Abstract
Leprosy is a chronic neglected infectious disease that affects over 200,000 people each year and causes disabilities in more than four million people in Asia, Africa, and Latin America. The disease can appear with a wide spectrum of clinical forms, and therefore the clinical suspicion is often difficult. Refugees and migrants from endemic countries affected by leprosy can remain undiagnosed in Europe due to the unpreparedness of clinicians. We retrospectively describe the characteristics of 55 refugees/migrants with a diagnosis of leprosy established in Italy from 2009 to 2018. Continents of origin were Africa (42%), Asia (40%), and South and Central America (18%). The symptoms reported were skin lesions (91%), neuropathy (71%), edema (7%), eye involvement (6%), fever (6%), arthritis (4%), and lymphadenopathy (4%). Seven patients (13%) had irreversible complications. Overall, 35% were relapses and 66% multibacillary leprosy. Furthermore, we conducted a review of 17 case reports or case series and five nationwide reports, published in the same decade, describing 280 migrant patients with leprosy in Europe. In Europe, leprosy is a rare chronic infectious disease, but it has not completely disappeared. Diagnosis and treatment of leprosy in refugees and migrants from endemic countries are a challenge. European guidelines for this neglected disease in this high-risk population would be beneficial.
Highlights
IntroductionLeprosy occurs in a wide spectrum of clinical forms depending on the host cell-mediated immune (CMI) response to the pathogen from the tuberculoid pole, through to borderline cases ending at the lepromatous pole [4]
Leprosy, or Hansen’s disease, is a neglected tropical disease (NTD) with a long incubation period caused by Mycobacterium leprae (M. leprae) and Mycobacterium lepromatosis (M. lepromatosis) [1,2,3].Leprosy occurs in a wide spectrum of clinical forms depending on the host cell-mediated immune (CMI) response to the pathogen from the tuberculoid pole, through to borderline cases ending at the lepromatous pole [4]
This is a retrospective, observational study intended to described the epidemiology of leprosy diagnosed in refugees/migrants reported in two specialized centers in Northern Italy in a ten-year period (2009–2018) and review the literature on the cases published in Europe in the same period
Summary
Leprosy occurs in a wide spectrum of clinical forms depending on the host cell-mediated immune (CMI) response to the pathogen from the tuberculoid pole, through to borderline cases ending at the lepromatous pole [4]. MDT and leprosy campaigns sponsored by the WHO worldwide have permitted a reduction in leprosy prevalence by over 90% [6]. 208,619 new leprosy cases were still reported globally at the end of 2018 [6]. About 95% of cases occurred in 23 high burden countries: Angola, Bangladesh, Brazil, Comoros, Democratic Republic of the Congo, Egypt, Ethiopia, Federated States of Micronesia, India, Indonesia, Ivory Coast, Kiribati, Madagascar, Mozambique, Myanmar, Nepal, Nigeria, Philippines, South Sudan, Sri Lanka, Sudan, Somalia, and the United Republic of Tanzania [6]
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