Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que.
CMAJ Open. 2022 Jun 21;10(2):E546-E553. doi: 10.9778/cmajo.20210238. Print 2022 Apr-Jun.
Cutaneous leishmaniasis is increasingly encountered in returned travellers and migrants to nonendemic countries. We sought to describe the clinical characteristics and treatment outcomes of cases of cutaneous leishmaniasis diagnosed at our reference centre over a 10-year period.
This case series included all laboratory-confirmed cases of cutaneous leishmaniasis in travellers and migrants for whom complete clinical data were available, diagnosed between January 2008 and October 2018 at the J.D. MacLean Centre for Tropical Diseases in Montréal. We examined the number of cases each year. We used descriptive statistics to summarize variables (e.g., demographic characteristics, travel history, clinical presentation, diagnostic methods, treatments, adverse events) extracted from the patients' electronic medical records. The primary outcome for evaluating clinical response to treatment was defined as the complete re-epithelialization of the wound surface at 1 year.
We identified 48 patients who received diagnoses of cutaneous leishmaniasis in the 10-year study period, including 33 exposed in the Americas and 15 exposed in other regions (median age 43.5 [range 1-75] yr); 28 [58%] males). The annual number of cases increased from 9 in 2008/09 to 16 in 2017/18. The median time from onset to diagnosis was 89 (IQR 58-134) days. Liposomal amphotericin B was the most commonly used initial treatment (20 [53%] patients). Thirty-five patients completed their follow-up, and 11 had successful response to 1 course of liposomal amphotericin B. Adverse events (including acute kidney injury, increased pancreatic enzymes and fatigue) were reported in 6 (30%) patients. Clinical cure was achieved within 1 year for 32 (91%) of the 35 patients who completed follow-up.
This study showed an increase in the number of cases of cutaneous leishmaniasis seen in our centre over the study period, likely because of increased travel and migration. This diagnosis should be considered in travellers and migrants with a chronic cutaneous lesion.
在非流行地区的旅行者和移民中，皮肤利什曼病的发病率不断上升。我们旨在描述我们的参考中心在 10 年期间诊断出的皮肤利什曼病病例的临床特征和治疗结果。
本病例系列包括在 2008 年 1 月至 2018 年 10 月期间，在蒙特利尔 J.D.麦克莱恩热带病中心，通过实验室确诊的所有旅行者和移民中的皮肤利什曼病病例，这些旅行者和移民有完整的临床数据。我们每年检查病例数量。我们使用描述性统计数据来总结从患者的电子病历中提取的变量（例如，人口统计学特征、旅行史、临床表现、诊断方法、治疗、不良事件）。评估治疗临床反应的主要结果定义为 1 年内伤口表面完全上皮化。
我们在 10 年的研究期间确定了 48 例皮肤利什曼病患者，其中 33 例患者在美洲暴露，15 例患者在其他地区暴露（中位数年龄 43.5 [范围 1-75] 岁；28 [58%] 为男性）。病例数量从 2008/09 年的 9 例增加到 2017/18 年的 16 例。从发病到诊断的中位数时间为 89（IQR 58-134）天。两性霉素 B 脂质体是最常用的初始治疗药物（20 [53%] 例患者）。35 例患者完成了随访，11 例患者接受了两性霉素 B 脂质体 1 疗程治疗后反应良好。6（30%）例患者出现不良事件（包括急性肾损伤、胰腺酶升高和疲劳）。完成随访的 35 例患者中，有 32 例（91%）在 1 年内达到临床治愈。
本研究显示，在研究期间，我们中心所见的皮肤利什曼病病例数量有所增加，这可能是由于旅行和移民的增加。对于慢性皮肤病变的旅行者和移民，应考虑该诊断。
