Clinical diversity and treatment results in Tegumentary Leishmaniasis: a European clinical report in 459 patients

Guery, Romain, Walker, Stephen L., Harms, Gundel, Neumayr, Andreas, Van Thiel, Pieter, Gangneux, Jean-Pierre, Clerinx, Jan, Soebirk, Sara Karlsson, Visser, Leo, Lachaud, Laurence, Bailey, Mark, Bart, Aldert, Ravel, Christophe, van der Auwera, Gert, Blum, Johannes, Lockwood, Diana N., and Buffet, Pierre (2021) Clinical diversity and treatment results in Tegumentary Leishmaniasis: a European clinical report in 459 patients. PLoS Neglected Tropical Diseases, 15 (10). e0009863.

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Background: Cutaneous leishmaniasis (CL) is frequent in travellers and can involve oro-nasal mucosae. Clinical presentation impacts therapeutic management.

Methodology: Demographic and clinical data from 459 travellers infected in 47 different countries were collected by members of the European LeishMan consortium. The infecting Leishmania species was identified in 198 patients.

Principal findings: Compared to Old World CL, New World CL was more frequently ulcerative (75% vs 47%), larger (3 vs 2cm), less frequently facial (17% vs 38%) and less frequently associated with mucosal involvement (2.7% vs 5.3%). Patients with mucosal lesions were older (58 vs 30 years) and more frequently immunocompromised (37% vs 3.5%) compared to patients with only skin lesions. Young adults infected in Latin America with L. braziliensis or L. guyanensis complex typically had an ulcer of the lower limbs with mucosal involvement in 5.8% of cases. Typically, infections with L. major and L. tropica acquired in Africa or the Middle East were not associated with mucosal lesions, while infections with L. infantum, acquired in Southern Europe resulted in slowly evolving facial lesions with mucosal involvement in 22% of cases. Local or systemic treatments were used in patients with different clinical presentations but resulted in similarly high cure rates (89% vs 86%).

Conclusion/Significance: CL acquired in L. infantum-endemic European and Mediterranean areas displays unexpected high rates of mucosal involvement comparable to those of CL acquired in Latin America, especially in immunocompromised patients. When used as per recommendations, local therapy is associated with high cure rates.

Item ID: 72346
Item Type: Article (Research - C1)
ISSN: 1935-2735
Copyright Information: Copyright: © 2021 Guery et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Date Deposited: 09 Feb 2022 14:00
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