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

Abstract

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.

Mycobacterium leprae transmission characteristics during the declining stages of leprosy incidence: A systematic review

“…Given that virtually all new cases are imported from endemic areas, increased migration to Germany may give rise to known risk factors for M. leprae transmission for asylum seekers with regards to crowding and poor hygiene standards within refugee camps, as well as the low socioeconomic status of many of these individuals. Currently, a new leprosy case in Germany is only notifiable if laboratory confirmed [43].…”

“…In this study, we extracted data from six reports with details on eight leprosy patients diagnosed in Germany between 1994 and 2016 [42][43][44][45][46][47]. There was only one suspected autochthonous case reported, with the remaining 7 (87.5%) imported from countries across Asia.…”

RLEP LAMP for the laboratory confirmation of leprosy: towards a point-of-care test

“…For the genome of Togolese strains as used in this study, the copy number was averaged to 30 cp, determined through two different qPCRs detecting RLEP and 16S rRNA using logarithmic dilutions of plasmid standards as published by Beissner et al [ 16 ]. For one patient with Pakistani origin but living for decades in Munich, Germany, diagnosed and treated at DITM (Division of Infectious Diseases and Tropical Medicine, Munich), the amplifiable RLEP copy number was 23 cp [ 17 ].…”

Lepra: sospecha diagnóstica en área no endémica. Serie de casos y revisión de la literatura

“…El espectro clínico de esta entidad es variado, oscilando desde la infección asintomática (más frecuente) u oligosintomática hasta la enfermedad altamente incapacitante. De esta manera, los contactos de lepra no tratada tienen mayor riesgo de enfermedad clínicamente aparente [5] . La manifestación clínica inicial suele ser neuritis sensorial la que, sin tratamiento, puede evolucionar a déficit motor severo [3] .…”

“…La manifestación clínica inicial suele ser neuritis sensorial la que, sin tratamiento, puede evolucionar a déficit motor severo [3] . La clasificación de Ridley-Jopling categoriza la EH según las características de las lesiones y la carga micobacteriana en lepra tuberculoide, lepromatosa o limítrofe [3,5] . Por otro lado, la OMS la clasifica según el número de áreas comprometidas en lepra paubacilar (presencia de cinco o menos lesiones en piel o afectación de un solo nervio) y lepra multibacilar (más de cinco lesiones en piel o afectación de varios nervios) [3,5] .…”