Characteristics, clinical manifestations and management of leprosy in KwaZulu-Natal, South Africa: A 20-year retrospective study

Authors

DOI:

https://doi.org/10.7196/SAMJ.2024.v114i5.1630

Keywords:

Leprosy, Dermatology, Infectious diseases

Abstract

Background. Although leprosy, a neglected tropical disease, has been eliminated (<1 case per 10 000 population) in South Africa (SA) since 1926, according to the World Health Organization, new cases continue to be reported. The management of leprosy poses several challenges, including patient adherence, education and insufficient training of healthcare practitioners.

Objectives. To describe the biographical profile, clinical manifestations and treatment outcomes in patients with leprosy in KwaZulu-Natal Province.

Methods. This retrospective study aimed to analyse the clinical data of leprosy patients in SA from 2002 to 2022. Data collected included patient demographics, comorbidities, cutaneous and neurological manifestations of leprosy, complications, treatment and adverse reactions. Descriptive statistics were used to summarise the data.

Results. The study analysed the clinical data of 194 leprosy patients from 2002 to 2022. The majority of patients were male and middle aged, with a disproportionate representation of black South Africans. Regarding socioeconomic status, 80% were unemployed and 40% were social grant recipients. Most cases were clustered in urban centres and diagnosed at secondary care facilities, with 15% being HIV positive. The majority of patients (90%) were classified as having multibacillary leprosy. Common symptoms included upper respiratory tract involvement, hair loss and painful nerves, with the face and limbs being most frequently affected. Cutaneous morphology predominantly included plaques and hypopigmented patches, while neurological signs included ulnar nerve tenderness, muscle weakness and sensory deficits. Debilitating neurological complications were found in one-fifth of patients. Despite initiation of multidrug therapy in most patients, a significant proportion (27.3%) did not complete the full course of treatment, and treatment reactions were noted in 33.5% of patients.

Conclusion. These findings emphasise the urgent need for enhanced patient and healthcare worker education, particularly in primary healthcare settings, to improve adherence to treatment, advocate for prophylactic measures and prevent new cases. Achieving leprosy-free status in SA requires the collaboration of many role-players to address these challenges and improve healthcare practices.

References

World Health Organization. Leprosy (Hansen’s Disease). Geneva: WHO, 2021. https://www.who. int/news-room/fact-sheets/detail/leprosy (accessed 2 November 2021).

World Health Organization. Towards zero leprosy. Global Leprosy (‎Hansen’s Disease)‎ strategy 2021 - 2030. Geneva: WHO, 2021. https://www.who.int/publications/i/item/9789290228509 (accessed 2 November 2021).

Grzybowski A, Nita M. Leprosy in the Bible. Clin Dermatol 2016;34(1):3-7. https://doi. org/10.1016/j.clindermatol.2015.10.003

Lockwood DNJ, Shetty V, Penna GO. Hazards of setting targets to eliminate disease: lessons from the leprosy elimination campaign. BMJ 2014;348(5):g1136-g1136. https://doi.org/10.1136/bmj. g1136

Bolognia J, Schaffer J, Cerroni L. Dermatology. 4th ed. Philadelphia: Elsevier, 2018: 1296-1319.

Arif T, Dorjay K, Adil M, Sami M. Classification of leprosy – from past to present. J Pak Assoc Dermatol 2018;28(1):95-99. https://jpad.com.pk/index.php/jpad/article/view/993 (accessed 2

November 2021).

Fischer M. Leprosy – an overview of clinical features, diagnosis, and treatment. J Dtsch Dermatol

Ges 2017;15(8):801-827. https://doi.org/10.1111/ddg.13301

Miguel CB, da Mota PB, Afonso BO, et al. Leprosy morbidity and mortality in Brazil: 2008 - 2018.

Brazilian J Infect Dis 2021:101638. https://doi.org/10.1016/j.bjid.2021.101638

White C, Franco-Paredes C. Leprosy in the 21st century. Clin Microbiol Rev 2015;28(1):80-94.

https://doi.org/10.1128/cmr.00079-13

KamathS,VaccaroSA,ReaTH,OchoaMT.Recognizingandmanagingtheimmunologicreactions in leprosy. J Am Acad Dermat 2014;71(4):795-803. https://doi.org/10.1016/j.jaad.2014.03.034

Lockwood DN, Suneetha S. Leprosy: Too complex a disease for a simple elimination paradigm.

Bull World Health Organ 2005;83:230-5. https://www.scielosp.org/article/bwho/2005.v83n3/230-

/en/ (accessed 22 April 2024).

Nkehli L, Menezes C, Tsitsi J. Patterns of leprosy at Chris Hani Baragwanath Academic Hospital,

Johannesburg, South Africa, and review of current clinical practice. S Afr Med J 2021;111(9):879-

https://doi.org/10.7196/SAMJ.2021.v111i9.15583

Maymone MB, Venkatesh S, Laughter M, et al. Leprosy: Treatment and management of

complications. J Am Acad Dermat 2020;83(1):17-30. https://doi.org/10.1016/j.jaad.2019.10.138 14. Karim SSA, Churchyard GJ, Karim QA, Lawn SD. HIV infection and tuberculosis in South Africa: An urgent need to escalate the public health response. Lancet 2009;374(9693):921-933. https://doi.

org/10.1016/s0140-6736(09)60916-8

Ustianowski AP, Lawn SD, Lockwood DN. Interactions between HIV infection and leprosy: A paradox. Lancet Infect Dis 2006;6(6):350-360. https://doi.org/10.1016/s1473-3099(06)70493-5

Massone C, Talhari C, Ribeiro-Rodrigues R, et al. Leprosy and HIV coinfection: A critical

approach. Expert Rev Anti-Infect Ther 2011;9(6):701-710. https://doi.org/10.1586/eri.11.44

World Health Organization. Guidelines for the Diagnosis, Treatment and Prevention of Leprosy 2018. https://apps.who.int/iris/bitstream/handle/10665/274127/9789290226383-eng.pdf ?ua=1

(accessed 5 November 2021).

Health Resources and Service Administration. Recommended Treatment Regimens 2018. https://

www.hrsa.gov/hansens-disease/diagnosis/recommended-treatment (accessed 2 Novemeber 2021). 19. Durrheim D, Fourie A, Balt E, et al. Leprosy in Mpumalanga Province, South Africa – eliminated or

hidden? Leprosy Rev 2002;73(4):326-333. https://doi.org/10.47276/lr.73.4.326

Ukpe IS. A study of health workers’ knowledge and practices regarding leprosy care and control at primary care clinics in the Eerstehoek area of Gert Sibande district in Mpumalanga Province, South Africa. S Afr Fam Pract 2006;48(5):16-16e. https://doi.org/10.1080/20786204.2006.10873388 21. NationalInstituteforCommunicableDiseases.SouthAfricanGuidelinesonLeprosyControl2021.

https://www.nicd.ac.za/diseases-a-z-index/leprosy/ (accessed 3 November 2021).

Schoenmakers A, Mieras L, Budiawan T, van Brakel WH. The state of affairs in post-exposure leprosy prevention: A descriptive meta-analysis on immuno- and chemo-prophylaxis. Res Rep

Trop Med 2020;11:97-117. https://doi.org/10.2147/rrtm.s190300

Merle CS, Cunha SS, Rodrigues LC. BCG vaccination and leprosy protection: Review of current

evidence and status of BCG in leprosy control. Expert Rev Vaccines 2010;9(2):209-222. https://

doi.org/10.1586/erv.09.161

Steinmann P, Cavaliero A, Aerts A, et al. The Leprosy Post-Exposure Prophylaxis (LPEP) programme: Update and interim analysis. Lepr Rev 2018;89(2):102-116. https://doi.org/10.47276/ lr.89.2.102

Tiwari A, Blok DJ, Arif M, Richardus JH. Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis. PLoS Negl Trop Dis 2020;14(8):e0008521. https://doi. org/10.1371/journal.pntd.0008521

Naaz F, Mohanty PS, Bansal AK, Kumar D, Gupta UD. Challenges beyond elimination in leprosy. Int J Mycobacteriol 2017;6(3):222. https://doi.org/10.4103/ijmy.ijmy_70_17

Makhakhe L. Leprosy review. S Afr Fam Pract 2021;63(1):1-6. https://doi.org/10.4102/safp. v63i1.5311

KwaZulu-NatalProvincialTreasury.Socio-economicreviewandoutlook2019/2020.KZNTreasury, 2019. https://www.treasury.gov.za/documents/provincial%20budget/2019/3.%20Estimates%20 of%20Prov%20Rev%20and%20Exp/KZN/1.%20Budget%20Overview/KZN%20-%20EPRE%20 -%20Budget%20Overview.pdf (accessed 3 January2023).

Pepito VCF, Amit AML, Samontina RED, Abdon SJA, Fuentes DNL, Saniel OP. Patterns and determinants of treatment completion and default among newly diagnosed multibacillary leprosy patients: A retrospective cohort study. Heliyon 2021;7(6):e07279. https://doi.org/10.1016/j. heliyon.2021.e07279

RodriguesLC,LockwoodDN.Leprosynow:Epidemiology,progress,challenges,andresearchgaps. Lancet Infect Dis 2011;11(6):464-470. https://doi.org/10.1016/s1473-3099(11)70006-8

Ellison GT, de Wet T. Poverty, disability and self-reported health amongst residents and migrants in Gauteng, South Africa. Ann Hum Biol 2016;43(2):131-143. https://doi.org/10.3109/03014460 .2016.1147597

NeryJS,RamondA,PescariniJM,etal.Socioeconomicdeterminantsofleprosynewcasedetection in the 100 million Brazilian cohort: A population-based linkage study. Lancet Glob Health 2019;7(9):e1226-e1236. https://doi.org/10.1016/s2214-109x(19)30260-8

KharsanyABM,CawoodC,LewisL,etal.TrendsinHIVprevention,treatment,andincidenceina hyperendemic area of KwaZulu-Natal, South Africa. JAMA Network Open 2019;2(11):e1914378-e. https://doi.org/10.1001/jamanetworkopen.2019.14378

Karim QA, Kharsany AB, Leask K, et al. Prevalence of HIV, HSV-2 and pregnancy among high school students in rural KwaZulu-Natal, South Africa: A bio-behavioural cross-sectional survey. Sexually Transmitted Infect 2014;90(8):620-626. https://doi.org/10.1136/sextrans-2014-051548

Jain S, Reddy R, Osmani S, Lockwood D, Suneetha S. Childhood leprosy in an urban clinic, Hyderabad, India: Clinical presentation and the role of household contacts. Leprosy Rev 2002;73(3):248-253. https://doi.org/10.47276/lr.73.3.248

Leon KE, Jacob JT, Franco-Paredes C, Kozarsky PE, Wu HM, Fairley JK, eds. Delayed Diagnosis, Leprosy Reactions, and Nerve Injury among Individuals with Hansen’s Disease Seen at a United States Clinic. Oxford University Press Open Forum Infectious Diseases, 2016. https://doi. org/10.1093/ofid/ofw063

Mvogo CE, Bella‐Hiag AL, Ellong A, Achu JH, Nkeng PF. Ocular complications of leprosy in Cameroon. Acta Ophthalmologica Scand 2001;79(1):31-33. https://doi.org/10.1034/j.1600- 0420.2001.079001031.x

Heukelbach J, Chichava OA, Oliveira AR, et al. Interruption and defaulting of multidrug therapy against leprosy: Population-based study in Brazil’s Savannah Region. PLoS Negl Trop Dis 2011;5(5):e1031. https://doi.org/10.1371/journal.pntd.0001031

Rathod S, Suneetha S, Narang T, et al. Management of leprosy in the context of COVID-19 pandemic: Recommendations by SIG leprosy (IADVL academy). Indian Dermat Online J 2020;11(3):345. https://doi.org/10.4103/idoj.idoj_234_20

Da Paz WS, do Rosario Souza M, dos Santos Tavares D, et al. Impact of the COVID-19 pandemic on the diagnosis of leprosy in Brazil: An ecological and population-based study. Lancet Regional Health Americas 2022;9:100181. https://doi.org/10.2139/ssrn.3918868

Ntshanga SP, Rustomjee R, Mabaso ML. Evaluation of directly observed therapy for tuberculosis in KwaZulu-Natal, South Africa. Trans Royal Soc Trop Med Hygiene 2009;103(6):571-574. https:// doi.org/10.1016/j.trstmh.2009.03.021

Naidoo P, Theron G, Rangaka MX, et al. The South African tuberculosis care cascade: Estimated losses and methodological challenges. J Infect Dis 2017;216(Suppl 7):S702-S713. https://doi. org/10.1093/infdis/jix335

Ali Y, Islam MF, Rahman MR, et al. Understanding health seeking behavior regarding leprosy patients. Am J Heal Res 2015;3:356-61. https://doi.org/10.11648/j.ajhr.20150306.17

Blessing O, Abanee PS. The prevalence of tuberculosis and leprosy in primary health care levels in Rivers State, Nigeria. Biomed Pharmacol J 2015;1(2):265-274. http://biomedpharmajournal. org/?p=414 (accessed 22 April 2024).

Downloads

Published

2024-05-09

Issue

Section

Research

How to Cite

1.
Sons JS, Mkhize ZN, Dlova NC, Aldous C, Bhat PR, Chateau AV. Characteristics, clinical manifestations and management of leprosy in KwaZulu-Natal, South Africa: A 20-year retrospective study. S Afr Med J [Internet]. 2024 May 9 [cited 2024 May 19];114(5):e1630. Available from: https://samajournals.co.za/index.php/samj/article/view/1630

Similar Articles

1-10 of 58

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 10 > >>