title: Imported and autochthonous leprosy presenting in Madrid (1989-2015): A case series and review of the literature.
abstract: BACKGROUND
  Leprosy remains infrequent in non-endemic areas. The objective of this study was to describe the cases of leprosy reviewed at a referral unit for imported diseases in Europe and to compare these findings with published data on imported leprosy.
  
  
  METHODS
  Cases of leprosy evaluated at a referral centre are described and salient features of autochthonous and imported cases are compared. A review of the literature on imported leprosy was performed.
  
  
  RESULTS
  During the study period, 25 patients with leprosy were followed-up (10 were autochthonous cases and 15 were considered to be imported). Regarding imported cases, the majority were diagnosed in Latin American immigrants (10/15, 67%), mean age was 42 years, there were no differences in gender distribution, estimated average time from arrival in Spain to first visit at the unit was 3 years and from symptom onset to diagnosis was 2 years. Over 80% of imported cases had multibacillary disease and over one third of patients had been previously diagnosed with leprosy. One third had received alternate incorrect diagnoses initially, <50% of patients with imported leprosy completed standard therapy and were considered cured and over one third were lost to follow-up.
  
  
  CONCLUSIONS
  Leprosy remains a complex disease for healthcare professionals unfamiliar with this infection. Manifestations are polymorphic so misdiagnoses and consequent delays in diagnosis are not infrequent and may lead to resulting disabilities. Early diagnosis and management are essential to prevent sequelae and possible transmission. Improving access to health care, especially for vulnerable groups, would be necessary to advance in the control of this disease.
authors.affiliation: National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, Ctra. de Colmenar Km 9, Madrid 28034, Spain. Electronic address: ffnorman@gmail.com.
authors.forename: Francesca F
authors.initials: FF
authors.lastname: Norman
authors.affiliation: National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, Ctra. de Colmenar Km 9, Madrid 28034, Spain.
authors.forename: Chiara
authors.initials: C
authors.lastname: Fanciulli
authors.affiliation: National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, Ctra. de Colmenar Km 9, Madrid 28034, Spain.
authors.forename: José-Antonio
authors.initials: JA
authors.lastname: Pérez-Molina
authors.affiliation: National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, Ctra. de Colmenar Km 9, Madrid 28034, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Monge-Maillo
authors.affiliation: National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, Ctra. de Colmenar Km 9, Madrid 28034, Spain.
authors.forename: Rogelio
authors.initials: R
authors.lastname: López-Vélez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors; D054242:Emigrants and Immigrants; D005060:Europe / Q000453:epidemiology; D005260:Female; D006282:Health Personnel / Q000193:education; D006801:Humans; D007223:Infant; D007918:Leprosy / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission*; D008297:Male; D008875:Middle Aged; D009166:Mycobacterium leprae / Q000302:isolation & purification; D058069:Neglected Diseases / Q000453:epidemiology / Q000382:microbiology; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D014195:Travel
keywords: Immigrant; Leprosy; Mycobacterium leprae; Neglected tropical disease; Travel