Imported leprosy in Italy

Massone, Cesare; Brunasso, Alexandra Maria Giovanna; Noto, Salvatore; Campbell, Terri M.; Clapasson, Andrea; Nunzi, Enrico

doi:10.1111/j.1468-3083.2011.04201.x

Cited by 22 publications

(26 citation statements)

References 13 publications

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“…On the other hand, in Italy there is an official leprosy register, the National Reference Centre for Hansen Disease. A recent report from that country showed a gradual reduction of leprosy cases in patients born in that country (with only 12 cases diagnosed between 1990 and 2009, the last of which was in 2003) but also a concurrent increase in imported incidence (n = 159) [ 10 ]. In Spain, the State Register of Leprosy began operating in 1992 under the direction of the National Epidemiology Centre.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of Leprosy in Spain: The Role of the International Migration

2016

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BackgroundAlthough incidence of leprosy in Spain has declined steadily over the years, the fivefold increase in immigration since the turn of the century—much of it from countries where leprosy is still prevalent—has been linked to an uptick in registered cases.ObjectiveTo describe the epidemiologic trends of incident leprosy cases detected in Spain among Spanish- and foreign-born population groups.MethodsObservational, retrospective study of suspected leprosy cases in Spain, as reported through the System of Compulsory Notification of Diseases from 2003 to 2013, with results disaggregated by country of birth. We collected statistical data on leprosy burden for other countries from WHO to estimate the expected number of imported cases.ResultsOf the 168 leprosy cases registered during the study period, 40 (24.6%) were in Spanish patients, while 128 (76.2%) were detected in legally resident immigrants. We identified a significantly higher number of imported leprosy cases during the 2008–2010 and 2011–2013 trienniums compared to the reference biennium 2003–2004 (OR 5.38, 95% CI 1.83–14.88 and OR 4.80, 95% CI 1.41–16.33, respectively). Most imported cases were diagnosed in Latin American immigrants (71.9%), especially Brazilians, but also Paraguayans, Bolivians and other nationalities from South and Central America. However, registered incidence was lower than expected for each year. For example, in 2003, the expected new cases in immigrants was 47.12, compared to only four cases that were actually detected (a 91% difference). Likewise, we expected to find 49.6 incident cases among immigrants in 2009, but only 15 new cases were reported (60% fewer than expected).ConclusionImported cases of leprosy are responsible for most leprosy incidence in Spain, and we cannot rule out some under-diagnosis. Clinicians should be made more aware of the potential for leprosy incidence among patients from countries where the disease is endemic.

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Section: Introductionmentioning

confidence: 99%

Epidemiology of Leprosy in Spain: The Role of the International Migration

2016

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“…With increasing international migration cases of leprosy may occur more often in countries outside endemic areas such as Germany and other European countries where awareness and knowledge of this disease have become low or absent. In terms of crowding, poor hygienic standards and low socio-economic status living conditions in camps for first accommodation of newly arrived refugees and asylum seekers provide precisely the risk factors that may favor the transmission of M. leprae from untreated MB patients excreting large amounts of viable bacteria [10].…”

Section: Discussionmentioning

confidence: 99%

“…There are, however, no uniform criteria for case definitions, laboratory confirmation or reporting obligations. During the last decade Germany, for example reported up to five cases per year, a German case is however only notifiable if laboratory confirmed, preferably by nucleic acid detection [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Report on an unusual case of leprosy from Germany: just an exception of the rule?

et al. 2019

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Case presentation We report on a German leprosy patient originating from Pakistan who had a relapse more than 5 years after completion of multi-drug therapy (MDT) of his first episode of multibacillary (MB) leprosy. State-of-the-art laboratory techniques (histopathology, PGL-I serology, microscopy and DNA/RNA qPCR) were applied for laboratory confirmation and monitoring of treatment outcome. Serology indicated the relapse long before the presence of unambiguous clinical signs. At the time of diagnosis of the relapse the patient had a remarkably high bacterial load suggesting increased risk for a second relapse. Furthermore, unexpectedly prolonged excretion of viable bacilli through the upper respiratory tract for more than 3 months after onset of MDT was shown. Therefore, MDT was administered for 2 years. Discussion and conclusions The clinical course of the patient, as well as the prolonged excretion of viable bacilli, underlines the usefulness of laboratory assessment. Laboratory tools including up-to-date molecular assays facilitate rapid diagnosis, timely MDT, identification of individuals excreting viable bacilli and patients at risk for relapses, monitoring of treatment outcome and respective adaptation of treatment where appropriate.

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“…The only case of leprosy transmission within the UK concerned a 9-year-old child who acquired the disease in the 1940s from his father who had been infected in Brazil [ 17 ]. In Germany two cases were reported in 2006 of patients born in Pakistan or Sri Lanka [ 18 ], whereas in Italy 59 cases were reported between 2003 and 2009, all of patients who had immigrated from various countries [ 19 ]. In Spain, seven cases were described between 2004 and 2009, six of immigrants and one of a Spanish patient who had worked for 25 years as a missionary in Venezuela [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

New Insights into the Geographic Distribution of Mycobacterium leprae SNP Genotypes Determined for Isolates from Leprosy Cases Diagnosed in Metropolitan France and French Territories

Reibel¹,

Chauffour²,

Brossier³

et al. 2015

PLoS Negl Trop Dis

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BackgroundBetween 20 and 30 bacteriologically confirmed cases of leprosy are diagnosed each year at the French National Reference Center for mycobacteria. Patients are mainly immigrants from various endemic countries or living in French overseas territories. We aimed at expanding data regarding the geographical distribution of the SNP genotypes of the M. leprae isolates from these patients.Methodology/Principal findingsSkin biopsies were obtained from 71 leprosy patients diagnosed between January 2009 and December 2013. Data regarding age, sex and place of birth and residence were also collected. Diagnosis of leprosy was confirmed by microscopic detection of acid-fast bacilli and/or amplification by PCR of the M. leprae-specific RLEP region. Single nucleotide polymorphisms (SNP), present in the M. leprae genome at positions 14 676, 1 642 875 and 2 935 685, were determined with an efficiency of 94% (67/71). Almost all patients were from countries other than France where leprosy is still prevalent (n = 31) or from French overseas territories (n = 36) where leprosy is not totally eradicated, while only a minority (n = 4) was born in metropolitan France but have lived in other countries. SNP type 1 was predominant (n = 33), followed by type 3 (n = 17), type 4 (n = 11) and type 2 (n = 6). SNP types were concordant with those previously reported as prevalent in the patients’ countries of birth. SNP types found in patients born in countries other than France (Comoros, Haiti, Benin, Congo, Sri Lanka) and French overseas territories (French Polynesia, Mayotte and La Réunion) not covered by previous work correlated well with geographical location and history of human settlements.Conclusions/SignificanceThe phylogenic analysis of M. leprae strains isolated in France strongly suggests that French leprosy cases are caused by SNP types that are (a) concordant with the geographic origin or residence of the patients (non-French countries, French overseas territories, metropolitan France) or (b) more likely random in regions where diverse migration flows occurred.

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Imported leprosy in Italy

Cited by 22 publications

References 13 publications

Epidemiology of Leprosy in Spain: The Role of the International Migration

Epidemiology of Leprosy in Spain: The Role of the International Migration

Report on an unusual case of leprosy from Germany: just an exception of the rule?

New Insights into the Geographic Distribution of Mycobacterium leprae SNP Genotypes Determined for Isolates from Leprosy Cases Diagnosed in Metropolitan France and French Territories

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