High prevalence of vasomotor reflex impairment in newly diagnosed leprosy patients

• Published in: European journal of clinical investigation Vol. 35; no. 10; pp. 658 - 665
• Main Authors: Illarramendi, X., Bührer-Sékula, S., Sales, A. M., Bakker, M. I., Oliveira, A., Nery, J. A. C., Oskam, L., Wilder-Smith, A., Sampaio, E. P., Sarno, E. N.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.10.2005; Blackwell
• Subjects: Adolescent; Adult; Autonomic Nervous System Diseases - epidemiology; Bacterial diseases; Biological and medical sciences; Child; Dysautonomia; Female; Fingers - innervation; General aspects; Human bacterial diseases; Humans; Infectious diseases; laser Doppler velocimetry; Laser-Doppler Flowmetry; Leprosy; Leprosy - diagnosis; Leprosy - physiopathology; Leprosy reaction; Male; Medical sciences; Middle Aged; Mycobacterium leprae; peripheral neuropathy; phenolic glycolipid-I; Reflex, Abnormal; Tropical bacterial diseases; Vasomotor System - physiopathology; Brazil; High; Human; Skin disease; Nervous system diseases; Prevalence; phenolic glycolipid-I; Leprosy; Early stage; Mycobacterial infection; Dysautonomia; Peripheral neuropathy; Epidemiology; laser Doppler velocimetry; Glycolipid; Infection; Medicine; Laser dopplerometry; Vasomotor reflex; Bacteriosis; Phenoplasts; Peripheral nerve disease; Leprosy reaction
• ISSN: 0014-2972; 1365-2362
• DOI: 10.1111/j.1365-2362.2005.01554.x

Background  Initial nerve damage in leprosy occurs in small myelinated and unmyelinated nerve fibers. Early detection of leprosy in the peripheral nervous system is challenging as extensive nerve damage may take place before clinical signs of leprosy become apparent. Patients and methods  In order to determine the prevalence of, and factors associated with, peripheral autonomic nerve dysfunction in newly diagnosed leprosy patients, 76 Brazilian patients were evaluated prior to treatment. Skin vasomotor reflex was tested by means of laser Doppler velocimetry. Blood perfusion and reflex vasoconstriction following an inspiratory gasp were registered on the second and fifth fingers. Results  Vasomotor reflex was impaired in at least one finger in 33/76 (43%) patients. The fifth fingers were more frequently impaired and suffered more frequent bilateral alterations than the second fingers. Multivariate regression analysis showed that leprosy reaction (adjusted odds ratio = 8·11, 95% confidence interval: 1·4–48·2) was associated with overall impaired vasomotor reflex (average of the four fingers). In addition, palmar erythrocyanosis and an abnormal upper limb sensory score were associated with vasomotor reflex impairment in the second fingers, whereas anti‐phenolic glycolipid‐I antibodies, ulnar somatic neuropathy and a low finger skin temperature were associated with impairment in the fifth fingers. Conclusions  A high prevalence of peripheral autonomic dysfunction as measured by laser Doppler velocimetry was observed in newly diagnosed leprosy patients, which is clinically evident late in the disease. Autonomic nerve lesion was more frequent than somatic lesions and was strongly related to the immune‐inflammatory reaction against M. leprae.