1
|
Rocha R, Conceição C, Gonçalves L, Maia C. Epidemiological and clinical trends of visceral leishmaniasis in Portugal: retrospective analysis of cases diagnosed in public hospitals between 2010 and 2020. Infect Dis Poverty 2024; 13:41. [PMID: 38822396 PMCID: PMC11143621 DOI: 10.1186/s40249-024-01204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/06/2024] [Indexed: 06/03/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Rafael Rocha
- Institute of Hygiene and Tropical Medicine (IHMT), University Novaof Lisbon (UNL), Rua da Junqueira Nº100, Lisboa, 1349-008, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA- REAL, IHMT, UNL, Rua da Junqueira Nº100, Lisboa, 1349-008, Portugal
- University Hospital Center of São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Cláudia Conceição
- Institute of Hygiene and Tropical Medicine (IHMT), University Novaof Lisbon (UNL), Rua da Junqueira Nº100, Lisboa, 1349-008, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA- REAL, IHMT, UNL, Rua da Junqueira Nº100, Lisboa, 1349-008, Portugal
| | - Luzia Gonçalves
- Institute of Hygiene and Tropical Medicine (IHMT), University Novaof Lisbon (UNL), Rua da Junqueira Nº100, Lisboa, 1349-008, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA- REAL, IHMT, UNL, Rua da Junqueira Nº100, Lisboa, 1349-008, Portugal
- Faculty of Sciences, Centre of Statistics and its Application of the University of Lisbon, University of Lisbon, Campo Grande, Lisboa, 1749-016, Portugal
- , Z-Stat4life, Cowork Space Baldaya, Baldaya Palace, Estrada de Benfica Nº 701ª, Lisboa, 1549-011, Portugal
| | - Carla Maia
- Institute of Hygiene and Tropical Medicine (IHMT), University Novaof Lisbon (UNL), Rua da Junqueira Nº100, Lisboa, 1349-008, Portugal.
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA- REAL, IHMT, UNL, Rua da Junqueira Nº100, Lisboa, 1349-008, Portugal.
| |
Collapse
|
2
|
Fikre H, Teklehaimanot E, Mohammed R, Mengistu M, Abebe B, van Griensven J, van Henten S. Atypical Mucocutaneous Leishmaniasis Presentation Mimicking Rectal Cancer. Case Rep Infect Dis 2023; 2023:2768626. [PMID: 37096133 PMCID: PMC10122573 DOI: 10.1155/2023/2768626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/26/2023] Open
Abstract
Cutaneous leishmaniasis is a neglected tropical disease affecting mostly the exposed skin, causing severe and disfiguring lesions in Ethiopia. In this report, we present two cases of atypical mucocutaneous leishmaniasis; one HIV positive and one HIV negative patient. Cases. A 32-year-old male HIV patient presented with 40 days of bleeding per-rectum and a perianal lesion of 5 years. An erythematous nontender plaque measuring 5 cm by 5 cm was observed over the right perianal area with circumferential constricting firm swelling of the rectum. The patient was cured with AmBisome and miltefosine after an incisional biopsy revealed leishmaniasis. A 40-year-old presented with bleeding per-rectum and stool incontinence of 3 months, generalized body swelling of 2 months, and mass around his anus for ten years. A 6 by 3 cm indurated ulcerating mass surrounding the anus and a fungating circumferential mass of 8 cm were seen above the proximal anal verge. An excisional biopsy revealed leishmaniasis, and the patient was treated with AmBisome but passed away due to complications with colostomy diarrhea. Conclusion. Clinicians should consider atypical mucocutaneous leishmaniasis as a possible diagnosis in patients with chronic skin lesions resembling hemorrhoids and colorectal masses, especially in endemic areas such as Ethiopia, regardless of their HIV status.
Collapse
Affiliation(s)
- Helina Fikre
- University of Gondar, Leishmaniasis Research and Treatment Center, Gondar, Ethiopia
| | | | - Rezika Mohammed
- University of Gondar, Leishmaniasis Research and Treatment Center, Gondar, Ethiopia
| | - Miklol Mengistu
- University of Gondar, Department of Surgery, Gondar, Ethiopia
| | - Bewketu Abebe
- University of Gondar, Department of Pathology, Gondar, Ethiopia
| | | | | |
Collapse
|
3
|
Dos Santos AGA, da Silva MGL, Carneiro EL, de Lima LL, Fernandes ACBS, Silveira TGV, Sant'Ana DDMG, Nogueira-Melo GDA. A New Target Organ of Leishmania (Viannia) braziliensis Chronic Infection: The Intestine. Front Cell Infect Microbiol 2021; 11:687499. [PMID: 34336715 PMCID: PMC8317265 DOI: 10.3389/fcimb.2021.687499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/22/2021] [Indexed: 01/22/2023] Open
Abstract
Leishmania (Viannia) braziliensis is one of the main causes of cutaneous leishmaniasis in the Americas. This species presents genetic polymorphism that can cause destructive lesions in oral, nasal, and oropharyngeal tracts. In a previous study, the parasite caused several histopathological changes to hamster ileums. Our study evaluates immune response components, morphological changes, and effects on neurons in the ileums of hamsters infected by three different strains of L. (V.) braziliensis in two infection periods. For the experiment, we separated hamsters into four groups: a control group and three infected groups. Infected hamsters were euthanized 90- or 120-days post infection. We used three strains of L. (V.) braziliensis: the reference MHOM/BR/1975/M2903 and two strains isolated from patients who had different responses to Glucantime® treatment (MHOM/BR/2003/2314 and MHOM/BR/2000/1655). After laparotomy, ileums were collected for histological processing, biochemical analysis, and evaluation of neurons in the myenteric and submucosal plexuses of the enteric nervous system (ENS). The results demonstrated the increase of blood leukocytes after the infection. Optical microscopy analysis showed histopathological changes with inflammatory infiltrates, edemas, ganglionitis, and Leishmania amastigotes in the ileums of infected hamsters. We observed changes in the organ histoarchitecture of infected hamsters when compared to control groups, such as thicker muscular and submucosa layers, deeper and wider crypts, and taller and broader villi. The number of intraepithelial lymphocytes and TGF-β-immunoreactive cells increased in all infected groups when compared to the control groups. Mast cells increased with longer infection periods. The infection also caused remodeling of intestinal collagen and morphometry of myenteric and submucosal plexus neurons; but this effect was dependent on infection duration. Our results show that L. (V.) braziliensis infection caused time-dependent alterations in hamster ileums. This was demonstrated by the reduction of inflammatory cells and the increase of tissue regeneration factors at 120 days of infection. The infected groups demonstrated different profiles in organ histoarchitecture, migration of immune cells, and morphometry of ENS neurons. These findings suggest that the small intestine (or at least the ileum) is a target organ for L. (V.) braziliensis infection, as the infection caused changes that were dependent on duration and strain.
Collapse
Affiliation(s)
| | | | - Erick Lincoln Carneiro
- Department of Clinical Analysis and Biomedicine, Universidade Estadual de Maringá, Maringá, Brazil
| | - Lainy Leiny de Lima
- Department of Morphological Sciences, Universidade Estadual de Maringá, Maringá, Brazil
| | | | | | - Debora de Mello Gonçales Sant'Ana
- Biosciences and Physiopathology Program, Universidade Estadual de Maringá, Maringá, Brazil.,Department of Morphological Sciences, Universidade Estadual de Maringá, Maringá, Brazil
| | - Gessilda de Alcantara Nogueira-Melo
- Biosciences and Physiopathology Program, Universidade Estadual de Maringá, Maringá, Brazil.,Department of Clinical Analysis and Biomedicine, Universidade Estadual de Maringá, Maringá, Brazil
| |
Collapse
|