Early detection of neuropathy in leprosy:a comparison of five tests for field settings  

作　　者：Inge Wagenaar Erik Post Wim Brandsma Dan Ziegler Moshiur Rahman Khorshed Alam Jan Hendrik Richardus 

机构地区：[1]Department of Public Health,Erasmus MC,Rotterdam,The Netherlands [2]KIT Health,Royal Tropical Institute,Amsterdam,The Netherlands [3]Independent leprosy consultant,Amsterdam,The Netherlands [4]Institute for Clinical Diabetology,German Diabetes Center at Heinrich Heine University,Leibniz Center for Diabetes Research,Dusseldorf,Germany [5]Department of Endocrinology and Diabetology,Medical Faculty,Heinrich Heine University,Düsseldorf,Germany [6]Rural Health Program,The Leprosy Mission International-Bangladesh,Nilphamari,Bangladesh

出　　处：《Infectious Diseases of Poverty》2017年第1期1034-1042,共9页贫困所致传染病（英文）

基　　金：The study was a sub-study of the TENLEP trial.The TENLEP trial was funded by the The American Leprosy Mission,the German Leprosy and TB Relief Association,the Netherlands Leprosy Relief,the Ordre de Malte,and the Turing Foundation.

摘　　要：Background:Early detection and treatment of neuropathy in leprosy is important to prevent disabilities.A recent study showed that the Nerve Conduction Studies(NCS)and Warm Detection Thresholds(WDT)tests can detect leprosy neuropathy the earliest.These two tests are not practical under field conditions,however,because they require climate-controlled rooms and highly trained staff and are expensive.We assessed the usefulness of alternative test methods and their sensitivity and specificity to detect neuropathy at an early stage.Methods:Through a literature search we identified five alternative devices that appeared user-friendly,more affordable,portable and/or battery-operated:the Neuropad^(■),Vibratip^(TM),NC-Stat^(■)DPNCheck^(TM),NeuroQuick and the Thermal Sensibility Tester(TST),assessing respectively sweat function,vibration sensation,nerve conduction,cold sensation and warm sensation.In leprosy patients in Bangladesh,the posterior tibial and sural nerves that tested normal for the monofilament test and voluntary muscle test were assessed with the NCS and WDT as reference standard tests.The alternative devices were then tested on 94 nerves with abnormal WDT and/or NCS results and on 94 unaffected nerves.Sensitivity and specificity were the main outcomes.Results:The NeuroQuick and the TST showed very good sensitivity and specificity.On the sural nerve,the NeuroQuick had both a sensitivity and a specificity of 86%.The TST had a sensitivity of 83%and a specificity of 82%.Both the NC-Stat^(■)DPNCheck^(TM)and Vibratip^(TM)had a high specificity(88%and 100%),but a low sensitivity(16%and 0%).On the posterior tibial nerve,the NeuroQuick and the TST also showed good sensitivity,but the sensitivity was lower than for the sural nerve.The Neuropad^(■)had a sensitivity of 56%and a specificity of 61%.Conclusions:The NeuroQuick and TST are good candidates for further field-testing for reliability and reproducibility.The feasibility of production on a larger scale should be examined.

关 键 词：LEPROSY NEUROPATHY Detection SUBCLINICAL Field use 

分 类 号：R75[医药卫生—皮肤病学与性病学]