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The value of Real time PCR and High Resolution Ultrasound in Diagnosis of Suspected Pure Neural Leprosy

Background: Cases with pure neural leprosy (PNL) are difficult in their diagnosis and
usually loss the early management opportunity. Objective: to evaluate Real time PCR
and high resolution ultrasonography of peripheral nerves as diagnostic tools in PNL.
Methodology The study included 25 suspected PNL and 25 healthy controls. All patients
were subjected to ultrasonography cross-sectional area (CSA) measurement. Fine needle
aspiration (FNA) was obtained, and followed by Ziehl-Neelsen (ZN) staining, and real
time PCR. Results: ZN staining demonstrated M leprae bacilli in only 8 cases while their
DNA was detected in 92 % cases (Sensitivity of both were 100%, and 44.4%,
respectively). Only the left median and right and left posterior tibial nerves CSA
measurements showed good performance in distinguishing patients of PNL. Median
nerve cut off=15.5 mm2
, with a sensitivity of 72%), and right and left posterior tibial
nerves CSA Cut Off were 12, 11.5 mm2 with sensitivity of 76-84%. Conclusions:
ultrasonography of suspected nerves and real time PCR of nerve aspirates are simple
accurate tests for diagnosis of PNL.