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

Abstract

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.

Treatment outcome of imported cutaneous leishmaniasis among travelers and migrants infected with Leishmania major and Leishmania tropica: a retrospective study in European centers 2013 to 2019

“…Most patients infected with L. tropica were migrants from Syria, and most patients infected with L. major had visited friends and relatives in North Africa. An increased risk of acquiring CL in these groups has previously been reported ( Boggild et al, 2019 ;Guery et al, 2021 ).…”

“…Pentavalent antimony has been the gold standard treatment for decades and is still a valuable drug, but it has been progressively replaced by treatments requiring shorter treatment courses and inducing less frequent alterations of laboratory parameters, such as local therapy Mosimann et al, 2016 ;Mosleh et al, 2008 ), miltefosine ( Guery et al, 2021 ;Mosimann et al, 2016 ), and liposomal amphotericin B ( Shirzadi, 2019 ;Solomon et al, 2011Solomon et al, , 2013. The use of liposomal amphotericin B in CL is nevertheless not devoid of potentially severe adverse events ( Guery et al, 2017 ).…”

“…Today, several alternatives are available, and recommendation depends on the clinical manifestation, the infecting species, and the geographical region where the patient was infected ( Blum et al, 2014 ;Hodiamont et al, 2014 ). In the case of larger lesions ( > 3 cm), multiple lesions ( > 3), or lesions in a delicate site (face, hands, joints), systemic treatment is recommended ( Blum et al, 2014 ;Guery et al, 2021 ;Morizot et al, 2013 ;World Health Organization, 2010.…”

“…Il, intralesional; im, intramuscular; iv, intravenous; NA, data missing; po, orally. Guery et al, 2021 ;Khatami et al, 2007 ), and a result because of selection criteria when to use local and systemic treatment.…”

“…Size, number, and location of the lesions, apart from the Leishmania spp. and immunosuppression, have to be considered when treating travelers with CL in Europe, and local treatments have been most commonly used ( Guery et al, 2021 ;Morizot et al, 2013 ). Systemic treatment is recommended in case of > 3 lesions or a lesion size > 3 cm or a lesion in a delicate site, such as the face, hands, and joints ( Blum et al, 2014 ).…”