Article type: Literature Review
Article title: Exploring the Neurological Manifestations of Leprosy: Clinical Insights and Implications
Journal: Cureus
Year: 2025
Authors: Masoumeh Rashidi, Jamir Pitton Rissardo, Vishnu V. Byroju, Ana Leticia Fornari Caprara, Fatemeh Rashidi, Omesh Prathiraja, Hania Moharam, Christopher C. Elendu, Mallak Bahar, Maleesha Jayasinghe
E-mail: jamirrissardo@gmail.com
ABSTRACT
Leprosy is one of the neglected tropical diseases, and its elimination remains a public health problem globally. This manuscript comprehensively explores the neurological manifestations of leprosy, offering clinical insights and implications for the diagnosis, management, and understanding of this disease. Beginning with a review of historical context, etiology, and epidemiology, we delve into the pathophysiology of leprosy neuropathy, highlighting mechanisms of nerve damage and immune response. Peripheral nerve involvement, including sensory and motor deficits, nerve enlargement, and deformities, are discussed in detail, along with the challenges in diagnosis and management. Psychological and social implications of neurological deficits in leprosy are addressed, emphasizing the importance of holistic care and support. Emerging trends in neuroimaging and molecular diagnostics offer promising avenues for improved diagnosis and therapeutic interventions. Novel therapeutic strategies are identified to enhance treatment efficacy and prevent disability in leprosy neuropathy by targeting immunomodulatory pathways, antibacterial agents, and a personalized medicine approach.
Keywords: cutaneous manifestations of leprosy, hansen's disease, leprosy, leprosy complications, leprosy transmission, leprosy treatment, manifestations of leprosy, mycobacterium leprae.
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DOI
Citation
Rashidi M, Pitton Rissardo J, Byroju V V, et al. Exploring the Neurological Manifestations of Leprosy: Clinical Insights and Implications. Cureus 2025;17: e77799.
Figure 1. Transmission and neural invasion of Mycobacterium leprae (M. leprae). Aerosol transmission is the most accepted route, although vectors and environmental factors are still being studied. Once they enter the bloodstream, M. leprae replicate in macrophages and reach the central nervous system, where they replicate in Schwann cells. Many animals, such as armadillos and monkeys, are considered reservoirs.
Figure 2. Th1 and Th2 responses in leprosy. Antigen-presenting cells activate Th1 cells, resulting in macrophage activation and granuloma formation. This triggers a tuberculoid form of leprosy, which is less severe. When the Th2 pathway is activated, macrophage activation is limited, and disseminated disease develops, termed lepromatous leprosy.
Table 1. Receptors and molecules related with leprosy neuropathy.
Table 2. Studies on the prevalence of leprosy neuropathic pain.
Table 3. Studies using steroids in leprosy neuropathy.