Epidemiology of human leishmaniasis in Greece, 1981-2011

Abstract

Leishmaniasis is endemic and mandatorily notifiable in Greece. Epidemiological surveillance data for leishmaniasis in Greece between 1981 and 2011 are presented. In 1998, the notification system began distinguishing between visceral and cutaneous leishmaniasis. The mean annual incidence of reported leishmaniasis cases between 1998 and 2011 was 0.36 per 100,000 population. Of a total 563 leishmaniasis cases reported after 1998, 523 (93%) were visceral leishmaniasis cases. Incidence of reported visceral leishmaniasis cases fluctuated during this period, generally decreasing after 2007, with a small re-increase in 2011. The mean annual incidence rate of reported visceral leishmaniasis cases was significantly higher in less than four year-olds (p <0.001). Leishmaniasis cases occurred both in the country mainland and islands. Between 1998 and 2011, Attica concentrated almost half of the reported visceral leishmaniasis cases, with incidence rates in western Attica and western Athens above 12.00 per 100,000 population. Compared to visceral leishmaniasis, cutaneous leishmaniasis had a rather sporadic distribution, with many prefectures appearing free of cases. From 2004, the notification also included risk factors and of 287 cases with known immune status, 44 (15%) were immunocompromised. Moreover having a dog at home was reported by 209 of 312 leishmaniasis cases (67%), whereas 229 of 307 cases (75%) reported the presence of stray dogs near their residence. Linking clinical surveillance data with laboratory data and improving collaboration with the veterinary public health sector are some of the future challenges for leishmaniasis surveillance in Greece.

Leishmaniasis: diagnostic issues in Europe

“…Despite having a specificity of up to 100%, lymph node aspiration or biopsy has a relatively lower sensitivity of 65.1% (95% CI = 63.5-66.6%) [33]. Due to the required level of expertise and experience needed to perform this procedure in order to yield good results, lymph node aspirates and biopsies are not widely used for the diagnosis of VL in Europe [27][28][29][30][31][32].…”

“…Despite the necessity of having considerable expertise, a splenic aspirate carries a significant risk of life-threatening hemorrhage in patients with VL complicated by severe thrombocytopenia [23]. Splenic aspirates are rarely performed within Europe due to the widespread availability of safer alternatives [27][28][29][30][31][32].…”

“…Tissue culture is a highly specific test, though very tedious, time-consuming and expensive [34]. At present, culture is by and large restricted to reference laboratories in several European countries [23,[27][28][29][30][31][32][33][34][35][36]. Recent advances in culture techniques include a more sensitive micro-culture method for the isolation of Leishmania, which increases sensitivity by using capillary tubes to concentrate the sample material and provide microaerophilic conditions favorable for transformation of the amastigotes to promastigotes [34].…”

Skin Infections in Returned Travelers: an Update

“…The geographic distribution may be expanding; recently, there are case reports of cutaneous leishmaniasis acquired in Texas and Oklahoma [13]. Old World species, such as Leishmania donovani, Leishmania major, Leishmania tropica, Leishmania aethipica, and Leishmania infantum, are mostly found in the Middle East, northern Africa, and southern Europe; endemic foci exist in southern France and Greece; and periodic outbreaks have occurred in Spain [14][15][16].…”

A patient with rheumatoid arthritis, cryoglobulinaemia, and an "accidental" finding

“…In the Athens region, where our patient acquired the infection, leishmaniasis is endemic, with an incidence of 12 cases per 100 000 people per year. 6 Fever, pallor, wasting, and organomegaly are clinical signs of visceral leishmaniasis. In practice, an enlarged spleen, often massive, is the feature that usually prompts clinicians to suspect visceral leishmaniasis in patients who have travelled to, or reside in, endemic areas and who present with fever and pancytopenia, or leucopenia.…”