Diana N. J. Lockwood

2024 marks the centenary of the charity, Lepra. Over the past 100 years of Lepra’s existence, the world has seen many ground-breaking developments in the care, treatment and support for people affected by leprosy. It has been a century of progress from the early days of chaulmoogra oil to initial drug treatment trials of Promin and Diasone, through to the paradigm-shifting development of Dapsone, Clofazimine and Rifampicin, and the introduction of free Multi-Drug Therapy in the 1980s. All of these developments and advancements have been documented in the annals of this journal, the Leprosy Review, which has been published by Lepra since 1928. As Lepra looks back on its long history and reflects on the global progress that has been made, it is proud to have contributed to some of the ground-breaking advancements; and it is proud that Leprosy Review has been on-hand to document them all along the way. As Leprosy Review now enters a new era as an online-only journal, we can look ahead to a future of more research and innovation for the care, treatment and support for people affected by leprosy, knowing that Leprosy Review will continue to be at the forefront, documenting and disseminating findings and advancements – and contributing to the collective leprosy lexicon, moving us forwards to continue improving the management and control of leprosy and its consequences.

This hybrid Congress had both physical and virtual sessions with large number of symposia, lead talks, paper presentations, poster and short video presentations. There were 8 plenary sessions, 72 faculty abstracts, 423 oral papers, 20 papers given different awards and 457 e-posters. Topics covered were clinical aspects (234), diagnostics (6) disability and rehabilitation (96) epidemiology and control (198) laboratory aspects (140), miscellaneous (49), programmatic management (8), rehabilitation, both social and physical (6), social aspects (132), surgery (1) and therapeutics (57). There were 1050 physical delegates and 450 people attended electronically. Delegates came from 56 countries with an age range of 25-75 years. The abstracts are available at https://ilc.abstracts.mediknit.org/ (https://doi.org/10.57202/ ILC2022).

Background: Leprosy is rare in the United Kingdom (UK), but migration from endemic countries results in new cases being diagnosed each year. We documented the clinical presentation of leprosy in a non-endemic setting. Methods: Demographic and clinical data on all new cases of leprosy managed in the Leprosy Clinic at the Hospital for Tropical Diseases, London between 1995 and 2018 were analysed. Results: 157 individuals with a median age of 34 (range 13–85) years were included. 67.5% were male. Patients came from 34 different countries and most contracted leprosy before migrating to the UK. Eighty-two (51.6%) acquired the infection in India, Sri Lanka, Bangladesh, Nepal and Pakistan. 30 patients (19.1%) acquired leprosy in Africa, including 11 from Nigeria. Seven patients were born in Europe; three acquired their leprosy infection in Africa, three in South East Asia, and one in Europe. The mean interval between arrival in the UK and symptom onset was 5.87 years (SD 10.33), the longest time to diagnosis was 20 years. Borderline tuberculoid leprosy (n = 71, 42.0%), and lepromatous leprosy (n =, 53 33.1%) were the commonest Ridley Jopling types. Dermatologists were the specialists diagnosing leprosy most often. Individuals were treated with World Health Organization recommended drug regimens (rifampicin, dapsone and clofazimine). Conclusion: Leprosy is not a disease of travellers but develops after residence in an leprosy endemic area. The number of individuals from a leprosy endemic country reflect both the leprosy prevalence and the migration rates to the United Kingdom. There are challenges in diagnosing leprosy in non-endemic areas and clinicians need to recognise the symptoms and signs of leprosy.

Background: Cutaneous leishmaniasis (CL) is frequent in travellers and can involve oro-nasal mucosae. Clinical presentation impacts therapeutic management. Methodology: Demographic and clinical data from 459 travellers infected in 47 different countries were collected by members of the European LeishMan consortium. The infecting Leishmania species was identified in 198 patients. Principal findings: Compared to Old World CL, New World CL was more frequently ulcerative (75% vs 47%), larger (3 vs 2cm), less frequently facial (17% vs 38%) and less frequently associated with mucosal involvement (2.7% vs 5.3%). Patients with mucosal lesions were older (58 vs 30 years) and more frequently immunocompromised (37% vs 3.5%) compared to patients with only skin lesions. Young adults infected in Latin America with L. braziliensis or L. guyanensis complex typically had an ulcer of the lower limbs with mucosal involvement in 5.8% of cases. Typically, infections with L. major and L. tropica acquired in Africa or the Middle East were not associated with mucosal lesions, while infections with L. infantum, acquired in Southern Europe resulted in slowly evolving facial lesions with mucosal involvement in 22% of cases. Local or systemic treatments were used in patients with different clinical presentations but resulted in similarly high cure rates (89% vs 86%). Conclusion/Significance: CL acquired in L. infantum-endemic European and Mediterranean areas displays unexpected high rates of mucosal involvement comparable to those of CL acquired in Latin America, especially in immunocompromised patients. When used as per recommendations, local therapy is associated with high cure rates.

The coronavirus disease 2019 (COVID-19) pandemic has led to governments implementing a variety of public health measures to control transmission and has affected health services. Leprosy is a communicable neglected tropical disease caused by Mycobacterium leprae and is an important health problem in low- and middle-income countries. The natural history of leprosy means that affected individuals need long-term follow-up. The measures recommended to reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can create barriers to health services. We evaluated the impact of the COVID-19 epidemic response on leprosy services and disease management. We conducted a cross-sectional online survey with healthcare professionals in leprosy referral centres. Eighty percent of leprosy diagnostic services were reduced. All respondents reported that multidrug therapy (MDT) was available but two reported a reduced stock. Clinicians used alternative strategies such as telephone consultations to maintain contact with patients. However, patients were not able to travel to the referral centres. This study highlights the effects of the initial phase of the SARS-CoV-2 pandemic on leprosy services in a range of leprosy-endemic countries. Many services remained open, providing leprosy diagnosis, MDT and leprosy reaction medications. Centres developed innovative measures to counter the negative impacts of the COVID-19 pandemic.