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Rocha R, Conceição C, Gonçalves L, Carvalho AC, Maia A, Martins A, Carujo A, Maio A, Forra C, Melita C, Couto D, Fernandes D, Pereira D, Leal E, Sarmento H, Sousa I, Gonçalves JP, Marinho J, Vasconcelos J, Cunha J, Rodrigues J, Silva JM, Caley L, Malheiro L, Santos L, Garcia M, Cunha M, Lima M, Andrade MM, Marques M, Alpalhão M, Silva M, Ferraz R, Soares R, Fernandes S, Llobet S, Cruz S, Guimarães T, Branco T, Robalo-Nunes T, Almeida V, Maia C. 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. Microorganisms 2024; 12:819. [PMID: 38674763 PMCID: PMC11052487 DOI: 10.3390/microorganisms12040819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
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.
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Affiliation(s)
- Rafael Rocha
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal; (R.R.); (C.C.)
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
- Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Cláudia Conceição
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal; (R.R.); (C.C.)
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
| | - Luzia Gonçalves
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal; (R.R.); (C.C.)
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal
- Z-Stat4life, Espaço Cowork Baldaya, Palácio Baldaya, Estrada de Benfica N° 701ª, 1549-011 Lisboa, Portugal
| | | | - André Maia
- Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida da Noruega, 5000-508 Vila Real, Portugal
| | - André Martins
- Hospital da Senhora da Oliveira Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal
| | - António Carujo
- Centro Hospitalar Universitário de Santo António, Rua Prof. Vicente José de Carvalho N° 37, 4050-366 Porto, Portugal
| | - António Maio
- Centro Hospitalar do Baixo Vouga, Av. Artur Ravara, 3810-501 Aveiro, Portugal
| | - Catarina Forra
- Unidade Local de Saúde de Castelo Branco, Avenida Pedro Álvares Cabral, 6000-085 Castelo Branco, Portugal
| | - Catarina Melita
- Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
| | - Daniela Couto
- Centro Hospitalar Universitário Cova da Beira, Alameda Pêro da Covilhã, 6200-251 Covilhã, Portugal
| | - Diana Fernandes
- Centro Hospitalar de Leiria, Rua das Olhalvas, 2410-197 Leiria, Portugal
| | - Dulce Pereira
- Centro Hospitalar Tondela-Viseu, Avenida Rei D. Duarte, 3504-509 Viseu, Portugal
| | - Ema Leal
- Centro Hospitalar Universitário de Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal
| | - Helena Sarmento
- Hospital da Senhora da Oliveira Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal
| | - Inês Sousa
- Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - Jean-Pierre Gonçalves
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal
| | - Joana Marinho
- Centro Hospitalar Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
| | - Joana Vasconcelos
- Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira N° 126, 1349-019 Lisboa, Portugal;
| | - João Cunha
- Hospital Distrital de Santarém, Avenida Bernardo Santareno, 2005-177 Santarém, Portugal
| | - João Rodrigues
- Unidade Local de Saúde da Guarda, Avenida Rainha Dona Amélia, 6300-858 Guarda, Portugal
| | - José Miguel Silva
- Unidade Local de Saúde do Norte Alentejano, Avenida de Santo António, Apartado 234, 7301-853 Portalegre, Portugal
| | - Lídia Caley
- Centro Hospitalar do Médio Tejo, Avenida Maria de Lourdes de Mello Castro, Ap. 118, 2304-909 Tomar, Portugal
| | - Luís Malheiro
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal
| | - Luís Santos
- Centro Hospitalar Universitário de Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal
| | - Margarida Garcia
- Centro Hospitalar Universitário de Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal
| | - Maria Cunha
- Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Maria Lima
- Centro Hospitalar de Setúbal, Rua Camilo Castelo Branco, Apartado 140, 2910-446 Setúbal, Portugal
| | - Maria Margarida Andrade
- Hospital de Cascais Dr. José de Almeida, Avenida Brigadeiro Victor Novais Gonçalves, 2755-009 Alcabideche, Portugal
| | - Marta Marques
- Centro Hospitalar Tondela-Viseu, Avenida Rei D. Duarte, 3504-509 Viseu, Portugal
| | - Miguel Alpalhão
- Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - Mónica Silva
- Centro Hospitalar Barreiro Montijo, Avenida Movimento das Forças Armadas, 2834-003 Barreiro, Portugal
| | - Rita Ferraz
- Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo, N° 210, Guilhufe, 4560-136 Penafiel, Portugal;
| | - Rui Soares
- Instituto Português de Oncologia de Coimbra Francisco Gentil, Avenida Bissaya Barreto N° 98, 3000-075 Coimbra, Portugal
| | - Salomão Fernandes
- Hospital Beatriz Ângelo, Avenida Carlos Teixeira, N° 3, 2674-514 Loures, Portugal
| | - Samuel Llobet
- Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - Sofia Cruz
- Hospital de Vila Franca de Xira, Estrada Carlos Lima Costa N°2, 2600-009 Vila Franca de Xira, Portugal
| | - Teresa Guimarães
- Unidade Local de Saúde do Nordeste, Avenida Abade de Baçal, 5301-852 Bragança, Portugal
| | - Tiago Branco
- Centro Hospitalar Universitário do Algarve, Rua Leão Penedo, 8000-386 Faro, Portugal
| | - Tomás Robalo-Nunes
- Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Vasco Almeida
- Centro Hospitalar Universitário de Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal
| | - Carla Maia
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal; (R.R.); (C.C.)
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
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