Clinical diversity and treatment results in Tegumentary Leishmaniasis: A European clinical report in 459 patients

Abstract

Background: Cutaneous leishmaniasis (CL) is frequent in travellers and can involve oro-nasal mucosae. Clinical presentation impacts therapeutic management.

Methodology: Demographic and clinical data from 459 travellers infected in 47 different countries were collected by members of the European LeishMan consortium. The infecting Leishmania species was identified in 198 patients.

Principal findings: Compared to Old World CL, New World CL was more frequently ulcerative (75% vs 47%), larger (3 vs 2cm), less frequently facial (17% vs 38%) and less frequently associated with mucosal involvement (2.7% vs 5.3%). Patients with mucosal lesions were older (58 vs 30 years) and more frequently immunocompromised (37% vs 3.5%) compared to patients with only skin lesions. Young adults infected in Latin America with L. braziliensis or L. guyanensis complex typically had an ulcer of the lower limbs with mucosal involvement in 5.8% of cases. Typically, infections with L. major and L. tropica acquired in Africa or the Middle East were not associated with mucosal lesions, while infections with L. infantum, acquired in Southern Europe resulted in slowly evolving facial lesions with mucosal involvement in 22% of cases. Local or systemic treatments were used in patients with different clinical presentations but resulted in similarly high cure rates (89% vs 86%).

Conclusion/significance: CL acquired in L. infantum-endemic European and Mediterranean areas displays unexpected high rates of mucosal involvement comparable to those of CL acquired in Latin America, especially in immunocompromised patients. When used as per recommendations, local therapy is associated with high cure rates.

Fig 1. Flow chart of entries in the LeishMan database and selected analyses.

Infection, Relapse or Reinfection correspond to a documented episode of visceral or cutaneous leishmaniasis, with or without mucosal involvement. * patients with multiple follow-up visits or samples. Notes: A “Patient” file corresponds to demographic information. A “Sample” file corresponds to one sample collected in one site with one technique at one date (eg. PCR on skin biopsy of right hand collected the 25^th of May 2017). Abbreviations: CL, cutaneous leishmaniasis; VL, visceral leishmaniasis

Fig 2. Number of cases reported from each country of acquisition (464 infections in 459 patients).

Created with mapchart.net.

Fig 3. Comparative features of 166 cases of cutaneous leishmaniasis by main infecting species.

Abbreviations: IQR, interquartile range; VFR, visiting friends and relatives.