Epidemiology of Imported Cutaneous Leishmaniasis at the Hospital for Tropical Diseases, London, United Kingdom: Use of Polymerase Chain Reaction to Identify the Species

Wall, Emma C; Watson, Julie; Armstrong, Margaret; Chiodini, Peter L.; Lockwood, Diana N. J.

doi:10.4269/ajtmh.2012.10-0558

Cited by 49 publications

(24 citation statements)

References 21 publications

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“…Under a light microscope, all Leishmania species are morphologically undistinguishable from each other, yet species or strain identification is very relevant for patient management (see next paragraph) [ 5 , 47 ]. For several decades, isoenzyme analysis of Leishmania has been used for strain typing and this has allowed the construction of phylogenetic classifications [ 48 ], and even the differentiation between antroponotic and zoonotic variants within a single species [ 49 ].…”

Section: Laboratory Diagnosismentioning

confidence: 99%

Cutaneous Leishmaniasis: Recent Developments in Diagnosis and Management

2015

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This review focuses on recent developments in the diagnosis, treatment, management, and strategies for the prevention and control of cutaneous leishmaniasis (CL) caused by both Old and New World Leishmania species. CL is caused by the vector-borne protozoan parasite Leishmania and is transmitted via infected female sandflies. The disease is endemic in more than 98 countries and an estimated 350 million people are at risk. The overall prevalence is 12 million cases and the annual incidence is 2–2.5 million. The World Health Organization considers CL a severely neglected disease and a category 1 emerging and uncontrolled disease. The management of CL differs from region to region and is primarily based on local experience-based evidence. Most CL patients can be treated with topical treatments, but some Leishmania species can cause mucocutaneous involvement requiring a systemic therapeutic approach. Moreover, Leishmania species can vary in their sensitivity to available therapeutic options. This makes species determination critical for the choice of treatment and the clinical outcome of CL. Identification of the infecting parasite used to be laborious, but now the Leishmania species can be identified relatively easy with new DNA techniques that enable a more rational therapy choice. Current treatment guidelines for CL are based on poorly designed and reported trials. There is a lack of evidence for potentially beneficial treatments, a desperate need for large well-conducted studies, and standardization of future trials. Moreover, intensified research programs to improve vector control, diagnostics, and the therapeutic arsenal to contain further incidence and morbidity are needed.

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Section: Laboratory Diagnosismentioning

confidence: 99%

Cutaneous Leishmaniasis: Recent Developments in Diagnosis and Management

2015

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“…In patients with epidemiological risk for new world cutaneous leishmaniasis, carry out species specific polymerase chain reaction testing to identify cutaneous leishmaniasis caused by L viannia complex 345…”

Section: Discussionmentioning

confidence: 99%

An ulcer that will not heal

Clegg

Hall

Lockwood

2018

BMJ

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“…A recent review of 213 cases in returned travelers identified 20 cases of old-world CL caused by L. donovani complex, which encompasses L. infantum [ 20 ]. 71% were tourists from the Mediterranean.…”

Section: Discussionmentioning

confidence: 99%

A case of imported Leishmania infantum cutaneous leishmaniasis; an unusual presentation occurring 19 years after travel

et al. 2014

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BackgroundLeishmania infantum is a flagellated protozoan parasite that is able to parasitize blood and tissue. Leishmania species cause a spectrum of clinical disease with cutaneous, visceral or mucosal involvement. L. infantum is recognised as a cause of visceral leishmaniasis (VL) and is less commonly reported as a cause of cutaneous leishmaniasis (CL) from countries around the Mediterranean basin. This is the first report of imported L. infantum CL to Australia and is remarkable for a 19 year period between the patient's exposure to an endemic region, and the manifestation of symptoms.Case presentationA 76 year old Italian-born man presented to our institution with a non-healing lesion over his upper lip, abutting his nasal mucosa. The patient had travelled to Italy, an endemic area for L. infantum 19 years earlier but had resided in Australia, a non-endemic area since. Histopathology performed on a biopsy of the lesion demonstrated findings consistent with CL. A species specific polymerase chain reaction (PCR) performed on the tissue detected L. infantum. The patient had complete clinical recovery following treatment with Liposomal amphotericin B at a dose of 3 mg/kg for five days followed by a subsequent 3 mg/kg dose at day ten.ConclusionsL. infantum should be recognised as a cause of imported CL in returned travellers from the Mediterranean. In this case, the incubation period for L. infantum CL was at least 19 years. This case adds to the described spectrum of clinical presentations of leishmaniasis and supports the theory of parasite persistence underlying natural immunity and recurrence of disease. Clinicians should consider L. infantum CL in the differential diagnosis of a non-healing skin lesion in any patient who reports travel to the Mediterranean, even when travel occurred several years before clinical presentation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0597-x) contains supplementary material, which is available to authorized users.

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Epidemiology of Imported Cutaneous Leishmaniasis at the Hospital for Tropical Diseases, London, United Kingdom: Use of Polymerase Chain Reaction to Identify the Species

Cited by 49 publications

References 21 publications

Cutaneous Leishmaniasis: Recent Developments in Diagnosis and Management

Cutaneous Leishmaniasis: Recent Developments in Diagnosis and Management

An ulcer that will not heal

A case of imported Leishmania infantum cutaneous leishmaniasis; an unusual presentation occurring 19 years after travel

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