Re-emergence of leishmaniasis in Spain: community outbreak in Madrid, Spain, 2009 to 2012

Abstract

Since July 2009, there has been a community outbreak of leishmaniasis in the south-west area of the Madrid autonomous community, Spain, affecting residents from four towns that are geographically close together and share extensive park areas. As of December 2012, 446 cases were reported (6 in 2009, 97 in 2010, 196 in 2011 and 147 in 2012), a mean incidence rate of 22.2 per 100,000 inhabitants during July 2009 and December 2012. The mean age was 44 years (range: 2 months to 95 years); 61.0% were male. A total of 68 (15.2%) had immunosuppressive conditions; 160 (35.9%) had visceral leishmaniasis and 286 (64.1%) cutaneous. A total of 421 (94.4%) cases were confirmed. Leishmania infantum was identified as the agent. Monitoring revealed high densities of the vector Phlebotomus perniciosus. The surveillance system for canine leishmaniasis did not detect any increase in prevalence during the period. Environmental control measures have been taken, such as improvements in sanitation and disinsection in the risk areas and control of the overpopulation of Leporidae, as xenodiagnosis studies have shown that hares play a role as active reservoirs. This is the largest reported community outbreak of leishmaniasis in Europe. The discovery of the new reservoir stands out in the multifactorial aetiology of the outbreak. Epidemiological research and environmental intervention measures are continuing.

Epidemiological Changes in Leishmaniasis in Spain According to Hospitalization-Based Records, 1997–2011: Raising Awareness towards Leishmaniasis in Non-HIV Patients

“…3), we can observe that this increasing trend occurs mainly at the expense of the community of Madrid, where one of the most important Leishmaniasis outbreaks in Europe, starting from 2010, has taken place. According to Arce et al ., in this outbreak, only 4% of all leishmaniasis cases were coinfected with HIV [19]. The risk of Leishmania onset for HIV infected persons during a Leishmania outbreak is unclear and must probably depend on the HIV-status and adherence treatment.…”

Visceral Leishmaniasis and HIV Coinfection in the Mediterranean Region

“…Moreover, in an ongoing outbreak in southwest Madrid, a region with around 500,000 inhabitants, an incidence of 22.2 cases per 100,000 habitants was found, with 286 cutaneous leishmaniasis cases and 160 (35.9%) VL cases. Among the latter, 16 (10%) were VL/HIV-coinfected patients and 20 (12.5%) had other types of immunosuppression [28].…”

Recent updates and perspectives on leishmaniasis

“…Autochthonous transmission has been reported in Portugal, Spain, France, Italy, Greece, Malta, Cyprus, Croatia, Albania, Bulgaria, and Turkey. Most are sporadic endemic diseases, but recent outbreaks of leishmaniasis have occurred in Spain and Italy [8,9]. A recent case described by de Silva et al [10] emphasizes the importance of a differential diagnosis in the presence of compatible skin lesions following foreign travel.…”