Autochthonous Leprosy Research Articles

1394. Autochthonous Leprosy in Missouri

BackgroundIntroduction: Leprosy (Hansen’s disease) is a chronic granulomatous infection of the skin/peripheral nerves caused by Mycobacterium leprae. Of 216 new cases reported in the US in 2019, 70% were in FL, LA, TX, HI, CA, GA and NY. Leprosy is considered a zoonosis in the southern US with the nine-banded armadillo as a reservoir. There have been no reported autochthonous leprosy cases in Missouri.MethodsCase: 55 y/o previously healthy male noted a new rash on his arm 2 years ago. Over time it spread to his extremities/torso. Skin biopsy showed a granulomatous infiltrate, suspected granuloma annulare, but it progressed despite appropriate therapy. He noted progressive numbness of the affected areas of skin and several regional nerve distributions. In the weeks prior to his initial visit he noted facial swelling, eyelid and ear induration, worsening fatigue, diffuse arthralgia, and some vision changes. His travel history is limited to Canada, Colorado and a brief vacation to the Texas/Mexico border (no notable outdoor exposure during the latter trip; no travel outside the country). He lives in rural Missouri where he is exposed to armadillos. His dogs frequently kill them and often bring them into the yard, rolling around on/in the dead carcasses which he disposes of. He typically wears gloves when handling them and has never consumed them. On exam he had diffuse purplish-red nummular infiltrated anesthetic papules and plaques diffusely distributed over the trunk and extremities. Distinct left ulnar neuropathy was noted. He exhibited leonine facies and infiltration of the bilateral helices. Repeat biopsy showed a granulomatous infiltrate with abundant acid-fast bacilli. DNA sequencing confirmed M. leprae. He was preventatively treated with prednisone and methotrexate to minimize immune reaction, and two weeks later began a regimen of monthly rifampin, minocycline, and moxifloxacin with an anticipated duration of 24 months. ResultsDiagnosislepromatous leprosy with pre-treatment immune reaction. This is potentially the first case of autochthonous leprosy in Missouri. Providers should include Hansen’s disease in the differential diagnosis of patients with dermal eruption and cutaneous neurological symptoms to avoid delays in diagnosis/care.Disclosures All Authors: No reported disclosures

Autochthonous leprosy in Europe: a case report and literature review

Leprosy is currently uncommon in Europe: the diagnosed cases are almost all imported from endemic areas.We report on an autochthonous case of borderline lepromatous leprosy in a 71-year-old Portuguese woman. The case was complicated by a reversal reaction and then by erythema nodosum leprosum.A literature review identified 18 reported cases of European autochthonous leprosy since 2000; all but one were observed in Mediterranean countries. Therefore, active clusters of leprosy persist in Europe, particularly in Spain, Greece, Portugal, and Italy.

Autochthonous leprosy in Spain: Has the transmission of Mycobacteriumleprae stopped?

BackgroundThe aim of this study is to explore whether transmission of M. leprae has ceased in Spain, based upon the patterns and trends of notified cases.MethodologyData on new cases reported to the National Leprosy Registry between the years 2003–2018 were extracted. In absence of detailed travel history, cases were considered “autochthonous” or “imported” based on whether they were born within or outside of Spain. These data were analyzed by age, sex, clinical type, country of origin, and location of residence at time of notification.Principal findingsData were available on 61 autochthonous and 199 imported cases since 2003. There were clear declines in incidence in both groups, and more imported than autochthonous cases every year since 2006. Autochthonous cases were more frequently multibacillary and had older age at diagnosis compared to imported cases. All the autochthonous cases had been born before 1985 and were more than 25 years old at diagnosis. Male-to-female ratio increased with time for autochthonous cases (except for the last time period). The imported cases originated from 25 countries, half of them from Brasil and Paraguay. Autochthonous cases were mainly distributed in the traditionally endemic regions, especially Andalucía and the eastern Mediterranean coast.ConclusionsAutochthonous and imported cases have different epidemiologic patterns in Spain. There was a clear decline in incidence rates of autochthonous disease, and patterns consistent with those reported from other regions where transmission has ceased. Autochthonous transmission of M. leprae is likely to have now effectively stopped in Spain.

Autochthonous Leprosy without Armadillo Exposure, Eastern United States

Autochthonous leprosy has been reported in New York City, where there are no wild armadillos. Recent autochthonous cases also have been reported in Georgia and Florida and blamed on armadillos, including cases with no known armadillo exposure. International migration needs to be considered as a cause of autochthonous leprosy.

The decline of autochthonous leprosy in the Valencia Region of Spain: patterns and trends 1940–2015

Objectives: The aim of this study was to describe the patterns and trends of autochthonous leprosy in the Valencia Region (Spain). Methods: We included all new leprosy cases originating from the Valencia Region between the years 1940 and 2015. Patients originating from other countries or other Spanish regions were excluded. New cases were analysed by age, sex, clinical type, occupation, and geographic distribution. Results: A total of 442 patients with presumably autochthonous leprosy were included. Incidence rates consistently declined over the study period. Mean age at onset gradually increased from 34.2 years during the period 1940-1949 to 59.5 years during 2000-2015. There were no cases with clinical onset after 2006 and no cases born after 1973. Patients were predominantly males (57.7%) and 85.4% had multibacillary leprosy. The proportion of multibacillary cases increased gradually after 1970. The majority of male patients (67.9%) worked in agriculture. Most of the cases, especially during the later periods, were concentrated in the coastal regions. Conclusions: Our findings are consistent with trends described in other regions with declining leprosy incidence rates and suggest that the transmission of M. leprae infection in this area may well have now stopped. Autochthonous leprosy in this region has had a male predominance and a high proportion of multibacillary cases. The geographic distribution and the high incidence in agricultural workers suggest that environmental factors should be further explored.

A case of autochthonous leprosy in an elderly Italian patient leaving in Milan province with peculiar clinical presentation

A case of autochthonous leprosy in an elderly Italian patient leaving in Milan province with peculiar clinical presentation

Autochthonous lepromatous leprosy in a Spanish woman with burns on both feet and skin lesions

The incidence of leprosy is decreasing worldwide and it is considered a rare disease in developed countries. In Spain, leprosy is mainly an imported disease with only few autochthonous cases seen. The diagnosis is difficult because of a low index of suspicion and the absence of visualisation of fast-acid bacilli in the lesions. Here, we report an autochthonous case of leprosy diagnosed after 4 years of evolution of skin lesions. Mechanical rupture of the biopsy helped finally to make the correct diagnosis of the disease.

Autochthonous borderline tuberculoid leprosy in a man from Florida

Leprosy (Hansen's disease) is a chronic contagious granulomatous disease principally affecting the skin and peripheral nervous system, caused by Mycobacterium leprae. In this report, we present a case of autochthonous leprosy in a man from Florida as the first human case reported from this region. Authors believe dermatologists need to be aware of the possibility of autochthonous transmission of leprosy in the Eastern-Southern United States, and should consider leprosy in any patient with atypical skin lesions, even when a history of contact with armadillo is missing.

Borderline Lepromatous Leprosy in an Italian Man

We report a 77-year-old man from Italy with a painful, red right eye with decreased vision (Figure 1A) and multiple asymptomatic erythematous infiltrated nodules and edematous plaques on the face (Figure 1B), tongue (Figure 1C), and trunk and extremities (Figure 1D). Lesions appeared on his face 20 years ago and progressively enlarged and diffused on the trunk. Two of his relatives had been affected by lepromatous leprosy. A skin biopsy specimen showed a diffuse infiltrate of vacuolar macrophages engulfed with mycobacteria (Figure 1E) and the focal presence in the dermis of few multinucleated giant cells and a focal infiltrate of neutrophils. Figure 1. A 77-year-old man from Italy with borderline lepromatous leprosy. Shown are a red right eye (A) and multiple asymptomatic erythematous edematous infiltrated nodules and plaques on the face (B), tongue (C), and trunk and extremities (D). E, Histopathologic ... A polymerase chain reaction identified Mycobacterium leprae. Mycobacteria were confirmed by multiple skin smears stained with Ziehl-Neelsen stain. An ophthalmologic consultation diagnosed acute right uveitis. A neurologic consultation disclosed enlargement of both ulnar nerves and sensory and motor impairment in the fourth and fifth fingers. Electroneurography confirmed involvement of both ulnar nerves, and ultrasound examination demonstrated diffuse swelling of the ulnar nerve at the elbow. According to the Ridley-Jopling classification, borderline lepromatous leprosy was diagnosed and the patient received rifampicin (600 mg/month), minocycline (100 mg/day) instead of dapsone because of anemia, and clofazimine (300 mg/month and 50 mg/day). The man was treated with prednisone (30 mg/day for 6 months with progressive tapering), thalidomide (200 mg/day for 6 weeks with progressive tapering), and topical prednisolone drops (4 times/day for 4 weeks). Treatment cured concomitant type-1 and type-2 leprosy reactions. At one-year of follow-up, the patient showed no adverse reactions to treatment, remission of skin and mucosal lesions, and improvement of leprosy reactions. During 1990–2009, progressive reduction of 12 autochthonous leprosy cases (the most recent case in 2003) was observed in Italy with a simultaneous increase of imported leprosy cases among immigrants from leprosy-endemic areas (159 cases).1 Fear of segregation and marginalization caused the patient to avoid medical treatment for 20 years, resulting in an advanced stage of leprosy. This presentation was unusual because patients are usually given a diagnosis at an earlier stage. Single, anesthetic, hypopigmented, asymmetrically arranged macules and a few macules characterize tuberculoid and borderline tuberculoid leprosy, respectively. Multiple, symmetrically arranged macules, nodules, and plaques characterize borderline lepromatous and early lepromatous leprosy.

わが国のハンセン病患者の動向

We aimed to elucidate the patterns and trends of autochthonous leprosy in Japan from 1964 to 2009, to compare them with the findings from other studies of leprosy in decline. Data on registered leprosy cases in Japan in the period 1964-2009 were analysed with reference to trends in case detection, geographical distribution, age at diagnosis, sex, classification and family history. A consistent decline in leprosy case detection was observed in all areas of the country over the period 1964-2009. Highest incidence was consistently in Okinawa. Autochthonous leprosy has not been reported in anyone born in Japan since 1980. Increasing average age and a shift towards lower latitudes were demonstrated throughout the period. Analyses of data on autochthonous cases revealed patterns similar to those reported in other countries with declining leprosy. Okinawa has had the highest incidence of leprosy in all of Japan since the first national survey in 1900. Several possible explanations include the difference of leprosy control history between Okinawa and the rest of Japan, Okinawa's unique geographical condition, large-scale problem of stigma and discrimination against leprosy patients and delayed improvement of socio-economic conditions.

The decline of leprosy in Japan: patterns and trends 1964–2008

Our purpose was to elucidate the patterns and trends of autochthonous leprosy in Japan from 1964 to 2008, to compare them with the findings from other studies of leprosy in decline, and to determine whether M. leprae transmission persists in Japan. Data on registered leprosy cases in Japan in the period 1964-2008 were analysed with reference to trends in case detection, geographical distribution, age at diagnosis, sex, classification, family history and broad correlation with socioeconomic conditions. A consistent decline in leprosy case detection was observed in all areas of the country over the period 1964-2008. Highest incidence was consistently in Okinawa, the southernmost part of Japan. Autochthonous leprosy has not been reported in anyone born in Japan since 1980. Increasing average age and a shift towards lower latitudes were demonstrated throughout the period. There was an inverse association between regional measures of wealth and leprosy incidence. Leprosy has declined throughout the past century in Japan. Autochthonous transmission has probably stopped in mainland Japan, but may still occur at a low level in Okinawa, the country's southernmost region. Analyses of data on autochthonous cases revealed patterns similar to those reported in other countries with declining leprosy. Detailed comparisons between countries with very low leprosy incidence may help us to better understand the epidemiology of leprosy.

Autochthonous leprosy in metropolitan France presenting with a diffuse infiltration of the face and febrile illness

Leprosy is now considered in Western Europe as a strictly imported disease. A case of presumed locally acquired diffuse lepromatous leprosy was observed in a native-Portuguese woman living in France who developed an acute febrile presentation with extensive cutaneous signs.

Familial transmission of leprosy in post-war brittain: discrimination and dissent

Introduction: Leprosy is a chronic granulomatous infection, which is still endemic in parts of Asia, South America and Africa, and which can be disabling with significant social stigma. We describe a case of autochthonous leprosy transmission in the UK after the second world war, and demonstrate the significant social stigma associated with the diagnosis.

Familial transmission of leprosy in post-war Britain--discrimination and dissent

A Polish immigrant, who was resident in the United Kingdom (UK), presented with lepromatous leprosy and was detained in two hospitals against his wishes in the late 1940s. The public reaction to his diagnosis was remarkable, with street riots and questions in the Houses of Parliament about 'this leper'. His wife was persecuted and had to change her name. The index patient died of tuberculosis during enforced isolation in hospital, and several years later his daughter (who had never left the UK) presented with a left median nerve palsy and probable lepromatous dactylitis of the left third finger, eventually requiring amputation and prolonged dapsone treatment. Her disease resolved slowly but completely. We believe these two familial cases represent the first documented episode of autochthonous leprosy transmission in the UK since the early 1920s. They also demonstrate the ability of this disease to engender fear, dissent and discrimination amongst the public. Parallels are drawn with reactions to the cholera epidemics in nineteenth century Britain, and to HIV/AIDS, SARS and multi-drug resistant tuberculosis in more recent times.

Global leprosy statistics: a cause for pride, or frustration?

Global statistics on leprosy are published annually in the Weekly Epidemiological Record (WER) of the WHO, most recently on 11 August 2006. They make challenging reading, including between the lines : : : .! The recent report begins with a comment that the new Global Strategy for Further Reducing the Leprosy Burden and Sustaining Leprosy Control Activities (plan Period: 2006– 2010) has been ‘endorsed by all partners’, emphasizing the need for ‘high quality diagnostic services and treatment services using multidrug therapy, and ensuring that they are equitably distributed, affordable and easily accessible.’ Importantly, though the word elimination is mentioned, it is not emphasized, and is used mainly with reference to continued progress towards the elimination target ‘within the next few years’, with no year specified. Importantly, it is acknowledged that eradication is not possible with current tools. Given the many unrealistic comments about leprosy in recent years, that is a useful public recognition. Leprosy will continue for many decades in today’s major endemic countries, even under the most favourable projections, and one is not going to eradicate armadillos from the New World. Leprosy is not an eradicable disease. Data from 115 countries and territories are reported. Among the absentees are all the nations of Europe, the USA, Australia, and several developing countries, all with endemic autochthonous (or, considering northern Europe, imported) leprosy. However, the major leprosy endemic countries are there; and 12 of the initial absentees, including the USA (but still no European nation – why not?) were reported in a supplementary WER note on 15 September. The August 11 report tells us that leprosy declined by about a quarter in the world over the year 1995 – more precisely, that there were 296,499 new cases reported in 2005 [down 111,292 (27%) from 407,791 in 2004] and that the registered prevalence was 219,826 on January 1, 2006 [down 66,237 (23%) from 286,063 the previous year]. We are told that only

P176 Autochthonous leprosy in Europe: Identification of two cases

P176 Autochthonous leprosy in Europe: Identification of two cases

A Case of Autochthonous Leprosy in the United States

A Case of Autochthonous Leprosy in the United States