Diabetic status of patients with leprosy in Kuwait.

OBJECTIVE: The aim of this study was to screen for diabetes mellitus in leprosy patients to elucidate whether leprosy infection may play a role in the pathogenesis of diabetes mellitus in this population. SUBJECTS AND METHODS: Thirty patients of different ages and of both sexes with various types of leprosy were included in this study. In addition, 15 healthy individuals of comparable age and sex who had no family history of diabetes mellitus were identified as controls. In both groups, determinations of fasting and postprandial blood sugar, an oral glucose tolerance test (OGTT), measures of fasting serum insulin and pro-inflammatory cytokine tumor necrosis factor alpha (TNFα), as well as calculations using the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR), were carried out. RESULT: Approximately 13.3% of the leprosy patients were diabetic, and 37.7% were in pre-diabetic. The highest incidences of diabetes and pre-diabetes were in lepromatous leprosy (10% and 20%, respectively); a lower incidence of pre-diabetes (6.6%) was observed in tuberculoid leprosy; and the lowest incidence of diabetes (0.0%) was noted in borderline leprosy patients. Although normal healthy persons were not diabetic (0%), 20% were pre-diabetic. CONCLUSION: This study revealed that the incidence of diabetes was higher in the leprosy patients than in the control group. As a result, we recommend that all leprosy patients should be screened for diabetes.

Changing demography of leprosy: Kuwait needs to be vigilant.

INTRODUCTION: 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. OBJECTIVES: 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. PATIENTS AND 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.

Leprosy in Kuwait: an epidemiological study of new cases.

The latency of infection in leprosy is long so that new cases may present several years after emigration from endemic areas. This is of concern to the health authorities in Kuwait, since there is a sizeable immigrant population. An epidemiological study of new cases was, therefore, conducted to assess the extent of the leprosy problem. A total of 121 (99 male, 22 female) consecutive new leprosy patients were diagnosed nationwide over a six-year period (1983-1988). Over 95% of the patients were foreign born, emphasizing that the problem in Kuwait is mainly a reflection of immigration patterns. There were 74 cases of Asio-Indian origin, 13 Oriental and 34 Arab (including two Kuwaiti). This represents a respective mean incidence of the disease in Kuwaitis and other nationalities of 0.49 and 18.92 per 100,000 per year. Polar lepromatous (LL) leprosy was the most frequent type in the Arab group (44.1%) and polar tuberculoid (TT) the most frequent in the Asio-Indian group (37.8%). LL and borderline lepromatous (BL) types of leprosy were significantly more frequent in patients over 45-years-old and in females (P less than 0.05), contributing to the higher rate of LL in the Arab cases. The mean lag time from symptoms onset to presentation to doctor was 9.4 (range 0-192) months, with lepromatous cases tending to present later than other types. The longest lag times occurred in Arab women with LL, suggesting that cultural influences may delay presentation of leprosy. The mean interval from presentation to diagnosis was 4.1 weeks. The mean latency from entry into Kuwait to diagnosis was 44.7 (range 0-180) months; which stresses the need for physicians to remain vigilant in considering leprosy, especially in any patient with dermatological, neurological or ophthalmic manifestations of disease.