Leprosy case investigation - Limpopo province, South Africa, December 2016
Khuliso Goodman Ravhuhali1,&, Ntsieni Ramalwa1, Carl Reddy1
1South African Field Epidemiology Training Program, Ghana
Khuliso Goodman Ravhuhali, South African Field Epidemiology Training Program, Ghana
leprosy remains an important public health problem globally. In Africa, 6 countries including Mozambique and Tanzania accounted for 14% of new cases reported globally in 2015. Prevalence in South Africa (SA) is below 1 per 10,000. On December 8, 2016, the Provincial Department of Health was notified of 2 confirmed leprosy patients. Case investigation was initiated to identify the source of infection, close contacts of the patients, and to follow contacts for any signs of leprosy.
we reviewed medical records and interviewed both patients. We conducted household
visits were conducted to assess close contacts for any signs and symptoms of
leprosy. A case of leprosy was any person who consulted at a tertiary hospital
in Limpopo province in November 2016 having one or more of the following: hypo-pigmented
or reddish skin lesion(s) with definitive loss of sensation on hands and feet;
and positive skin-smear for acid-fast bacilli. A contact was defined as any
person living in the same household of known leprosy patient.
patient 1 was a newly diagnosed 50-year-old, HIV positive male with grade 1 disability. Patient was referred to the hospital after numerous incorrect diagnoses in the nearby clinic. He worked in Tanzania, Mauritius and Namibia since 2007. He started multidrug therapy (MDT) in November 2016. Patient 2 was a 29-year-old female with grade 0 disability. She lived in Mozambique for 17 years until her return to SA in 2011 when she began experiencing symptoms. She started MDT in December 2014, defaulted and reinitiated treatment in November 2016. A total of 24 contacts were reported, 18 were clinically examined and none showed signs of leprosy. Current patients were educated on treatment adherence and follow-up. Contacts were advised to report to hospital if experiencing similar symptoms.
the two reported patients are unrelated and both lived in leprosy endemic countries outside SA. Due to the long incubation period of leprosy and low prevalence in SA, we conclude that infection likely occurred outside SA. We recommended training of health workers in leprosy-specific skills to improve early diagnosis and treatment throughout SA.
1st Ghana Field Epidemiology and Laboratory Training Programme Scientific conference (Accra)
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