Abstract
Visceral leishmaniasis is a sporadic illness in Bulgaria. However, cases in humans are registered nearly every year. This study describes the geographical distribution of the disease in Bulgaria from 1988 to 2012, over a period of 25 years. Cases were analysed according to age, sex, and place of residence. A total of 122 cases were registered in 25 years, 118 of which were autochthonous and four of which were imported from endemic countries in southern Europe. The average annual incidence for the study period was 0.06 per 100,000 population, or an average of five cases per year (maximum 15 in 1989; no cases notified in 1991, 1995, 1996 and 2008). Cases of visceral leishmaniasis were recorded in 13 out of 28 regions in Bulgaria, mainly in the southern part of the country. The highest number of cases were registered in the regions of Blagoevgrad (n=36) and Stara Zagora (n=34). Data presented in this study show that there is ongoing transmission of visceral leishmaniasis in Bulgaria with a high mortality rate (1:7), affecting mostly children.
Highlights
Visceral leishmaniasis (VL) is a protozoan, vectorborne disease characterised by chronic course, remittent fever, hepatosplenomegaly, and anaemia to complete pancytopenia and secondary immunosuppression
The ratio between children and adults with leishmaniasis in the Mediterranean region is 7:3 and the average age of the affected children is under four years [3]
Four imported cases were recorded in Bulgarian citizens who had visited European countries in the Mediterranean region [9,10,11,26]
Summary
Visceral leishmaniasis (VL) is a protozoan, vectorborne disease characterised by chronic course, remittent fever, hepatosplenomegaly, and anaemia to complete pancytopenia and secondary immunosuppression. Leishmania infantum is the causing agent of VL in the Mediterranean region. In areas endemic for VL, the disease tends to have a chronic course and children are especially affected [1]. Children aged between one and four years were the group most affected by endemic VL caused by L. infantum in southern Europe, North Africa, west and central Asia [2]. The ratio between children and adults with leishmaniasis in the Mediterranean region is 7:3 and the average age of the affected children is under four years [3]. In recent years, about a half of leishmaniasis cases in Europe have occurred in adults, following the appearance of the human immunodeficiency virus (HIV) infection and the increased number of patients receiving immunosuppressing treatments due to transplantation, malignancies or other underlying conditions [4]
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