Abstract
BackgroundLeishmaniasis, considered by the World Health Organization as one of the most important tropical diseases, is endemic in the Mediterranean Basin. The aim of this study was to evaluate epidemiological and clinical characteristics of cutaneous (CL) and mucocutaneous leishmaniasis (MCL) in La Fe University Hospital, Valencia, Spain. The particular focus was on diagnosis techniques and clinical differences according to the immunological status of the patients.MethodsAn eleven-year retrospective observational study of CL and MCL episodes at the hospital was performed. Epidemiological, clinical and therapeutic variables of each case, together with the microbiological and anatomopathological diagnosis, were analyzed.ResultsA total of 42 patients were included, 30 of them were male and 28 were immunocompetent. Most of the cases (36/42) were diagnosed in the last 5 years (2013–2017). The incidence of CL and MCL increased from 3.6/100,000 (2006–2012) to 13.58/100,000 (2013–2017). The majority of the patients (37/42) exhibited CL, in 30 cases as single lesions (30/37). Ulcerative lesions were more common in immunosuppressed patients (13/14) than in immunocompetent patients (20/28), (P = 0.2302). The length of lesion presence before diagnosis was 7.36 ± 6.72 months in immunocompetent patients and 8.79 ± 6.9 months in immunosuppressed patients (P = 0.1863). Leishmania DNA detection (92.3%) was the most sensitive diagnostic technique followed by Giemsa stain (65%) and histopathological examination (53.8%). Twelve patients (12/42) had close contact with dogs or were living near to kennels, and 10 of them did not present underlying conditions. Intralesional glucantime (21/42) and liposomal amphotericin B (7/42) were the most common treatments administered in monotherapy. All patients evolved successfully and no relapse was reported.ConclusionsSome interesting clinical and epidemiological differences were found in our series between immunocompetent and immunosuppressed patients. Future studies can take these results further especially by studying patients with biological therapy. Skin biopsies combining NAAT with histological techniques are the most productive techniques for CL or MCL diagnosis.
Highlights
Leishmaniasis, considered by the World Health Organization as one of the most important tropical diseases, is endemic in the Mediterranean Basin
We focused our study on describing and comparing clinical manifestations of cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (MCL) in immunosuppressed and immunocompetent patients in a tertiary hospital of the Mediterranean basin
A total of 42 cases (37 CL and 5 MCL) were included during the study period; 36 patients were diagnosed in the 2013–2017 period (13.58 cases/100,000), and the remaining six between 2006–2012 (3.6 cases/100,000)
Summary
Leishmaniasis, considered by the World Health Organization as one of the most important tropical diseases, is endemic in the Mediterranean Basin. The disease is transmitted by Phlebotominae sand flies of the genus Phlebotomus in the Old World (Europe, Africa and Asia) and Lutzomyia in America. The disease is endemic in 88 countries, but Spain is within the 48 countries in which its declaration is not mandatory. It is estimated that there is a total of 350 million people at risk of suffering from the disease with an annual incidence of approximately 0.7–1.2 million cases of cutaneous leishmaniasis (CL) [1]. Human data underestimate the actual prevalence of the disease due to certain limiting factors, including a discontinuous distribution in endemic areas and a large number of undiagnosed cases
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
