The First Cases of Imported Leprosy in Romania After More than Four Decades of Absence of New Cases.

Although in Romania an increase in migrant population has been reported in the last years, there are no screening programs for infectious diseases implemented for migrants. We report the first two cases of leprosy (Hansen's disease) since 1981 and the first imported ones in Romania, in two sisters originating from Indonesia, employed as massage therapists at a SPA center. Case one was diagnosed with multibacillary Hansen's disease of mid-borderline type, and case two with paucibacillary Hansen's disease borderline tuberculoid form based on epidemiological, clinical, histopathological and molecular diagnosis. Both patients have started multidrug therapy with dapsone, rifampicin and clofazimine provided by WHO. Both patients developed dapsone induced anemia under therapy, even though no G6PD deficiency was present, and dapsone was stopped. The clinical evolution of skin lesions was favorable under therapy, and the haemoglobin level started to increase after dapsone was stopped. This publication underlines the risk of importing rare diseases in Romania and in other European countries and the delay in diagnosis due to insufficient awareness among occupational medicine doctors. Improved strategies are needed at national level in order to increase awareness on rare imported infectious diseases and introduce screening programs in migrant population from high-risk areas.