Dados do Trabalho

Título

Detailed clinical evaluation in asymptomatic seropositive household contacts of patients diagnosed with leprosy - The importance of the neurologist in early diagnosis

Resumo

Introduction: The long incubation period of leprosy, its insidious signs and symptoms produce difficulties in its diagnosis and correct clinical classification. The early recognition of neural involvement in leprosy, especially in household contacts with subclinical infection, in which the classic clinical and laboratory findings of the disease are, by definition, absent, represents a major challenge in clinical practice. Objective: To characterize the clinical, molecular, serological and neurophysiological aspects in the early diagnosis of leprosy neuropathy in household contacts with subclinical infection (positive anti-PGL1 ELISA serology). Method: 361 asymptomatic seropositive household contacts (SPHC), defined as subclinical infection, followed up in a national reference center for leprosy in Brazil, from 2016 to 2020, were recruited. All individuals underwent a clinical, laboratory and neurophysiological evaluation. Results: 361 SPHC were evaluated, with a mean age of 35.7 years and female predominance (66.2%; 239/361). The qPCR analysis was positive in 35.5% (128/361) in dermal scrapings and in 25.8% (85/361) in skin biopsy of SPHC. In electroneuromyographic evaluation, 23.5% (93/361) of SPHC showed signs of neural involvement, with an average of 2.1 compromised nerves per SPHC. 62.3% (53/93) showed a mononeuropathy pattern on electroneuromyography (ENMG). The group of SPHC with altered ENMG had a higher qPCR positivity of dermal scrapings (47.0%; 40/85) when compared to the group with normal ENMG (31.9%; 88/276) (p=0.01), conferring a greater chance of neural involvement (OR, 1.8; p=0.02). Conclusion: The annual monitoring of SPHC showed a considerable prevalence of peripheral nerve impairment assessed by ENMG, favoring the early initiation of treatment. It is essential the role of neurologists in the control protocols of this endemic, favoring the breaking of the transmission chain of the disease.

Palavras Chave

Electroneuromyography; Leprosy; Seropositive household contacts.