Barbiero Anna, Spinicci Michele, Aiello Andrea, Maruotto Martina, Antonello Roberta Maria, Formica Giuseppe, Piccica Matteo, Isola Patrizia, Parisio Eva Maria, Nardone Maria, Valentini Silvia, Mangano Valentina, Brunelli Tamara, Bianchi Loria, Bartalesi Filippo, Costa Cecilia, Sambo Margherita, Tumbarello Mario, Sani Spartaco, Fabiani Silvia, Rossetti Barbara, Nencioni Cesira, Lanari Alessandro, Aquilini Donatella, Montorzi Giulia, Venturini Elisabetta, Galli Luisa, Rinninella Giada, Falcone Marco, Ceriegi Federica, Amadori Francesco, Vincenti Antonella, Blanc Pierluigi, Vellere Iacopo, Tacconi Danilo, Luchi Sauro, Moneta Sara, Massi Daniela, Brogi Michela, Voller Fabio, Gemmi Fabrizio, Rossolini Gian Maria, Cusi Maria Grazia, Bruschi Fabrizio, Bartoloni Alessandro, Zammarchi Lorenzo
Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy.
Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy.
Microorganisms. 2024 Sep 27;12(10):1963. doi: 10.3390/microorganisms12101963.
Human leishmaniasis is facing important epidemiological changes in Southern Europe, driven by increased urbanization, climate changes, emerging of new animal reservoirs, shifts in human behavior and a growing population of immunocompromised and elderly individuals. In this evolving epidemiological landscape, we analyzed the clinical and epidemiological characteristics of human leishmaniasis in the Tuscany region of Central Italy. Through a multicentric retrospective analysis, we collected clinical and demographic data about all cases of leishmaniasis recorded between 2018 and 2023. We observed 176 cases of human leishmaniasis, with 128 (72.7%) visceral leishmaniasis (VL) and 47 (26.7%) cutaneous leishmaniasis (CL). Among these, 92.2% of VL and 85.1% of CL cases were autochthonous. The cumulative incidence of autochthonous human leishmaniasis was 0.22 cases per 100,000 inhabitants in 2018, but reached 1.81/100,000 in 2023. We identified three main areas of transmission: around the city of Florence (North-East Tuscany), around Grosseto city (South-West Tuscany) and Elba Island. Our findings confirm that the epidemiology of leishmaniasis is undergoing significant changes in Central Italy. Awareness towards this emerging health threat and surveillance strategies need to be improved in order to reliably assess the disease's burden. Further research is needed in a "One-Health" perspective, to clarify the epidemiological dynamics at the environmental, reservoir, vector and human levels. The role of climate change and specific climatic factors affecting the epidemiological patterns of human leishmaniasis should be assessed. Further knowledge in these fields would promote targeted control and prevention strategies at regional and national levels.
在城市化进程加快、气候变化、新动物宿主出现、人类行为改变以及免疫功能低下和老年人口不断增加的推动下，欧洲南部的人类利什曼病正面临着重要的流行病学变化。在这一不断演变的流行病学格局中，我们分析了意大利中部托斯卡纳地区人类利什曼病的临床和流行病学特征。通过多中心回顾性分析，我们收集了2018年至2023年期间记录的所有利什曼病病例的临床和人口统计学数据。我们观察到176例人类利什曼病病例，其中128例（72.7%）为内脏利什曼病（VL），47例（26.7%）为皮肤利什曼病（CL）。其中，92.2%的VL病例和85.1%的CL病例为本地感染。2018年本地感染人类利什曼病的累积发病率为每10万居民0.22例，但在2023年达到了1.81/10万。我们确定了三个主要传播区域：佛罗伦萨市周边（托斯卡纳东北部）、格罗塞托市周边（托斯卡纳西南部）和厄尔巴岛。我们的研究结果证实，意大利中部利什曼病的流行病学正在发生重大变化。需要提高对这一新兴健康威胁的认识并改进监测策略，以便可靠地评估该疾病的负担。需要从“同一健康”的角度进行进一步研究，以阐明环境、宿主、媒介和人类层面的流行病学动态。应评估气候变化和特定气候因素对人类利什曼病流行病学模式的影响。这些领域的更多知识将促进区域和国家层面的针对性控制和预防策略。
