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Clinical diversity and treatment results in tegumentary leishmaniasis : A European clinical report in 459 patients

Guery, Romain ; Walker, Stephen L. ; Harms, Gundel ; Neumayr, Andreas ; Van Thiel, Pieter ; Gangneux, Jean Pierre ; Clerinx, Jan ; Söbirk, Sara Karlsson LU orcid ; Visser, Leo and Lachaud, Laurence , et al. (2021) In PLoS Neglected Tropical Diseases 15(10).
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... (More)

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.

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publishing date
type
Contribution to journal
publication status
published
subject
in
PLoS Neglected Tropical Diseases
volume
15
issue
10
article number
e0009863
publisher
Public Library of Science (PLoS)
external identifiers
  • pmid:34644288
  • scopus:85118937110
ISSN
1935-2727
DOI
10.1371/journal.pntd.0009863
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2021 Guery et al.
id
8afb3a61-f23c-475c-840f-61c9296bc750
date added to LUP
2022-01-21 17:09:52
date last changed
2024-04-06 16:52:21
@article{8afb3a61-f23c-475c-840f-61c9296bc750,
  abstract     = {{<p>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.</p>}},
  author       = {{Guery, Romain and Walker, Stephen L. and Harms, Gundel and Neumayr, Andreas and Van Thiel, Pieter and Gangneux, Jean Pierre and Clerinx, Jan and Söbirk, Sara Karlsson and Visser, Leo and Lachaud, Laurence and Bailey, Mark and Bart, Aldert and Ravel, Christophe and Van der Auwera, Gert and Blum, Johannes and Lockwood, Diana N. and Buffet, Pierre}},
  issn         = {{1935-2727}},
  language     = {{eng}},
  number       = {{10}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLoS Neglected Tropical Diseases}},
  title        = {{Clinical diversity and treatment results in tegumentary leishmaniasis : A European clinical report in 459 patients}},
  url          = {{http://dx.doi.org/10.1371/journal.pntd.0009863}},
  doi          = {{10.1371/journal.pntd.0009863}},
  volume       = {{15}},
  year         = {{2021}},
}