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. 2024 Apr 18;12(4):819.
doi: 10.3390/microorganisms12040819.

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  1   2   3 , Cláudia Conceição  1   2 , Luzia Gonçalves  1   2   4   5 , Ana Cláudia Carvalho  6 , André Maia  7 , André Martins  8 , António Carujo  9 , António Maio  10 , Catarina Forra  11 , Catarina Melita  12 , Daniela Couto  13 , Diana Fernandes  14 , Dulce Pereira  15 , Ema Leal  16 , Helena Sarmento  8 , Inês Sousa  17 , Jean-Pierre Gonçalves  18 , Joana Marinho  19 , Joana Vasconcelos  20 , João Cunha  21 , João Rodrigues  22 , José Miguel Silva  23 , Lídia Caley  24 , Luís Malheiro  25 , Luís Santos  16 , Margarida Garcia  16 , Maria Cunha  17   26 , Maria Lima  27 , Maria Margarida Andrade  28 , Marta Marques  15 , Miguel Alpalhão  17 , Mónica Silva  29 , Rita Ferraz  30 , Rui Soares  31 , Salomão Fernandes  32 , Samuel Llobet  17 , Sofia Cruz  33 , Teresa Guimarães  34 , Tiago Branco  35 , Tomás Robalo-Nunes  36 , Vasco Almeida  16 , Carla Maia  1   2
Affiliations

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 et al. Microorganisms. .

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.

Keywords: 2010–2020; Leishmania; Portugal; cutaneous; leishmaniasis; mucosal.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Estimated mean annual incidence, per 100,000 population, between 2010 and 2020 of cutaneous leishmaniasis by NUTS3 region.
Figure 2
Figure 2
Strategies used for primary treatment of patients with autochthonous exclusively cutaneous leishmaniasis (no evidence of simultaneous visceral involvement) (n = 20).
See this image and copyright information in PMC

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