TY - JOUR
T1 - Epidemiological and clinical trends of visceral leishmaniasis in Portugal
T2 - retrospective analysis of cases diagnosed in public hospitals between 2010 and 2020
AU - Rocha, Rafael
AU - Conceição, Cláudia
AU - Gonçalves, Luzia
AU - Maia, Carla
N1 - Funding Information:
The authors would like to acknowledge the Directorate-General of Health (DGS) for providing access to data of visceral leishmaniasis cases available on the National Database of Compulsory Notifiable Diseases and the National System of Epidemiological Surveillance (SINAVE). The authors would also like to acknowledge the Directors of the all the clinical and laboratory Departments involved in this study and the Administration Councils of the hospitals that authorized the study. LeishPT group (Ana Cl\u00E1udia Carvalho6, Andr\u00E9 Maia7, Andr\u00E9 Martins8, Ant\u00F3nio Carujo9, Ant\u00F3nio Maio10, Catarina Forra11, Catarina Melita12, Daniela Couto13, Diana Fernandes14, Dulce Pereira15, Ema Leal16, Helena Sarmento8, In\u00EAs Sousa17, Jean-Pierre Gon\u00E7alves18, Joana Marinho19, Joana Vasconcelos20, Jo\u00E3o Cunha21, Jo\u00E3o Rodrigues22, Jos\u00E9 Miguel Silva23, L\u00EDdia Caley24, Lu\u00EDs Malheiro25, Lu\u00EDs Santos16, Margarida Garcia16, Margarida Prata19, Maria Cunha17,26, Maria Lima27, Maria Margarida Andrade28, Marta Marques15, Miguel Alpalh\u00E3o17, M\u00F3nica Silva29, Rita Ferraz30, Rui Soares31, Salom\u00E3o Fernandes32, Samuel Llobet17, Sofia Cruz33, Teresa Guimar\u00E3es34, Tiago Branco35, Tom\u00E1s Robalo-Nunes36, Vasco Almeida16) 6Hospital of Braga, Sete Fontes - S\u00E3o Victor, 4710-243 Braga, Portugal 7Hospital Center of Tr\u00E1s-os-Montes e Alto Douro, Avenida da Noruega, 5000-508 Vila Real, Portugal 8Hospital of Senhora da Oliveira Guimar\u00E3es, Rua dos Cutileiros, Creixomil, 4835-044 Guimar\u00E3es, Portugal 9University Hospital Center of Santo Ant\u00F3nio, Rua Prof. Vicente Jos\u00E9 de Carvalho 37, 4050-366 Porto, Portugal 10Hospital Center of Baixo Vouga, Av. Artur Ravara, 3810-501 Aveiro, Portugal 11Local Health Unit of Castelo Branco, Avenida Pedro \u00C1lvares Cabral, 6000-085 Castelo Branco, Portugal 12Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal 13University Hospital Center of Cova da Beira, Alameda P\u00EAro da Covilh\u00E3, 6200-251 Covilh\u00E3, Portugal 14Hospital Center of Leiria, Rua das Olhalvas, 2410-197 Leiria, Portugal 15Hospital Center of Tondela-Viseu, Avenida Rei D. Duarte, 3504-509 Viseu, Portugal 16University Hospital Center of Central Lisbon, Rua Jos\u00E9 Ant\u00F3nio Serrano, 1150-199 Lisboa, Portugal 17University Hospital Center of Northern Lisbon, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal 18Portuguese Oncology Institute of Lisbon Francisco Gentil, Rua Professor Lima Basto 1099-023, Lisboa, Portugal 19University Hospital Center of Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal 20Hospital Center of Western Lisbon, Rua da Junqueira 126, 1349-019 Lisboa, Portugal 21District Hospital of Santar\u00E9m, Avenida Bernardo Santareno, 2005-177 Santar\u00E9m, Portugal 22Local Health Unit of Guarda, Avenida Rainha Dona Am\u00E9lia, 6300-858 Guarda, Portugal 23Local Health Unit of the Northern Alentejo, Avenida de Santo Ant\u00F3nio, Apartado 234, 7301-853 Portalegre, Portugal 24Hospital Center of M\u00E9dio Tejo, Avenida Maria de Lourdes de Mello Castro, Ap. 118, 2304-909 Tomar, Portugal 25Hospital Center of Vila Nova de Gaia/Espinho, Rua Concei\u00E7\u00E3o Fernandes, 4434-502 Vila Nova de Gaia, Portugal 26Faculty of Medicine of the University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal 27Hospital Center of Set\u00FAbal, Rua Camilo Castelo Branco, Apartado 140, 2910-446 Set\u00FAbal, Portugal 28Hospital of Cascais Dr. Jos\u00E9 de Almeida, Avenida Brigadeiro Victor Novais Gon\u00E7alves, 2755-009 Alcabideche, Portugal 29Hospital Center Barreiro-Montijo, Avenida Movimento das For\u00E7as Armadas, 2834-003 Barreiro, Portugal 30Hospital Center of T\u00E2mega and Sousa, Avenida do Hospital Padre Am\u00E9rico, N\u00BA 210, 4560-136 Guilhufe \u2013 Penafiel, Portugal 31Portuguese Oncology Institute of Coimbra Francisco Gentil, Avenida Bissaya Barreto 98, 3000-075 Coimbra, Portugal 32Hospital Beatriz \u00C2ngelo, Avenida Carlos Teixeira, 3, 2674-514 Loures, Portugal 33Hospital of Vila Franca de Xira, Estrada Carlos Lima Costa N\u00BA2, 2600-009 Vila Franca de Xira, Portugal 34Local Health Unit of Nordeste, Avenida Abade de Ba\u00E7al, 5301-852 Bragan\u00E7a, Portugal 35University Hospital Center of the Algarve, Rua Le\u00E3o Penedo, 8000-386 Faro, Portugal 36Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal
Funding Information:
RR was supported by the Portuguese Ministry of Education and Science (via Funda\u00E7\u00E3o para a Ci\u00EAncia e a Tecnologia, I.P. - FCT) through a PhD grant (UI/BD/151067/2021).
Funding Information:
The work of CM was supported by the European Commission grant 101057690 and UKRI grants 10038150 and 10039289 and is catalogued by the CLIMOS Scientific Committee as CLIMOS number 005 ( http://www.climos-project.eu ). The contents of this publication are the sole responsibility of the author and do not necessarily reflect the views of the European Commission, the Health and Digital Executive Agency, or UKRI. Neither the European Union nor granting authority nor UKRI can be held responsible. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. For the purposes of Open Access, the authors have applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. The six Horizon Europe projects, BlueAdapt, CATALYSE, CLIMOS, HIGH Horizons, IDAlert, and TRIGGER, from the Climate Change and Health Cluster.
Funding Information:
The authors would also like to acknowledge FCT for funding through contracts with GHTM (UID/Multi/04413/2020) and LA-REAL (LA/P/0117/2020). The work of LG was also supported by FCT contracts with CEAUL (UIDB/00006/2020 and UIDP/00006/2020).
Publisher Copyright:
© The Author(s) 2024.
PY - 2024/6
Y1 - 2024/6
N2 - Background: Leishmania infantum is endemic in the Mediterranean region, presenting mostly as visceral leishmaniasis (VL). In Portugal, reporting of VL cases to public health authorities is mandatory, but significant underreporting is likely. This study aimed to describe the epidemiological and clinical aspects of the VL cases diagnosed in hospitals of the Portuguese National Health Service (NHS), between 2010 and 2020. Methods: Collaboration was requested to every hospital of the Portuguese NHS in Mainland Portugal. Cases were screened through a search of diagnostic discharge codes or, if not available, by a search of positive laboratory results for Leishmania infection. Sociodemographic and clinical data was retrieved from medical records. Simultaneously, the National Health authority was contacted to request access to data of notified cases of VL between 2010 and 2020. Descriptive, hypothesis testing and multiple binary logistic regression models were performed. Results: A total of 221 VL cases were identified. A significant increase in estimated national incidence was seen in the years after 2016 (P = 0.030). VL was predominantly diagnosed in people living with HIV (PLWH) and in children (representing around 60% of the new cases), but the outcome was generally poorer in non-HIV patients with associated immunosuppression, with significantly lower rates of clinical improvement at 7 (P = 0.003) and 30 days (P = 0.008) after treatment. Atypical presentations, with gastrointestinal and/or respiratory involvement, were seen in 8.5% of VL cases. Hemophagocytic lymphohistiocytosis was diagnosed in 40.0% of children under 5 years of age. Only 49.7% of incident VL cases were reported. Simultaneous involvement of the skin was confirmed in 5.9% of patients. Conclusions: VL presents a continuing threat in Portugal, especially to PLWH and children, and an increasing threat to other immunosuppressed groups. Recent increases in incidence should be closely monitored to allow prompt interventions. Programs to control the disease should focus on providing tools for earlier diagnosis and on reducing underreporting and promoting an integrated surveillance of human and animal disease. These data should be combined with asymptomatic infection and vector information, following a One Health approach. Graphical Abstract: (Figure presented.)
AB - Background: Leishmania infantum is endemic in the Mediterranean region, presenting mostly as visceral leishmaniasis (VL). In Portugal, reporting of VL cases to public health authorities is mandatory, but significant underreporting is likely. This study aimed to describe the epidemiological and clinical aspects of the VL cases diagnosed in hospitals of the Portuguese National Health Service (NHS), between 2010 and 2020. Methods: Collaboration was requested to every hospital of the Portuguese NHS in Mainland Portugal. Cases were screened through a search of diagnostic discharge codes or, if not available, by a search of positive laboratory results for Leishmania infection. Sociodemographic and clinical data was retrieved from medical records. Simultaneously, the National Health authority was contacted to request access to data of notified cases of VL between 2010 and 2020. Descriptive, hypothesis testing and multiple binary logistic regression models were performed. Results: A total of 221 VL cases were identified. A significant increase in estimated national incidence was seen in the years after 2016 (P = 0.030). VL was predominantly diagnosed in people living with HIV (PLWH) and in children (representing around 60% of the new cases), but the outcome was generally poorer in non-HIV patients with associated immunosuppression, with significantly lower rates of clinical improvement at 7 (P = 0.003) and 30 days (P = 0.008) after treatment. Atypical presentations, with gastrointestinal and/or respiratory involvement, were seen in 8.5% of VL cases. Hemophagocytic lymphohistiocytosis was diagnosed in 40.0% of children under 5 years of age. Only 49.7% of incident VL cases were reported. Simultaneous involvement of the skin was confirmed in 5.9% of patients. Conclusions: VL presents a continuing threat in Portugal, especially to PLWH and children, and an increasing threat to other immunosuppressed groups. Recent increases in incidence should be closely monitored to allow prompt interventions. Programs to control the disease should focus on providing tools for earlier diagnosis and on reducing underreporting and promoting an integrated surveillance of human and animal disease. These data should be combined with asymptomatic infection and vector information, following a One Health approach. Graphical Abstract: (Figure presented.)
KW - Children
KW - Leishmania
KW - Leishmaniasis
KW - People living with HIV
KW - Portugal
KW - Visceral
UR - http://www.scopus.com/inward/record.url?scp=85194991980&partnerID=8YFLogxK
U2 - 10.1186/s40249-024-01204-5
DO - 10.1186/s40249-024-01204-5
M3 - Article
C2 - 38822396
AN - SCOPUS:85194991980
SN - 2095-5162
VL - 13
JO - Infectious diseases of poverty
JF - Infectious diseases of poverty
IS - 1
M1 - 41
ER -