Abstract
In Spain, Leishmania infantum is endemic, human visceral and cutaneous leishmaniasis cases occurring both in the Peninsula, as well as in the Balearic Islands. We aimed to describe the clinical characteristics of leishmaniasis patients and the changes in the disease evolution after the introduction of antiretroviral therapy in 1997. In this descriptive study, we used Spanish Centralized Hospital Discharge Database for the hospitalized leishmaniasis cases between 1997 and 2011. We included in the analysis only the records having leishmaniasis as the first registered diagnosis and calculated the hospitalization rates. Disease trend was described taking into account the HIV status. Adjusted odds-ratio was used to estimate the association between clinical and socio-demographic factors and HIV co-infection. Of the total 8010 Leishmaniasis hospitalizations records, 3442 had leishmaniasis as first diagnosis; 2545/3442 (75.6%) were males and 2240/3442 (65.1%) aged between 14-65 years. Regarding disease forms, 2844/3442 (82.6%) of hospitalizations were due to visceral leishmaniasis (VL), while 118/3442 (3.4%) hospitalizations were cutaneous leishmaniasis (CL). Overall, 1737/2844 of VL (61.1%) were HIV negatives. An overall increasing trend was observed for the records with leishmaniasis as first diagnosis (p=0.113). Non-HIV leishmaniasis increased during this time period (p=0.021) while leishmaniasis-HIV co-infection hospitalization revealed a slight descending trend (p=0.717). Leishmaniasis-HIV co-infection was significantly associated with male sex (aOR=1.6; 95% CI: 1.25-2.04), 16-64 years age group (aOR=17.4; 95%CI: 2.1-143.3), visceral leishmaniasis aOR=6.1 (95%CI: 3.27-11.28) and solid neoplasms 4.5 (95% CI: 1.65-12.04). The absence of HIV co-infection was associated with lymph/hematopoietic neoplasms (aOR=0.3; 95%CI:0.14-0.57), other immunodeficiency (aOR=0.04; 95% CI:0.01-0.32) and transplant (aOR=0.01; 95%CI:0.00-0.07). Our findings suggest a significant increase of hospitalization in the absence of HIV co-infection, with a predomination of VL. We consider that clinicians in Spain should be aware of leishmaniasis not only in the HIV population but also in non HIV patients, especially for those having immunosuppression as an associate condition.
Highlights
Leishmaniasis represents a complex of mammalian diseases caused by parasitic protozoans classified as Leishmania species and spread through the bite of the sand fly
Two major clinical forms are known: cutaneous leishmaniasis (CL), causing scars and eventually disfiguration, and systemic or visceral leishmaniasis (VL) that can lead to deadly complications if left untreated [1]
A retrospective descriptive study was conducted using the CMBD, which is a national hospital admission database managed by the Ministry of Health and Social Policy that includes all hospitalizations and where diagnoses are coded according to the Spanish version of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) [12]
Summary
Leishmaniasis represents a complex of mammalian diseases caused by parasitic protozoans classified as Leishmania species and spread through the bite of the sand fly. L. infantum is the causative agent of both the cutaneous and visceral forms of leishmaniasis in Southwest Europe [2]. This zoonotic-vector-borne disease has a proven complex transmission dynamic; the seasonality of the vector species directly affects the transmission of the disease while the length of the activity period and sand fly densities are influenced by the climate conditions that affect their life cycle [3]. Phlebotomus sergenti, the main vector of Leishmania tropica, is represented in Spain, whilst L. tropica is not an endemic species in this country [4].
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