Tegumentary Leishmaniasis in Northeastern Italy from 2017 to 2020: A Neglected Public Health Issue

Abstract

Tegumentary leishmaniasis (TL) includes cutaneous (CL) and mucosal (ML) leishmaniasis; despite being endemic in southern Europe, it is often underdiagnosed and underreported. This study aimed to retrospectively examine data collected from patients with TL in a selected area of northeastern Italy (Emilia-Romagna region, RER). A network of 10 diagnostic units within RER was established, and TL cases diagnosed in RER from 2017 to 2020 were evaluated. A total of 135 TL cases were collected (62% male, 38% female); patients ranged from 1 to 84 years, with a median age of 57. Among these cases, 113 (84%) were notified to the public health authorities. The average annual incidence of TL was 0.76 cases per 100,000 inhabitants. Infections were acquired within the RER in 84% of cases; the 113 autochthonous cases were distributed in the foothills areas of the region. We provide evidence of a defined spatial distribution of TL cases in a selected area of northeastern Italy, as well as a relevant number of ML cases. Our observations suggest the need to raise awareness about TL among clinicians and pathologists, promote the molecular confirmation of cases by reference laboratories, and encourage the establishment of surveillance networks for this neglected disease.

Re-emergence of human leishmaniasis in northern Italy, 2004 to 2022: a retrospective analysis

“…Diagnosis of TL is carried out by histological examination on skin or mucosal biopsies. From July 2013, real-time PCR was introduced in the diagnostic workflow of both VL (on bone marrow aspirate and/or peripheral blood) and TL (on biopsies) [ 14 , 17 ].…”

“…From November 2012 to May 2013, an upsurge of VL was observed in the Bologna province; during these 6 months, 14 cases were notified [ 12 ]. After this period, the incidence of reported VL and CL increased in the LHU of Bologna as well as in other areas of the Emilia-Romagna region [ 13 , 14 ]. Cases of ML also emerged in the selected area [ 15 ].…”

Neglected Tropical Diseases in Italy: introducing IN-NTD, the Italian network for NTDs

“…However, high standardized incidence ratios were also observed in some coastal and inland areas of northern Italy, confirming the northward expansion of vector populations due to climatic changes. This is consistent with the detection of new endemic foci of canine and human leishmaniasis in our country (Moirano et al ., 2020 ; Gaspari et al ., 2022 ; Gradoni et al ., 2022 ). The study by Moirano et al showed, during an 8-year period (2009–2016), 1126 cases of VL with a crude incidence rate (IR) of 2.43 cases per 10 6 person-years with 2 age peaks: the first in the age groups of 0–4 years (IR 7.63 cases) and the second in the age group of 65–74 years (IR: 2.79 cases) (Moirano et al ., 2022 ).…”

“…The highest IR (16 cases per 10 6 person-years) was reported in the Agrigento province of Sicily; these data agree with a retrospective study of leishmaniasis conducted in Sicily from 2013 to 2021 that showed that the largest number of cases of human and canine leishmaniasis were from Agrigento (45.4 and 41.5%, respectively) (Bruno et al ., 2022 ; Moirano et al ., 2022 ). The changing epidemiologic landscape for leishmaniasis in Italy with the recognition of new endemic foci is further confirmed by the upsurge (observed since 2012) in VL and CL cases diagnosed in the Emilia-Romagna region (Varani et al ., 2013 ; Gaspari et al ., 2022 ). However, in the same period, no rise in L. infantum infection among dogs was observed and molecular typing studies clearly showed that the protozoan strains circulating in dogs belonged to different population in comparison with the strains coming from human cases and sand flies (Rugna et al ., 2017 , 2018 ).…”

Epidemiological and Clinical Aspects of Cutaneous and Mucosal Leishmaniases in Portugal: Retrospective Analysis of Cases Diagnosed in Public Hospitals and Reported in the Literature between 2010 and 2020

“…In this region, L. infantum, which belongs to the L. donovani complex, is the etiologic species of most autochthonous human leishmaniasis cases [2]. Infection with L. infantum, when symptomatic, usually presents as VL, although cases of simultaneous or independent CL and mucosal leishmaniasis (ML) caused by this species are increasingly recognized [3]. In the western Mediterranean regions where L. infantum is endemic, including in Portugal, Phlebotomus perniciosus is the main vector [4], and dogs are the main reservoir for human infection [5].…”