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J Reconstr Microsurg 2015; 31(08): 607-613
DOI: 10.1055/s-0035-1556062
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Selecting a Test for Leprous Neuropathy Screening

Pablo A. Baltodano
1   Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland
,
Eric L. Wan
1   Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland
,
Jonathan Noboa
2   Father Damien House, Guayaquil, Ecuador
,
Gedge D. Rosson
1   Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland
,
A. Lee Dellon
1   Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

13 March 2015

10 May 2015

Publication Date:
28 July 2015 (online)

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Abstract

Background Worldwide, leprosy represents a significant cause of disability due to progressive neurological impairment. Screening for leprous neuropathy is performed with Semmes–Weinstein monofilament (SWM) or ballpoint pen testing (BPT), which results in underreporting of its prevalence. The Pressure-specified sensory device (PSSD; Sensory Management Services, LLC, Baltimore, MD) is a sensitive, noninvasive, portable, neurosensory instrument, which has not been field-tested for leprosy screening. Early identification of leprous neuropathy would permit early antibiotic treatment to prevent contagion and early microsurgical neurolysis.

Methods A prospective, clinical diagnostic, cross-sectional study screened a consecutive sample of patients for leprous neuropathy in the leprosy-endemic province of Los Ríos, Ecuador. Patients meeting the World Health Organization criteria for leprosy and complaining of neuropathy symptoms were classified as leprous neuropathy patients. Patients without any signs of leprosy were used as normal controls. Bilateral ulnar nerve screening with the PSSD, SWM (0.07, 0.4, 2, 4, 10, and 300 g), and BPT was performed in all patients. Sensitivity and specificity were calculated and compared across tests. A total of 71 patients (142 nerves) were evaluated.

Results Compared with the 10 g SWM and the BPT, the PSSD was found to have significantly higher sensitivity (78.3 vs. 0% with p < 0.001, for both) with comparable specificity (97.8 vs. 100% with p > 0.999, for both). Compared with the 0.07 g SWM (lightest filament in our series), the PSSD showed better sensitivity (78.3 vs. 65.2%, p = 0.514) and significantly higher specificity (97.8 vs. 51.1%, p < 0.001).

Conclusions The PSSD provides superior diagnostic accuracy for detecting leprous neuropathy as compared with SWM and BPT.

Keywords

leprous neuropathy - Semmes–Weinstein filaments - Pressure-Specified Sensory Device
 

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