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

Rafael Rocha, Cláudia Conceição, Luzia Gonçalves, Ana Cláudia Carvalho, André Maia, André Martins, António Carujo, António Maio, Catarina Forra, Catarina Melita, Daniela Couto, Diana Fernandes, Dulce Pereira, Ema Leal, Helena Sarmento, Inês Sousa, Jean Pierre Gonçalves, Joana Marinho, Joana Vasconcelos, João CunhaJoão Rodrigues, José Miguel Silva, Lídia Caley, Luís Malheiro, Luís Santos, Margarida Garcia, Maria Cunha, Maria Lima, Maria Margarida Andrade, Marta Marques, Miguel Alpalhão, Mónica Silva, Rita Ferraz, Rui Soares, Salomão Fernandes, Samuel Llobet, Sofia Cruz, Teresa Guimarães, Tiago Branco, Tomás Robalo-Nunes, Vasco Almeida, Carla Maia

Research output: Contribution to journalArticlepeer-review

Abstract

Leishmania infantum, a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM® SPSS® Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond.

Original languageEnglish
Article number819
JournalMicroorganisms
Volume12
Issue number4
DOIs
Publication statusPublished - Apr 2024

Keywords

  • 2010–2020
  • cutaneous
  • Leishmania
  • leishmaniasis
  • mucosal
  • Portugal

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