Imported leishmaniasis in Sweden 1993–2016

Abstract

In Sweden, leishmaniasis is an imported disease and its epidemiology and incidence were not known until now. We conducted a retrospective, nationwide, epidemiological study from 1993 to 2016. Probable cases were patients with leishmaniasis diagnoses reported to the Swedish Patient registry, collecting data on admitted patients in Swedish healthcare since 1993 and out-patient visits since 2001. Confirmed cases were those with a laboratory test positive for leishmaniasis during 1993-2016. 299 probable cases and 182 confirmed cases were identified. Annual incidence ranged from 0.023 to 0.35 per 100 000 with a rapid increase in the last 4 years. Of 182 laboratory-verified cases, 96 were diagnosed from 2013 to 2016, and in this group, almost half of the patients were children under 18 years. Patients presented in different healthcare settings in all regions of Sweden. Cutaneous leishmaniasis was the most common clinical manifestation and the majority of infections were acquired in Asia including the Middle East, specifically Syria and Afghanistan. Leishmania tropica was responsible for the majority of cases (42%). A combination of laboratory methods increased the sensitivity of diagnosis among confirmed cases. In 2016, one-tenth of the Swedish population were born in Leishmania-endemic countries and many Swedes travel to these countries for work or vacation. Swedish residents who have spent time in Leishmania-endemic areas, could be at risk of developing disease some time during their lives. Increased awareness and knowledge are needed for correct diagnosis and management of leishmaniasis in Sweden.

Prevalence of asymptomatic Leishmania infection and associated risk factors, after an outbreak in the south-western Madrid region, Spain, 2015

“…In recent years, the incidence of imported leishmaniasis has increased in non-endemic European countries, a consequence of increased travel and immigration from endemic regions [42-44], with over 50% of those infections acquired in either Spain or Greece. Indeed, it is known that several Swedish patients undergoing tumor necrosis factor (TNF)-α modulating therapy became infected with leishmaniasis while visiting Spain [45]. Physicians outside of Europe's Leishmania -endemic area should consider imported leishmaniasis when a patient's symptoms and travel history suggest this, especially if the patient is already being treated with immunosuppressants.…”

Sandfly surveillance and investigation of Leishmania spp. DNA in sandflies in Kosovo

“…Nevertheless, real-time PCR conducted on approximately 40% of randomly chosen females from both years of research detected the presence of L. tropica DNA. Regarding the impact of the increased migrant crisis in the past few years, and the increased number of documented L. tropica cases among native and migrant populations in Europe (Mockenhaupt et al, 2016;Söbirk et al, 2018), detection of L. tropica in sandflies from Kosovo is not so surprising. Although real-time PCR detected the presence of the L. tropica, the sequencing analysis of detected L. tropica DNA did not give conclusive result due to the weak PCR peak.…”

A cluster of intracellular parasitic infections among patients on biological DMARDs – the tip of the iceberg?

“…The touristic province of Alicante has previously been reported as a high-endemic spot for leishmaniasis, with an estimation of >50% prevalence of subclinical leishmaniasis in adults residing in the province [7]. Being a non-endemic country with <0.4 cases of imported leishmaniasis per 100 000 persons/year [8], leishmaniasis is rarely diagnosed in Sweden, and our patients were symptomatic for several months before receiving a final diagnosis. This led us to initiate a clinical investigation in which we tracked the ∼150 patients with ongoing biological treatment who had taken part in the Swedish programme for external rehabilitation at the unit since 2014.…”