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.

Keywords: Europe; Italy; Leprosy; Mycobacterium leprae; Mycobacterium lepromatosis; migrants; refugees.

Figure 1

Study flow diagram. Information extracted from each paper were: (1) year of publication, (2) year and country of diagnosis, and (3) country of the patient’s origin. Other information was obtained when available. (4) Demographic characteristics of the patients (gender and age); (5) duration of stay in Europe; (6) clinical manifestations; (7) method of diagnosis; (8) WHO classification; (9) Ridley–Jopling classification.

Figure 2

Skin lesion over the dorsum of hand in a 38-years old migrant from Sri Lanka with a diagnosis of borderline tuberculoid leprosy.

Figure 3

Hypotrophy of the hypothenar region with the flexion of the fifth proximal interphalangeal joint in a 37-years old migrant from Senegal with a diagnosis of tuberculoid leprosy.

Figure 4

(a) Erythematous-infiltrated and edematous plaque edema symmetrically distributed over the face (with raised margins) and conjunctivitis (Type 1 reaction) in a 46-year old migrant from Bangladesh with a diagnosis of borderline lepromatous leprosy. (b) The plaque resolved after combination treatment with multidrug therapy and steroid.

Figure 5

Plantar ulcer of the left foot caused by anesthesia of the sole resulting from damage to the posterior tibial nerve.