diagnosis and before incident events. Results from the INFIR cohort study
Background

Leprosy is a disease of skin and peripheral nerves. The process of nerve injury occurs gradually through the course of the disease as well as acutely in association with reactions. The INFIR (ILEP Nerve Function Impairment and Reactions) Cohort was established to identify clinically relevant neurological and immunological predictors for nerve injury and reactions.
Methodology/Principal Findings

The study, in two centres in India, recruited 188 new, previously untreated patients with multi-bacillary leprosy who had no recent nerve damage. These patients underwent a series of novel blood tests and nerve function testing including motor and sensory nerve conduction, warm and cold detection thresholds, vibrometry, dynamometry, monofilament sensory testing and voluntary muscle testing at diagnosis and at monthly follow up for the first year and every second month for the second year. During the 2 year follow up a total of 74 incident events were detected. Sub-clinical changes to nerve function at diagnosis and during follow-up predicted these new nerve events. Serological assays at baseline and immediately before an event were not predictive; however, change in TNF alpha before an event was a statistically significant predictor of that event.
Conclusions/Significance

These findings increase our understanding of the processes of nerve damage in leprosy showing that nerve function impairment is more widespread than previously appreciated. Any nerve involvement, including sub-clinical changes, is predictive of further nerve function impairment. These new factors could be used to identify patients at high risk of developing impairment and disability.
1935-2727
e500
Smith, W. Cairns S.
12c0d943-9be3-40a8-a121-54f4275d1aeb
Nicholls, P.G.
b569acda-01e1-4022-93ef-efce28ea7ddd
Das, Loretta
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Barkataki, Pramila
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Suneetha, Sujai
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Suneetha, Lavanya
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Jadhav, Rupendra
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Sundar Rao, P.S.S.
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Wilder-Smith, Einar P.
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Lockwood, Diana N.J.
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van Brakel, Wim H.
0ab1a81c-c2f5-46c9-9119-e9a7ba05c25c
Smith, W. Cairns S.
12c0d943-9be3-40a8-a121-54f4275d1aeb
Nicholls, P.G.
b569acda-01e1-4022-93ef-efce28ea7ddd
Das, Loretta
49dd5bc8-1de0-4d96-97d4-eb78a483378e
Barkataki, Pramila
13f702d9-d42b-42e9-9e58-80b387367ce5
Suneetha, Sujai
888c7eb6-190c-44e4-8889-5bd69dc9fe97
Suneetha, Lavanya
8b90472a-30f2-4e30-bd1e-936250c4e34c
Jadhav, Rupendra
4b1b42cd-e832-44cc-8713-9f527f9c0f42
Sundar Rao, P.S.S.
6bb6a5c6-deed-4356-90b9-78f9da8a26c9
Wilder-Smith, Einar P.
cd8e8269-0cfe-4ac9-b5d4-3e70ec8b0d17
Lockwood, Diana N.J.
347a15a0-9690-4128-bacd-c2030f5f4799
van Brakel, Wim H.
0ab1a81c-c2f5-46c9-9119-e9a7ba05c25c

Smith, W. Cairns S., Nicholls, P.G., Das, Loretta, Barkataki, Pramila, Suneetha, Sujai, Suneetha, Lavanya, Jadhav, Rupendra, Sundar Rao, P.S.S., Wilder-Smith, Einar P., Lockwood, Diana N.J. and van Brakel, Wim H. (2009) Predicting neuropathy and reactions in leprosy at diagnosis and before incident events. Results from the INFIR cohort study. PLoS Neglected Tropical Diseases, 3 (8), e500. (doi:10.1371/journal.pntd.0000500).

Record type: Article

Abstract

Background

Leprosy is a disease of skin and peripheral nerves. The process of nerve injury occurs gradually through the course of the disease as well as acutely in association with reactions. The INFIR (ILEP Nerve Function Impairment and Reactions) Cohort was established to identify clinically relevant neurological and immunological predictors for nerve injury and reactions.
Methodology/Principal Findings

The study, in two centres in India, recruited 188 new, previously untreated patients with multi-bacillary leprosy who had no recent nerve damage. These patients underwent a series of novel blood tests and nerve function testing including motor and sensory nerve conduction, warm and cold detection thresholds, vibrometry, dynamometry, monofilament sensory testing and voluntary muscle testing at diagnosis and at monthly follow up for the first year and every second month for the second year. During the 2 year follow up a total of 74 incident events were detected. Sub-clinical changes to nerve function at diagnosis and during follow-up predicted these new nerve events. Serological assays at baseline and immediately before an event were not predictive; however, change in TNF alpha before an event was a statistically significant predictor of that event.
Conclusions/Significance

These findings increase our understanding of the processes of nerve damage in leprosy showing that nerve function impairment is more widespread than previously appreciated. Any nerve involvement, including sub-clinical changes, is predictive of further nerve function impairment. These new factors could be used to identify patients at high risk of developing impairment and disability.

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Published date: August 2009

Identifiers

Local EPrints ID: 162221
URI: http://eprints.soton.ac.uk/id/eprint/162221
ISSN: 1935-2727
PURE UUID: 7af5cb97-17c9-4c59-93df-1e662509cc41

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Date deposited: 17 Aug 2010 13:55
Last modified: 04 Nov 2019 21:02

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Contributors

Author: W. Cairns S. Smith
Author: P.G. Nicholls
Author: Loretta Das
Author: Pramila Barkataki
Author: Sujai Suneetha
Author: Lavanya Suneetha
Author: Rupendra Jadhav
Author: P.S.S. Sundar Rao
Author: Einar P. Wilder-Smith
Author: Diana N.J. Lockwood
Author: Wim H. van Brakel

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