Leprosy in Refugees and Migrants in Italy and a Literature Review of Cases Reported in Europe between 2009 and 2018

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.

Autochthonous leprosy in Europe: a case report and literature review

“…This suggests that clusters of the disease persist in these countries, especially in Portugal, where our patient may have been exposed. The patients' median age was 55 (IQR: 49 -73), which is greater than the median age of 33 for imported leprosy [4]. We found a sex-ratio of 1.67 (Men 62.5%, 10 cases; Women 37.5%, 6 cases).…”

“…Type-1 reactions were reported in 2 cases, and type-2 reactions were reported in 4 cases. The median time interval between symptoms onset and diagnosis was 3.0 years (IQR: 2 -5.5 ; mean: 8.6 years); these values are greater than the median of 12 months [4] and the mean of 2.1 years [5] reported for the cases imported in Europe. This could be explained by the low level of clinical suspicion for the disease in European populations.…”

“…For example in Germany, where leprosy is a notifiable disease, only 29 cases were reported between 2001 and 2015 [3]. The few cases diagnosed in Europe are almost all imported from endemic areas [4]. In most cases, there is a diagnostic delay due to low physician awareness of the disease.…”

Neglected Tropical Diseases in Lebanon

“…Leprosy is likely to be under-diagnosed due to lack of knowledge and awareness among healthcare workers mainly in countries with very low prevalence. Only a few physicians are trained to recognize the typical skin anesthetic lesions or peripheral nerve pathology associated with the disease [ 52 ]. The WHO has published in 2018 clinical guidelines for the diagnosis and management of leprosy in endemic countries, but no similar WHO guidance exists for non-endemic countries, such as Lebanon [ 53 ].…”

Leprosy in an Adopted Woman Diagnosed by Molecular Tools: A Case Report from a Non-Endemic Area

“…In 2020, 127,396 new cases of leprosy were reported in 127 countries, including 74% in India, Brazil, and Indonesia [ 4 ]. Leprosy in Europe has become rare as of the second half of the 20th century, and the most recent cases were primarily imported from endemic regions [ 5 , 6 ]. Up to the 1980s, Italy only had autochthonous leprosy cases in distinct, endemic areas (Northern Tuscany, Eastern Sicily, Calabria, Puglia, and Liguria) [ 7 ].…”