Madero-Velázquez L, Mínguez A, Mayorga L, Ramírez J J, Moreno N, Amorós C, Nieto M A, Mena R, Benítez J M, Gimeno-Pitarch L, Maroto N, Suria C, Rodríguez-Moranta F, Ordás I, Ruiz L, García-Brenes M A, Martín-Cardona A, de Célix C Rubín, Cárdenas K, Ginard D, Medina L, Pedrero N, Plaza R, Salmoral R, Martínez-Pérez T J, Algara V, Merino E, Zabana Y, Gutiérrez A
Gastroenterology Department, Hospital General Universitario Dr Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
Gastroenterology Department, Hospital Policlínico Universitario La Fe, Valencia, Spain.
United European Gastroenterol J. 2025 Jun;13(5):674-684. doi: 10.1002/ueg2.12740. Epub 2025 Jan 8.
Leishmaniasis (LI) is a vector-borne illness caused by a protozoan of the genus Leishmania. Data on the features of LI in patients with inflammatory bowel disease (IBD) are scarce.
To describe the characteristics of patients with IBD who present with leishmaniasis, infection outcomes and the risk factors associated with developing visceral leishmaniasis (VL).
An observational retrospective study performed in 26 hospitals in Spain, including all adult patients with IBD who developed Leishmaniasis from 2012 to 2022.
A total of 73 patients were included [mean age 48 years; 65% male; 68% Crohn's disease]. Sixty patients (82.2%) presented localized cutaneous Leishmaniasis (CL), 2 (2.7%) diffuse CL, 3 (4.1%) mucocutaneous Leishmaniasis (MCL) and 8 (11%) VL. All patients were under biologicals (69 [94.5%]) or immunosuppressants (IMM) (4 [5.5%]) at Leishmaniasis diagnosis. AntiTNF was used in 97%, while 2 patients (3%) were receiving ustekinumab. Leishmaniasis resolution was achieved by 48% and 96% of the patients after 1 and 12 months, respectively. Biological withdrawal after Leishmaniasis diagnosis was not statistically related to increased rates of infection resolution among patients with localized CL. Age was the only risk factor associated with VL (OR 1.2, 95%CI 1.04-1.39; p = 0.012).
Leishmaniasis in patients with IBD doesn't seem to follow a complicated clinical course, even in those with localized CL who do not discontinue biological therapy after infection diagnosis. Age might be a risk factor for developing VL. This infection should be considered for immunosuppressed patients with IBD and suggestive symptoms dwelling or travelling to endemic areas.
利什曼病（LI）是由利什曼原虫属的原生动物引起的一种媒介传播疾病。关于炎症性肠病（IBD）患者中利什曼病特征的数据很少。
描述出现利什曼病的IBD患者的特征、感染结局以及与发生内脏利什曼病（VL）相关的危险因素。
在西班牙的26家医院进行了一项观察性回顾性研究，纳入了2012年至2022年期间所有发生利什曼病的成年IBD患者。
共纳入73例患者[平均年龄48岁；65%为男性；68%为克罗恩病]。60例（82.2%）出现局限性皮肤利什曼病（CL），2例（2.7%）为弥漫性CL，3例（4.1%）为黏膜皮肤利什曼病（MCL），8例（11%）为VL。在利什曼病诊断时，所有患者均在使用生物制剂（69例[94.5%]）或免疫抑制剂（IMM）（4例[5.5%]）。97%的患者使用了抗TNF药物，而2例（3%）患者正在接受乌司奴单抗治疗。分别有48%和96%的患者在1个月和12个月后利什曼病得到缓解。利什曼病诊断后停用生物制剂与局限性CL患者感染缓解率的增加无统计学关联。年龄是与VL相关的唯一危险因素（OR 1.2，95%CI 1.04 - 1.39；p = 0.012）。
IBD患者的利什曼病似乎没有复杂的临床病程，即使是那些在感染诊断后未停用生物治疗的局限性CL患者。年龄可能是发生VL的危险因素。对于有IBD且有提示症状、居住或前往流行地区的免疫抑制患者，应考虑这种感染。
