Necker-Pasteur Infectiology Centre, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France.
Confluent Private Hospital, Nantes, France.
PLoS Negl Trop Dis. 2021 Oct 13;15(10):e0009863. doi: 10.1371/journal.pntd.0009863. eCollection 2021 Oct.
Cutaneous leishmaniasis (CL) is frequent in travellers and can involve oro-nasal mucosae. Clinical presentation impacts therapeutic management.
Demographic and clinical data from 459 travellers infected in 47 different countries were collected by members of the European LeishMan consortium. The infecting Leishmania species was identified in 198 patients.
Compared to Old World CL, New World CL was more frequently ulcerative (75% vs 47%), larger (3 vs 2cm), less frequently facial (17% vs 38%) and less frequently associated with mucosal involvement (2.7% vs 5.3%). Patients with mucosal lesions were older (58 vs 30 years) and more frequently immunocompromised (37% vs 3.5%) compared to patients with only skin lesions. Young adults infected in Latin America with L. braziliensis or L. guyanensis complex typically had an ulcer of the lower limbs with mucosal involvement in 5.8% of cases. Typically, infections with L. major and L. tropica acquired in Africa or the Middle East were not associated with mucosal lesions, while infections with L. infantum, acquired in Southern Europe resulted in slowly evolving facial lesions with mucosal involvement in 22% of cases. Local or systemic treatments were used in patients with different clinical presentations but resulted in similarly high cure rates (89% vs 86%).
CONCLUSION/SIGNIFICANCE: CL acquired in L. infantum-endemic European and Mediterranean areas displays unexpected high rates of mucosal involvement comparable to those of CL acquired in Latin America, especially in immunocompromised patients. When used as per recommendations, local therapy is associated with high cure rates.
皮肤利什曼病（CL）在旅行者中很常见，可累及口腔和鼻腔黏膜。临床表现影响治疗管理。
欧洲利什曼虫病联盟成员收集了来自 47 个不同国家的 459 名旅行者的人口统计学和临床数据。在 198 名患者中鉴定了感染的利什曼原虫种。
与旧世界 CL 相比，新世界 CL 更常为溃疡性（75% vs 47%）、更大（3 厘米 vs 2 厘米）、较少发生于面部（17% vs 38%）、较少发生黏膜受累（2.7% vs 5.3%）。有黏膜病变的患者年龄较大（58 岁 vs 30 岁）且免疫功能受损的情况更常见（37% vs 3.5%）。与仅有皮肤病变的患者相比，在拉丁美洲感染 L. braziliensis 或 L. guyanensis 复合物的年轻成年人下肢溃疡有 5.8%的情况下伴有黏膜受累。通常，在非洲或中东感染的 L. major 和 L. tropica 不伴有黏膜病变，而在南欧感染的 L. infantum 则导致黏膜受累的面部病变缓慢进展，在 22%的病例中出现这种情况。不同临床表现的患者使用局部或全身治疗，但治愈率相似（89% vs 86%）。
结论/意义：在 L. infantum 流行的欧洲和地中海地区获得的 CL 显示出出人意料的高黏膜受累率，与在拉丁美洲获得的 CL 相当，尤其是在免疫功能受损的患者中。当按照建议使用时，局部治疗与高治愈率相关。
