BackgroundVisceral leishmaniasis (VL) is a protozoan disease, which is responsible for 200.000–400.000 yearly infections worldwide. If left untreated, the fatality rate can be as high as 100% within 2 years. 90% of cases occur in just six countries: India, Bangladesh, Sudan, South Sudan, Ethiopia and Brazil. It is thus a disease rarely seen by physicians in Europe or North America. We report on the fatal case of VL in an 80-year-old immunosuppressed patient who presented with a latency of over 15 years after having visited an endemic region. This is the first report showing such extreme latency of VL in a European traveller. This case is furthermore unusual because it suggests primary treatment failure to liposomal amphotericin B.Case presentationAn 80-year-old man who was on immunosuppressive treatment due to a non-specific inflammatory disease of the liver and kidney presented to our hospital with recurrent fever, fatigue and bloody diarrhoea. Histopathological analysis from a colon biopsy showed intracellular amastigotes. The diagnosis of VL was confirmed by polymerase-chain-reaction (PCR) of the colon biopsy. PCR was also performed in plasma, a bronchopulmonary lavage, a lymph node, liver and bone marrow biopsy and proved L. donovani as causative species. The disseminated infection was unresponsive to treatment with liposomal amphotericin B as recommended in immunosuppressed individuals despite stopping immunosuppressive treatment.ConclusionImported cases of VL to non-endemic regions are increasing due to extensive international travel and migration. Furthermore, the increase of elderly patients and immunosuppressed individuals, secondary to HIV, post-transplant and chemotherapeutic agents, has resulted in an increase of VL also in endemic regions of Europe. It is thus important for physicians to be able to recognize the infection. This case also demonstrates treatment failure to amphotericin B, which was only a known problem in patients with HIV until now. The knowledge of this as a possible complication is important for specialists treating the disease.

Background Protests and police fieldwork provides a high exposure environment for SARS-CoV-2 infections. In this cross-sectional analysis, we investigated the seroprevalence among a police cohort, and sociodemographic, work and health-related factors associated with seropositivity. Methods Study participants were invited for serological testing of SARS-CoV-2 and to complete online questionnaires. Serum neutralization titres towards the wild-type SARS-CoV-2 spike protein (expressing D614G) and the alpha and beta variants were measured in seropositive study participants. Results 978 police personnel representing 35% of the entire staff participated from February to March 2021. The seroprevalence was 12.9%. It varied by geographic region within the canton; ranged from 9% to 13.5% in three regions, including the city; and was 22% in Bernese Seeland/Jura with higher odds for seropositivity (OR 2.38, 95% CI 1.28–4.44, P=0.006). Job roles with mainly office activity were associated with a lower risk of seropositivity (0.33, 0.14–0.77, P=0.010). Most seropositive employees (67.5%) reported having had COVID-19 three months or longer prior to serological testing. Selfreported compliance with mask wearing during working hours was 100%; 45% of all seropositive versus 5% of all seronegative participants (P<0.001) reported having had contact with a proven COVID-19 case living in the same household prior to serological testing. The level of serum antibody titres correlated with neutralization capacity. Antibodies derived from natural SARS-CoV-2 infection effectively neutralized the SARS-CoV-2 spike protein, but were less effective against the alpha and beta variants. Conclusions The seroprevalence of anti-SARS-CoV-2 antibodies of police officers was comparable to that reported in the general population, suggesting that the personal protective equipment of the police is effective, and that household contacts are the leading transmission venues. The level of serum antibody titres, in particular that of anti-spike antibodies, correlated well with neutralization capacity. Low antibody titres acquired from natural infection were not effective against variants.