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Diagnosis and therapeutic outcomes of biopsy-confirmed Pure Neuritic Leprosy: A two-decade experience.

Overview

Authors: Shrimantika Sarkar1, Angel Miraclin T1, Ranjani Jayachandran2, Anitha Jasper3, Reethu Anny Eapen2, Lydia Mathew4, Dharshini Sathishkumar4, Dincy Peter4, Leni George4, Harshad Arvind Vanjare3, Deepti Bal1, Hemalatha R1, Aditya V. Nair1, Shaikh Atif Iqbal Ahmed1, Appaswamy Thirumal Prabhakar1, Vivek Mathew1, Sanjith Aaron1, Susanne Pulimood4, Rima Sathyakumar2, Geeta Chacko2, Ajith Sivadasan1
ORCID iDs: Angel Miraclin T, Harshad Arvind Vanjare, Aditya V. Nair
  1. Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
  2. Department of General Pathology (Division of Neuropathology), Christian Medical College, Vellore, Tamil Nadu, India
  3. Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
  4. Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
Institutions: Christian Medical College, Vellore (India)
Journal: PLoS neglected tropical diseases, volume 20, issue 4, article e0014212
Dates: received 18 October 2025; accepted 1 April 2026; published online 10 April 2026
Type: Research article · Language: English
License: CC BY
Identifiers: DOI 10.1371/journal.pntd.0014212 · PMID 41961892 · PMCID PMC13095098 · OpenAlex W7152982916
Open access: gold, a free copy (OpenAlex)
Status: data only
Categories: human (organism), clinical / translational (subfield)
Methods: Statistics
MeSH: Leprosy*, Neuritis*, Adolescent, Adult, Biopsy, Female, Humans, India, Leprostatic Agents, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Young Adult (* major topic)
Journal subjects: Medicine and Health Sciences, Medical Conditions, Infectious Diseases, Bacterial Diseases, Leprosy, Tropical Diseases, Neglected Tropical Diseases, Biology and Life Sciences, Physiology, Electrophysiology, Surgical and Invasive Medical Procedures, Biopsy, Anatomy, Nervous System, Nerves, Neuroscience, Cognitive Science, Cognitive Psychology, Perception, Sensory Perception, Psychology, Social Sciences, Clinical Medicine, Signs and Symptoms, Lesions, Electrophysiological Properties, Diagnostic Medicine
Topic: Leprosy Research and Treatment (Infectious Diseases, Medicine), according to OpenAlex
Citations: not cited yet (Europe PMC); 25 references in the paper

Abstract

Background: Pure neuritic leprosy (PNL) is a distinct form of leprosy characterized by peripheral nerve involvement without skin lesions. Diagnosis is often delayed, and ‘silent neuritis’ contributes to progressive and irreversible nerve damage. Despite appropriate therapy, many patients develop long-term disability. This study describes the clinical profile, diagnostic patterns, therapeutic outcomes, and predictors of disability in biopsy-confirmed PNL.

Methods: We conducted a retrospective observational cohort study at a tertiary referral centre in South India, enrolling biopsy-confirmed PNL cases from January 2003 to May 2023. Demographic, clinical, electrophysiological, and histopathological data were collected. The primary outcome was the proportion of patients with high disability at follow-up (WHO grade 2). Predictors of disability were identified using multivariate analysis.

Results: Ninety-five patients were included (mean age 43.02 years (SD 15.32); 77% male). Over half (55%) presented 1–5 years after symptom onset. Sensory deficits were most common (80%), followed by foot drop (51%), ulnar claw (38%), and trophic ulcers (25%). Electrophysiology revealed mononeuritis multiplex in 52.6% and axonal polyneuropathy in 22.2%. Nerve biopsy showed borderline tuberculoid pathology in 78% and borderline lepromatous in 15.7%. Notably, 6 patients with mononeuropathy had lepromatous pathology. All patients received multidrug therapy; 41 experienced lepra reactions. Higher severity at treatment initiation was significantly associated with persistent disability.

Conclusions: PNL often presents late, with many patients already experiencing nerve damage. A substantial subset of clinically mononeuritis patients demonstrated lepromatous pathology, emphasizing the need for nerve biopsy in all suspected cases. Early detection and timely treatment may reduce disability burden. These findings highlight critical gaps in current diagnostic strategies and underscore the importance of aggressive early intervention in PNL.

Reproduced under the paper's license (CC BY), from the paper cited above.

Code

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Data

Datasets cited

Data Availability

The data used in this study is available at https://doi.org/10.5281/zenodo.19275592.

Reproduced under the paper's license (CC BY), from the paper cited above.

Versions

The history of this record: each version stored by the harvester or made by a correction of its authors or of the maintainers of its code, and what changed in its facts. The texts of the paper (its abstract, its availability statements) are not part of it; versions that changed only those are not listed.

Version 1, 29 September 2026: the first record

Recorded: type, language, journal, volume, issue, pages, dates, 21 authors, 14 MeSH terms, 24 references.

Cite

This paper

Sarkar, S., Miraclin T, A., Jayachandran, R., Jasper, A., Eapen, R. A., Mathew, L., Sathishkumar, D., Peter, D., George, L., Vanjare, H. A., Bal, D., R, H., Nair, A. V., Ahmed, S. A. I., Prabhakar, A. T., Mathew, V., Aaron, S., Pulimood, S., Sathyakumar, R., . . . Sivadasan, A. (2026). Diagnosis and therapeutic outcomes of biopsy-confirmed Pure Neuritic Leprosy: A two-decade experience. PLoS neglected tropical diseases, 20(4), e0014212. https://doi.org/10.1371/journal.pntd.0014212

BibTeX

@article{sarkar2026diagnosis,
author = {Sarkar, Shrimantika and Miraclin T, Angel and Jayachandran, Ranjani and Jasper, Anitha and Eapen, Reethu Anny and Mathew, Lydia and Sathishkumar, Dharshini and Peter, Dincy and George, Leni and Vanjare, Harshad Arvind and Bal, Deepti and R, Hemalatha and Nair, Aditya V. and Ahmed, Shaikh Atif Iqbal and Prabhakar, Appaswamy Thirumal and Mathew, Vivek and Aaron, Sanjith and Pulimood, Susanne and Sathyakumar, Rima and Chacko, Geeta and Sivadasan, Ajith},
title = {{Diagnosis and therapeutic outcomes of biopsy-confirmed Pure Neuritic Leprosy: A two-decade experience}},
journal = {PLoS neglected tropical diseases},
year = {2026},
month = apr,
volume = {20},
number = {4},
pages = {e0014212},
publisher = {PLOS},
issn = {1935-2727},
doi = {10.1371/journal.pntd.0014212},
url = {https://doi.org/10.1371/journal.pntd.0014212},
pmid = {41961892},
pmcid = {PMC13095098}
}

RIS

TY - JOUR
AU - Sarkar, Shrimantika
AU - Miraclin T, Angel
AU - Jayachandran, Ranjani
AU - Jasper, Anitha
AU - Eapen, Reethu Anny
AU - Mathew, Lydia
AU - Sathishkumar, Dharshini
AU - Peter, Dincy
AU - George, Leni
AU - Vanjare, Harshad Arvind
AU - Bal, Deepti
AU - R, Hemalatha
AU - Nair, Aditya V.
AU - Ahmed, Shaikh Atif Iqbal
AU - Prabhakar, Appaswamy Thirumal
AU - Mathew, Vivek
AU - Aaron, Sanjith
AU - Pulimood, Susanne
AU - Sathyakumar, Rima
AU - Chacko, Geeta
AU - Sivadasan, Ajith
TI - Diagnosis and therapeutic outcomes of biopsy-confirmed Pure Neuritic Leprosy: A two-decade experience
T2 - PLoS neglected tropical diseases
J2 - PLoS Negl Trop Dis
PY - 2026
DA - 2026/04/10
VL - 20
IS - 4
SP - e0014212
SN - 1935-2727
PB - PLOS
DO - 10.1371/journal.pntd.0014212
UR - https://doi.org/10.1371/journal.pntd.0014212
LA - en
ER -

CSL-JSON

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