Ab1280 prevalence of Leishmaniasis in a Sample of Patients Treated With Biologic Therapies

Abstract

BackgroundLeishmaniasis is an infectious disease caused by an intracellular parasite of the genus Leishmania. According to the clinical expression, it can be identified: subclinical, cutaneous (CL) and visceral leishmaniasis (VL). The immune response triggered in this type of infections is based in the activation of the TH1 pathway, in which molecules such as TNF α and interleukins such as IL 12 and IL1 are involved [1,2]. In recent years, an increase in the incidence of opportunistic infectious diseases, such as leishmaniasis, has been observed in patients with rheumatological diseases under treatment with anti-TNFα drugs, such as Psoriatic Arthritis (PsA), Ankylosing Spondylitis (AS) or Rheumatoid Arthritis (RA) [1,3,4].ObjectivesEvaluate the prevalence of Leishmaniasis in a sample of patients in a hospital center in treatment with biologic therapies. As secondary objective, study the characteristics of the patients with Leishmania.MethodsIt can been carried out an observational, descriptive, retrospective, and single-center study. The sample consisted of patients followed in a rheumatology department between January 1, 2022 and January 1, 2023, whose only inclusion criteria was to be in treatment with biologic therapies, including a total of 720 subjects, and, only five patients were found with de diagnosis of leishmaniasis.ResultsFive patients were found diagnosed with leishmaniasis in the 720 subjects on biological treatment included in the sample, which represents a prevalence of 0.69%. Three patients were male (60%) and two were female (30%). The mean age was 52.164 ± 10.38 years with a mean duration of rheumatic disease of 13.2 ± 7.8 years. All the subjets were diagnosed with spondyloarthritis: 3 with AS (60%), 1 with PsA (20%) and another with spondyloarthritis associated with inflammatory instetinal disease (20%). About the forms of leishmaniasis, four subjects were diagnosed with CL (80%) and only one patient was diagnosed with LV (20%). The 100% of the patients diagnosed with LC were on treatment or had been on treatment before with an antiTNFα (75% with adalimumab and 25% with infliximab). The only case diagnosed with LV, was in treatment with an anti-IL 17, although the patient had been on adalimumab up to 3 months prior to diagnosis. It can be stated that 100% of the patients diagnosed with leishmaniasis had received treatment with an anti-TNFα, with a mean duration of the treatment of 6.94 ± 4.7 years.Table 1.Subjects diagnosed with leishmaniasis included in the study.Gender/AgeDiseaseCurrent biologicalCL/VLLocalizationM43ASADALIMUMABLCthighM48SpondyloarthritisADALIMUMABLCelbowsM62ASINFLIXIMABLCelbowW40PsASECUKINUMABLVW66ASADALIMUMABLCelbowFigure 1.Biological treatment administered at the time of diagnosis of leishmaniasis.ConclusionIn the present study, 100% of the subjects suffering from Leishmaniasis were on treatment with an anti-TNF α molecule, being adalimumab the most frequent, which coincides with other case series published in the literature.References[1]Bosch-Nicolau P, Ubals M, Salvador F, Sánchez-Montalvá A, Aparicio G, Erra A, Martínez de Salazar P, Sulleiro E, Molina I. Leishmaniasis and tumor necrosis factor-alpha antagonists in the Mediterranean basin. A change in clinical expression. PLoS Negl Trop Dis. 2019 Aug 30;13(8):e0007708[2]Kurizky PS, Marianelli FF, Cesetti MV, Damiani G, Sampaio RNR, Gonçalves LMT, Sousa CAF, Martins SS, Vernal S, Mota LMHD, Gomes CM. A comprehensive systematic review of leishmaniasis in patients undergoing drug-induced immunosuppression for the treatment of dermatological, rheumatological and gastroenterological diseases. Rev Inst Med Trop Sao Paulo. 2020;62:e28.[3]Sánchez-Rodríguez G, Puig L. Skin. Formación Continuada en Dermatología, 2022-06-01, Volume 37, Number 6, Pages 356-360.[4]Plachouri KM, Gkermpesi M, Vryzaki E, Kollyrou P, Marangos M, Georgiou S. A rare infectious complication of treatment with biologics: adalimumab-associated disseminated cutaneous leishmaniasis. Dermatol Pract Concept. 2020 Jun 29;10(3):e2020061.Acknowledgements:NIL.Disclosure of InterestsNone Declared.