[Leish-l] LEISHMANIASIS, CUTANEOUS - AUSTRIA: ex MALTA

Wed Apr 18 19:23:14 BRT 2018

 LEISHMANIASIS, CUTANEOUS - AUSTRIA: ex MALTA
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Date: Mon 13 Mar 2018
From: Christian Lenart <christian at lenart.at> [edited]

We report a case of _Leishmania donovani_/_L. infantum_ in a
56-year-old man from Austria. He travelled to Malta in June 2017 and
complained about itchy, partly exulcerated papules in November 2017.
His wife too was suffering from the same lesions but did not consult a
dermatologist, since the lesions regressed spontaneously.

The patient first contacted a dermatologist, who performed an excision
showing _Leishmania_ negative granulomatous inflammation as a
histological result. He was then referred to the dermatological ward
of the municipal hospital.

The lesions were up to 2 cm [0.8 in] in size, disseminated on all
extremities. Another excision was performed, showing plenty of
amastigotes affected macrophages. He then was checked for signs of
visceral manifestation, but showed no hepatosplenomegaly.

The blood sample showed no conspicuity with normal hematological
results and normal CRP [C-reactive protein]. The PCR test for
_Leishmania_ sp. DNA was positive. The Western blot (IgG) was positive
as well, whilst immunoaffinity chromatography was negative. Skin
biopsy genotyping proved a diagnosis of _Leishmania
infantum_/_L.donovani_.
Since the patient had multiple lesions treatment with miltefosine was
initiated.

Leishmania in Malta
-------------------
While especially leishmaniasis was quite common in the early 20th
century in Malta, there were hardly any cases of cutaneous
leishmaniasis at the end of the century. For the last years the
incidence has been stable with about 3 to 4 cases of visceral
leishmaniasis, VL, per year (1).
In 2012, 3 VL and no CL cases were reported (2). All cases of
leishmaniasis are caused by _L. infantum_ in Malta, transmitted from
dogs to humans by _Phlebotomus perniciosus_. The 2 identified
zymodemes in Malta are MON 1, causing visceral and MON 78, causing
cutaneous leishmaniasis (3).

References
----------
1. Alvar J, Vélez ID, Bern C, et al and the WHO Leishmaniasis Control
Team. Leishmaniasis worldwide and global estimates of its incidence.
PLoS One. 2012; 7(5): e35671. doi: 10.1371/journal.pone.0035671;
available at
<http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0035671
<https://nam02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fjournals.plos.org%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0035671&data=02%7C01%7C%7C0c8f3ec2cb9c4951d24308d5a46fef9f%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636595723018627528&sdata=GW5O9RyUiSbaFZFly472WCDb7PajpzAQ3zqw%2FX17YEQ%3D&reserved=0>
>.
2. Government of Malta, Ministry for Health, the Elderly and Community
Care: Annual report 2012; p. 46; available at
<https://www.gov.mt/en/Government/Publications/Documents/
Annual%20Reports/MHEC.pdf
<https://nam02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.gov.mt%2Fen%2FGovernment%2FPublications%2FDocuments%2FAnnual%2520Reports%2FMHEC.pdf&data=02%7C01%7C%7C0c8f3ec2cb9c4951d24308d5a46fef9f%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636595723018627528&sdata=dv%2Fq321dnCPDCfcG0cG1SSLmm3fyQzMP8WyMIFcrbm0%3D&reserved=0>
>.
3. Pace D, Williams TN, Grochowska A, et al. Manifestations of
paediatric _Leishmania infantum_ infections in Malta. Travel Med
Infect Dis. 2011; 9(1):37-46. doi: 10.1016/j.tmaid.2010.11.005;
available at
<http://www.travelmedicinejournal.com/article/S1477-8939(10)00196-1/fulltext
<https://nam02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.travelmedicinejournal.com%2Farticle%2FS1477-8939(10)00196-1%2Ffulltext&data=02%7C01%7C%7C0c8f3ec2cb9c4951d24308d5a46fef9f%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636595723018627528&sdata=ivNyZwnaTeJWiHF4x66CEE14GVDd14%2Ftkn5hUiwSTfI%3D&reserved=0>
>.

--
Dr Christian Lenart
Department of Emergency Medicine
Krankenhaus Hietzing (Municipal Hospital Vienna-Hietzing)
Austria
<christian at lenart.at>

[Leishmaniasis is endemic in Malta and cases imported from Malta to
other countries are not unusual. _Leishmania infantum_ usually results
in visceral leishmaniasis and the genotyping in this case could not
distinguish between _L. donovani_/_L. infantum_. Miltefosine is the
drug of choice for cutaneous leishmaniasis. - Mod.EP

HealthMap/ProMED-mail maps:
Austria: <http://healthmap.org/promed/p/63886
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Malta: <http://healthmap.org/promed/p/77
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>]

.................................................ep/mj/dk
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