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 rele...
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ftdoajarticles:oai:doaj.org/article:59a66225dcbe4d9b98f6f30af38e4803 2023-05-15T15:11:28+02:00 Predicting neuropathy and reactions in leprosy at diagnosis and before incident events-results from the INFIR cohort study. W Cairns S Smith Peter G Nicholls Loretta Das Pramila Barkataki Sujai Suneetha Lavanya Suneetha Rupendra Jadhav P S S Sundar Rao Einar P Wilder-Smith Diana N J Lockwood Wim H van Brakel 2009-01-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0000500 https://doaj.org/article/59a66225dcbe4d9b98f6f30af38e4803 EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC2716523?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0000500 https://doaj.org/article/59a66225dcbe4d9b98f6f30af38e4803 PLoS Neglected Tropical Diseases, Vol 3, Iss 8, p e500 (2009) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2009 ftdoajarticles https://doi.org/10.1371/journal.pntd.0000500 2022-12-31T03:57:56Z 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. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLoS Neglected Tropical Diseases 3 8 e500 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 W Cairns S Smith Peter G Nicholls Loretta Das Pramila Barkataki Sujai Suneetha Lavanya Suneetha Rupendra Jadhav P S S Sundar Rao Einar P Wilder-Smith Diana N J Lockwood Wim H van Brakel Predicting neuropathy and reactions in leprosy at diagnosis and before incident events-results from the INFIR cohort study. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
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. |
format |
Article in Journal/Newspaper |
author |
W Cairns S Smith Peter G Nicholls Loretta Das Pramila Barkataki Sujai Suneetha Lavanya Suneetha Rupendra Jadhav P S S Sundar Rao Einar P Wilder-Smith Diana N J Lockwood Wim H van Brakel |
author_facet |
W Cairns S Smith Peter G Nicholls Loretta Das Pramila Barkataki Sujai Suneetha Lavanya Suneetha Rupendra Jadhav P S S Sundar Rao Einar P Wilder-Smith Diana N J Lockwood Wim H van Brakel |
author_sort |
W Cairns S Smith |
title |
Predicting neuropathy and reactions in leprosy at diagnosis and before incident events-results from the INFIR cohort study. |
title_short |
Predicting neuropathy and reactions in leprosy at diagnosis and before incident events-results from the INFIR cohort study. |
title_full |
Predicting neuropathy and reactions in leprosy at diagnosis and before incident events-results from the INFIR cohort study. |
title_fullStr |
Predicting neuropathy and reactions in leprosy at diagnosis and before incident events-results from the INFIR cohort study. |
title_full_unstemmed |
Predicting neuropathy and reactions in leprosy at diagnosis and before incident events-results from the INFIR cohort study. |
title_sort |
predicting neuropathy and reactions in leprosy at diagnosis and before incident events-results from the infir cohort study. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2009 |
url |
https://doi.org/10.1371/journal.pntd.0000500 https://doaj.org/article/59a66225dcbe4d9b98f6f30af38e4803 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 3, Iss 8, p e500 (2009) |
op_relation |
http://europepmc.org/articles/PMC2716523?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0000500 https://doaj.org/article/59a66225dcbe4d9b98f6f30af38e4803 |
op_doi |
https://doi.org/10.1371/journal.pntd.0000500 |
container_title |
PLoS Neglected Tropical Diseases |
container_volume |
3 |
container_issue |
8 |
container_start_page |
e500 |
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1766342314357161984 |