Environmental Factors as Key Determinants for Visceral Leishmaniasis in Solid Organ Transplant Recipients, Madrid, Spain

Carrasco-Antón, Nerea; López‐Medrano, Francisco; Fernández‐Ruiz, Mario; Carrillo, Eugenia; Moreno, Javier; García‐Reyne, Ana; Pérez‐Ayala, Ana; Rodríguez-Ferrero, María Luisa; Lumbreras, Carlos; Juan, Rafael San; Alvar, Jorge; Aguado, José María

doi:10.3201/eid2307.151251

Cited by 17 publications

(20 citation statements)

References 9 publications

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“…The recent outbreak of leishmaniasis in Fuenlabrada (southwest Madrid, Spain), with a mean incidence rate of 22.2 per 100,000 inhabitants in the general population [ 32 ], has allowed the study of a cohort of patients with SOT living in the area [ 33 ]. During the outbreak, a total of 7 VL cases were counted amongst the 68 SOT recipients included in the study, yielding an annual incidence of 2,997 cases per 100,000 population.…”

Section: Resultsmentioning

confidence: 99%

New insights into leishmaniasis in the immunosuppressed

et al. 2018

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Immunosuppression contributes significantly to the caseload of visceral leishmaniasis (VL). HIV coinfection, solid organ transplantation, malnutrition, and helminth infections are the most important immunosuppression-related factors. This review briefly describes the challenges of these associations. East Africa and the Indian subcontinent are the places where HIV imposes the highest burden in VL. In the highlands of Northern Ethiopia, migrant rural workers are at a greater risk of coinfection and malnutrition, while in India, HIV reduces the sustainability of a successful elimination programme. As shown from a longitudinal cohort in Madrid, VL is an additional threat to solid organ transplantation. The association with malnutrition is more complex since it can be both a cause and a consequence of VL. Different regimes for therapy and secondary prevention are discussed as well as the role of nutrients on the prophylaxis of VL in poverty-stricken endemic areas.

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Section: Resultsmentioning

confidence: 99%

New insights into leishmaniasis in the immunosuppressed

et al. 2018

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“…Overall, the major risk factor for VL appears to be related to the prevalence of the disease, as suggested by two studies involving SOT patients from endemic areas [16,66]. Additionally, in a recent outbreak of leishmaniasis in Spain, the risk of developing VL was 135 times higher in SOT patients than in immunocompetent individuals from the same area [18]. Regarding the immunosuppression (IS) regimen, the risk of VL increases with the use of high-dose steroids [16].…”

Section: Risk For the Recipient: Infection And Reactivationmentioning

confidence: 99%

Leishmaniasis in Transplant Candidates and Recipients: Diagnosis and Management

Clemente¹,

Mourão²

2020

Emerging Transplant Infections

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Leishmaniasis is a rare disease in both solid-organ and hematopoietic stem cell transplantation. Additionally, the frequency of disease is likely related to the leishmaniasis prevalence in the general population. Although cutaneous leishmaniasis (CL) presentation is more prevalent than that of visceral leishmaniasis (VL) in the general population, the opposite occurs in transplant patients. The current available knowledge is based on small series, case reports, or extrapolations from studies conducted in the general population or in immunocompromised subjects. Therefore, recommendations for disease management are based on the opinion of experts. Leishmania transmission through organ grafts has not been conclusively demonstrated, and there are relatively low rates of transfusion-transmitted leishmaniasis (TTL). To date, compulsory screening for VL in organ donors and the deferral criteria have still not been established. In the context of transplant recipients, diagnosis and management remain a challenge. Delayed diagnosis frequently occurs because of low clinical suspicion and atypical disease presentation. Liposomal amphotericin is the drug of choice and the most commonly used therapy. However, patient profile, Leishmania species, disease extent, drug availability or toxicity, presence of concomitant infections, and especially response can influence this choice. Immunosuppression dose reduction is often recommended, but such decisions must be taken on an individual basis. The main challenges include donor screening and organ deferral, duration of therapy, secondary prophylaxis, and follow-up.

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“…Interestingly, a study conducted in Madrid during an outbreak of leishmaniasis found an annual risk of developing VL among SOT recipients 136 times higher compared to immunocompetent subjects living in the same area [80]. Three risk factors emerged as associated with the diagnosis of VL: 1) living in close proximity to the area affected by the outbreak (relative risk 11.74%), explained by a higher chance to be bitten by the infected phlebotomous; 2) receiving a SOT during the outbreak; and 3) being black from sub-Saharan Africa, with a relative risk of 6.40% [80]. The role of ethnicity and its possible association with VL needs to be explored in future studies, as black people emerged as the most affected in another study from Brazil [81].…”

Section: Risk Factorsmentioning

confidence: 99%

“…VL is by far the most frequently encountered clinical presentation of leishmaniasis among SOT recipients described in kidney, liver, heart, lung, and pancreas transplantation [7,68,[79][80][81]. Fever is the most common symptom of VL, but in the study by Clemente et al, 14% of patients were afebrile [68,79].…”

Section: Clinical Presentationmentioning

confidence: 99%

Chagas Disease, Leishmaniasis, and Malaria in Solid Organ Transplant Recipients

Antinori¹,

Milazzo²

2018

obm transplant

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Solid organ transplantation (SOT) is increasingly employed worldwide to treat several diseases causing both acute and chronic organ failure. Recipients of SOT are at an increased risk to develop infections as a consequence of immunosuppressive therapy. Sometimes such infections may be acquired by the transplanted organ or by reactivation of a previously acquired latent infection. The globalization and the increase of international travel poses a risk for exposure to infections such as Chagas disease (CD), leishmaniasis, and malaria endemic in tropical and subtropical areas of the world. We have reviewed the literature regarding risk factors, clinical presentation, diagnosis, and treatment of CD, leishmaniasis, and malaria in the setting of SOT.

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Environmental Factors as Key Determinants for Visceral Leishmaniasis in Solid Organ Transplant Recipients, Madrid, Spain

Cited by 17 publications

References 9 publications

New insights into leishmaniasis in the immunosuppressed

New insights into leishmaniasis in the immunosuppressed

Leishmaniasis in Transplant Candidates and Recipients: Diagnosis and Management

Chagas Disease, Leishmaniasis, and Malaria in Solid Organ Transplant Recipients

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