Leprosy in Toronto: an analysis of 184 imported cases

January 2004
CMAJ: Canadian Medical Association Journal;1/6/2004, Vol. 170 Issue 1, p55
Academic Journal
Background: Leprosy is a rare but serious mycobacterial infection. Immigration from areas where the disease is endemic has resulted in the importation of leprosy into countries where it is not endemic and where physicians and health care workers have little or no experience in diagnosis and therapy. In this study we characterized leprosy patients seen in a tropical disease unit that manages most of the reported leprosy cases in Canada. Methods: We reviewed the clinical records of all 184 leprosy pa-tients who were referred to the Tropical Disease Unit at Toronto General Hospital between 1979 and 2002 and ab-stracted demographic and clinical information. Results: Patients were more likely to be male (122 or 66.3%) and of Indian (44 or 23.9%), Filipino (49 or 26.6%) or Vietnamese (37 or 20.1%) origin. Patients experienced symptoms for a mean of 4.8 years before referral to the Tropical Disease Unit. Most had no family history of leprosy (152/172 or 88.4%). Most patients presented with either borderline tuberculoid (80 or 43.5%) or borderline lepromatous (37 or 20.1%) disease. On average, patients presented with 5.8 skin lesions. Upper-and lower-extremity nerve dysfunction was common at pre-sentation, with up to one-third of patients demonstrating either sensory or motor loss. A significantly greater lag time to pre-sentation was observed in patients who emigrated from low-prevalence regions ( p< 0.001). Interpretation: Leprosy is a chronic infectious disease that is associ-ated with serious morbidity if left untreated. Leprosy is uncom-mon in developed countries, but it is important for physicians to have a high index of suspicion when a foreign-born patient presents with chronic dermatitis and peripheral nerve involvement.


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