Journal Article

Imported leishmaniasis in travelers: a 7-year retrospective from a Parisian hospital in France

Bagot, Martine, Denis, Blandine, Gits-Muselli, Maud, Aissaoui, Nesrine, Hamane, Samia, Petit, Antoine, Bretagne, Stéphane, Benderdouche, Mazouz, Alanio, Alexandre, Dellière, Sarah

2021

Overview

Background Leishmaniases are regularly seen in non-endemic areas due to the increase of international travels. They include cutaneous leishmaniases (CL) and mucocutaneous (MC) caused by different Leishmania species, and visceral leishmaniases (VL) which present with non-specific symptoms. Methods We reviewed all consecutive leishmaniasis cases seen between September 2012 and May 2020. The diagnostic strategy included microscopy after May-Grünwald-Giemsa staining, a diagnostic quantitative PCR (qPCR) assay, and species identification based on sequencing of the cytochrome b gene. Results Eighty-nine patients had a definitive leishmaniasis diagnosis. Nine patients had VL with Leishmania infantum . Eighty patients had CL. Twelve patients acquired CL after trips in Latin America (7 Leishmania guyanensis , 2 Leishmania braziliensis , 2 Leishmania mexicana , and 1 Leishmania panamensis ). Species could be identified in 63 of the 68 CLs mainly after travel in North Africa (59%) with Leishmania major (65%), Leishmania tropica/killicki (24%), and L. infantum (11%), or in West Sub-Saharan Africa (32%), all due to L. major . The median day between appearance of the lesions and diagnosis was 90 [range 60–127]. Conclusions Our diagnostic strategy allows both positive diagnoses and species identifications. Travelers in West Sub-Saharan Africa and North Africa should be better aware of the risk of contracting leishmananiasis. Highlights Imported leishmaniases are regularly seen in non-endemic areas. Cutaneous forms are due to different species that need to be correctly identified for adapting treatment and epidemiologic purposes. The index of suspicion for the visceral form is often low because of the non-specificity of the clinical symptoms and the notion of travel in endemic areas often remote. The strategy, based on diagnostic quantitative PCR followed by sequencing for species identification, allows for rapid and safe diagnoses in a routine laboratory.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Biopsy / Cutaneous leishmaniasis / Cytochrome b / Cytochrome b sequencing / Cytochromes / Diagnosis / Diagnostic systems / Diseases / Identification / Infectious Diseases / Internal Medicine / Laboratories / Leishmania major / Leishmania tropica / Leishmaniasis / Length of stay / Life Sciences / Lymphoma / Medical Microbiology / Medicine / Medicine & Public Health / Microscopy / Parasitic diseases / Parasitology / Patients / Quantitative PCR / Risk factors / Species / Statistics / Strategy / Travelers / Tropical Medicine / Vector-borne diseases / Visceral leishmaniasis