# A Retrospective Review of Neglected Tropical Diseases Diagnosed on Histopathological Specimens in the Free State Province, South Africa, 2015–2020

## TL;DR

This study reviewed neglected tropical diseases diagnosed in South Africa's Free State province from 2015 to 2020, finding echinococcosis as the most common.

## Contribution

The study provides new data on NTD prevalence in a non-tropical region and suggests adding echinococcosis to South Africa's key NTD list.

## Key findings

- Echinococcosis was the most common NTD diagnosed (45.8% of cases).
- 30.3% of echinococcosis cases were from neighboring Lesotho.
- The study recommends adding echinococcosis to South Africa's principal NTDs.

## Abstract

Neglected tropical diseases (NTDs) are a heterogeneous group of medical conditions that commonly occur in underprivileged populations. NTDs are primarily diagnosed in tropical areas. Although South Africa is not situated in a tropical region, the high poverty rate makes the country susceptible to some NTDs. Limited data are available on the burden of NTDs in the Free State province of South Africa. This study aimed to determine the number of NTDs diagnosed on histopathological specimens in the public sector of the Free State province over a six-year period and to evaluate the patient demographics.

A retrospective, descriptive study was performed. All NTDs diagnosed in histopathological specimens from public sector hospitals in the province submitted to the Department of Anatomical Pathology, National Health Laboratory Service, and University of the Free State between 1 January 2015 and 31 December 2020 were included in the study. The demographic information, biopsy site, and referring hospital were noted for each case identified.

A total of 72 NTDs were diagnosed. The five most common diagnoses were echinococcosis (n = 33; 45.8%), bilharzia (n = 13; 18.1%), leprosy (n = 9; 12.5%), mycetoma (n = 8; 11.1%), and intestinal worms (n = 5; 6.9%). Ten (30.3%) patients diagnosed with echinococcosis came from the Free State's neighbouring country, Lesotho.

Echinococcosis was the most prevalent NTD diagnosed in central South Africa. We recommend that the South African Department of Health add echinococcosis to the principal NTDs of significance in South Africa, alongside soil-transmitted helminths, schistosomiasis, leprosy, and rabies.