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Article

Epidemiological and Clinical Aspects of Cutaneous and Mucosal Leishmaniases in Portugal: Retrospective Analysis of Cases Diagnosed in Public Hospitals and Reported in the Literature between 2010 and 2020

by
Rafael Rocha
1,2,3,
Cláudia Conceição
1,2,
Luzia Gonçalves
1,2,4,5,
Ana Cláudia Carvalho
6,
André Maia
7,
André Martins
8,
António Carujo
9,
António Maio
10,
Catarina Forra
11,
Catarina Melita
12,
Daniela Couto
13,
Diana Fernandes
14,
Dulce Pereira
15,
Ema Leal
16,
Helena Sarmento
8,
Inês Sousa
17,
Jean-Pierre Gonçalves
18,
Joana Marinho
19,
Joana Vasconcelos
20,
João Cunha
21,
João Rodrigues
22,
José Miguel Silva
23,
Lídia Caley
24,
Luís Malheiro
25,
Luís Santos
16,
Margarida Garcia
16,
Maria Cunha
17,26,
Maria Lima
27,
Maria Margarida Andrade
28,
Marta Marques
15,
Miguel Alpalhão
17,
Mónica Silva
29,
Rita Ferraz
30,
Rui Soares
31,
Salomão Fernandes
32,
Samuel Llobet
17,
Sofia Cruz
33,
Teresa Guimarães
34,
Tiago Branco
35,
Tomás Robalo-Nunes
36,
Vasco Almeida
16 and
Carla Maia
1,2,*add Show full author list remove Hide full author list
1
Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
2
Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
3
Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
4
Centro de Estatística e Aplicações da Universidade de Lisboa, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal
5
Z-Stat4life, Espaço Cowork Baldaya, Palácio Baldaya, Estrada de Benfica N° 701ª, 1549-011 Lisboa, Portugal
6
Hospital de Braga, Sete Fontes—São Victor, 4710-243 Braga, Portugal
7
Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida da Noruega, 5000-508 Vila Real, Portugal
8
Hospital da Senhora da Oliveira Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal
9
Centro Hospitalar Universitário de Santo António, Rua Prof. Vicente José de Carvalho N° 37, 4050-366 Porto, Portugal
10
Centro Hospitalar do Baixo Vouga, Av. Artur Ravara, 3810-501 Aveiro, Portugal
11
Unidade Local de Saúde de Castelo Branco, Avenida Pedro Álvares Cabral, 6000-085 Castelo Branco, Portugal
12
Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
13
Centro Hospitalar Universitário Cova da Beira, Alameda Pêro da Covilhã, 6200-251 Covilhã, Portugal
14
Centro Hospitalar de Leiria, Rua das Olhalvas, 2410-197 Leiria, Portugal
15
Centro Hospitalar Tondela-Viseu, Avenida Rei D. Duarte, 3504-509 Viseu, Portugal
16
Centro Hospitalar Universitário de Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal
17
Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
18
Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal
19
Centro Hospitalar Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
20
Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira N° 126, 1349-019 Lisboa, Portugal
21
Hospital Distrital de Santarém, Avenida Bernardo Santareno, 2005-177 Santarém, Portugal
22
Unidade Local de Saúde da Guarda, Avenida Rainha Dona Amélia, 6300-858 Guarda, Portugal
23
Unidade Local de Saúde do Norte Alentejano, Avenida de Santo António, Apartado 234, 7301-853 Portalegre, Portugal
24
Centro Hospitalar do Médio Tejo, Avenida Maria de Lourdes de Mello Castro, Ap. 118, 2304-909 Tomar, Portugal
25
Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal
26
Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
27
Centro Hospitalar de Setúbal, Rua Camilo Castelo Branco, Apartado 140, 2910-446 Setúbal, Portugal
28
Hospital de Cascais Dr. José de Almeida, Avenida Brigadeiro Victor Novais Gonçalves, 2755-009 Alcabideche, Portugal
29
Centro Hospitalar Barreiro Montijo, Avenida Movimento das Forças Armadas, 2834-003 Barreiro, Portugal
30
Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo, N° 210, Guilhufe, 4560-136 Penafiel, Portugal
31
Instituto Português de Oncologia de Coimbra Francisco Gentil, Avenida Bissaya Barreto N° 98, 3000-075 Coimbra, Portugal
32
Hospital Beatriz Ângelo, Avenida Carlos Teixeira, N° 3, 2674-514 Loures, Portugal
33
Hospital de Vila Franca de Xira, Estrada Carlos Lima Costa N°2, 2600-009 Vila Franca de Xira, Portugal
34
Unidade Local de Saúde do Nordeste, Avenida Abade de Baçal, 5301-852 Bragança, Portugal
35
Centro Hospitalar Universitário do Algarve, Rua Leão Penedo, 8000-386 Faro, Portugal
36
Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal
 
add Show full affiliation list
 
remove Hide full affiliation list
*
Author to whom correspondence should be addressed.
Microorganisms 2024, 12(4), 819; https://doi.org/10.3390/microorganisms12040819
Submission received: 28 March 2024 / Revised: 14 April 2024 / Accepted: 15 April 2024 / Published: 18 April 2024
(This article belongs to the Section Parasitology)
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Abstract

Leishmania infantum, a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM® SPSS® Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond.
Keywords: Leishmania; leishmaniasis; cutaneous; mucosal; Portugal; 2010–2020 Leishmania; leishmaniasis; cutaneous; mucosal; Portugal; 2010–2020

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MDPI and ACS Style

Rocha, R.; Conceição, C.; Gonçalves, L.; Carvalho, A.C.; Maia, A.; Martins, A.; Carujo, A.; Maio, A.; Forra, C.; Melita, C.; et al. Epidemiological and Clinical Aspects of Cutaneous and Mucosal Leishmaniases in Portugal: Retrospective Analysis of Cases Diagnosed in Public Hospitals and Reported in the Literature between 2010 and 2020. Microorganisms 2024, 12, 819. https://doi.org/10.3390/microorganisms12040819

AMA Style

Rocha R, Conceição C, Gonçalves L, Carvalho AC, Maia A, Martins A, Carujo A, Maio A, Forra C, Melita C, et al. Epidemiological and Clinical Aspects of Cutaneous and Mucosal Leishmaniases in Portugal: Retrospective Analysis of Cases Diagnosed in Public Hospitals and Reported in the Literature between 2010 and 2020. Microorganisms. 2024; 12(4):819. https://doi.org/10.3390/microorganisms12040819

Chicago/Turabian Style

Rocha, Rafael, Cláudia Conceição, Luzia Gonçalves, Ana Cláudia Carvalho, André Maia, André Martins, António Carujo, António Maio, Catarina Forra, Catarina Melita, and et al. 2024. "Epidemiological and Clinical Aspects of Cutaneous and Mucosal Leishmaniases in Portugal: Retrospective Analysis of Cases Diagnosed in Public Hospitals and Reported in the Literature between 2010 and 2020" Microorganisms 12, no. 4: 819. https://doi.org/10.3390/microorganisms12040819

APA Style

Rocha, R., Conceição, C., Gonçalves, L., Carvalho, A. C., Maia, A., Martins, A., Carujo, A., Maio, A., Forra, C., Melita, C., Couto, D., Fernandes, D., Pereira, D., Leal, E., Sarmento, H., Sousa, I., Gonçalves, J.-P., Marinho, J., Vasconcelos, J., ... Maia, C. (2024). Epidemiological and Clinical Aspects of Cutaneous and Mucosal Leishmaniases in Portugal: Retrospective Analysis of Cases Diagnosed in Public Hospitals and Reported in the Literature between 2010 and 2020. Microorganisms, 12(4), 819. https://doi.org/10.3390/microorganisms12040819

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