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J Travel Med. 2019 Dec 23;26(8). pii: taz055. doi: 10.1093/jtm/taz055.

Cutaneous and mucocutaneous leishmaniasis in travellers and migrants: a 20-year GeoSentinel Surveillance Network analysis.

Author information

1
Tropical Disease Unit, Division of Infectious Diseases, University Health Network-Toronto General Hospital, Toronto, Canada.
2
Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada.
3
Department of Medicine, University of Toronto, Toronto, Canada.
4
Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), 75013, Paris, France.
5
Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Academic Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
6
Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.
7
Centre de Recherches Médicales en Lambaréné (CERMEL), Lambaréné, Gabon.
8
Institute of Geographic Medicine and Tropical Diseases, Sheba Medical Center Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
9
School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
10
Bloomberg School Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
11
J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal Canada.
12
Department of Medicine, Weill Cornell Medical College, New York, USA.
13
Trillium Health Partners, Mississauga, Canada.
14
Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.
15
IHU-Méditerranée Infection, Marseille, France.
16
Clinical Parasitology Section, Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
17
Georgetown University, Washington, DC.
18
Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
19
Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
20
Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
21
Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
22
Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA.
23
SAR Laboratories, Sandra Rotman Centre for Global Health, Toronto, Canada.

Abstract

BACKGROUND:

Cutaneous leishmaniasis (CL) may be emerging among international travellers and migrants. Limited data exist on mucocutaneous leishmaniasis (MCL) in travellers. We describe the epidemiology of travel-associated CL and MCL among international travellers and immigrants over a 20-year period through descriptive analysis of GeoSentinel data.

METHODS:

Demographic and travel-related data on returned international travellers diagnosed with CL or MCL at a GeoSentinel Surveillance Network site between 1 September 1997 and 31 August 2017 were analysed.

RESULTS:

A total of 955 returned travellers or migrants were diagnosed with travel-acquired CL (n = 916) or MCL during the study period, of whom 10% (n = 97) were migrants. For the 858 non-migrant travellers, common source countries were Bolivia (n = 156, 18.2%) and Costa Rica (n = 97, 11.3%), while for migrants, they were Syria (n = 34, 35%) and Afghanistan (n = 22, 22.7%). A total of 99 travellers (10%) acquired their disease on trips of ≤ 2 weeks. Of 274 cases for which species identification was available, Leishmania Viannia braziliensis was the most well-represented strain (n = 117, 42.7%), followed by L. major (n = 40, 14.6%) and L. V. panamensis (n = 38, 13.9%). Forty cases of MCL occurred, most commonly in tourists (n = 29, 72.5%) and from Bolivia (n = 18, 45%). A total of 10% of MCL cases were acquired in the Old World.

CONCLUSIONS:

Among GeoSentinel reporting sites, CL is predominantly a disease of tourists travelling mostly to countries in Central and South America such as Bolivia where risk of acquiring L. V. braziliensis and subsequent MCL is high. The finding that some travellers acquired leishmaniasis on trips of short duration challenges the common notion that CL is a disease of prolonged travel. Migrants from areas of conflict and political instability, such as Afghanistan and Syria, were well represented, suggesting that as mass migration of refugees continues, CL will be increasingly encountered in intake countries.

KEYWORDS:

GeoSentinel; cutaneous leishmaniasis; mucosal leishmaniasis; skin lesions after travel; tegumentary leishmaniasis; vector-borne disease

PMID:
31553455
DOI:
10.1093/jtm/taz055

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