Changing demography of leprosy: Kuwait needs to be vigilant.
BACKGROUND
Leprosy is an ancient, chronic, communicable disease. It is claimed that it has been 'eliminated' as a public health problem at the global level. However, sporadic new cases are increasingly being encountered, even in non-endemic countries such as ours. A more disturbing fact is the increase in the number of cases in the indigenous population.


OBJECTIVE
The aim of this study was to analyze the magnitude of the leprosy problem in the region of Farwaniya, in which most of the immigrants in Kuwait live, based on detection and prevalence rates over the last 6 years, in addition to a clinico-pathological analysis of the collected data.


METHODS
All clinically diagnosed cases of leprosy seen over a period of 6 years, from January 2003 to December 2008, were included in the study. Socio-demographic details and clinical features were recorded on a proforma. The results were compared to similar previous data from Kuwait, and to that from other countries in the region.


RESULTS
Forty-six patients (38 male and eight female) aged 22-48 years (average 33.6 years), clinically diagnosed with leprosy, were enrolled. Of the enrolled patients, 89.1% were expatriates, while 10.9% were Kuwaiti citizens. The majority of patients (n=24) were from India, followed by Bangladesh (n=6), Egypt (n=5), Pakistan (n=3), and Indonesia, Philippines and Sri Lanka (n=1 each). The duration of signs and symptoms ranged from 1 to 24 months (average 4.7 months). A total of 58.5% of expatriate patients developed their symptoms 2-5 years after entry into Kuwait. Delayed diagnosis (after 12 weeks) was observed in 70.8%. Thirty-one patients (67.4%) had multibacillary leprosy (borderline lepromatous n=15, borderline type n=7, borderline tuberculoid n=5, and lepromatous leprosy n=4), while 15 patients (32.6%) had the paucibacillary form of leprosy (tuberculoid type n=8, borderline tuberculoid n=7). The detection of lepra bacilli in tissue sections was the most common diagnostic tool (67.4%), while nasal smears showed positive results in 28.3% of cases and the slit skin smear in 17.4%.


CONCLUSIONS
This study shows that leprosy in the region of Farwaniya, Kuwait, which has predominantly been a disease of immigrants, has started to infect the Kuwaiti population; such cases may just represent the tip of the iceberg. Careful examination of immigrants on arrival and subsequent periodic regular check-ups are required to prevent the spread of the disease. Furthermore, early referral of suspected cases and screening of contacts, with initiation of treatment as early as possible, are essential to control the spread of leprosy in Kuwait.
Al-Mutairi
Nawaf
N
Department of Dermatology and Venereology, Farwaniya Hospital, PO Box 280, Farwaniya 80000, Kuwait. nalmut@usa.net
Al-Doukhi
Azari
A
Ahmad
Mahmoud S
MS
El-Khelwany
Mohamed
M
Al-Haddad
Ahmad
A
D000328:Adult; D005260:Female; D006801:Humans; D007730:Kuwait / Q000453:epidemiology; D007918:Leprosy / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D015995:Prevalence