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BackgroundSurveillance of human leishmaniasis in Europe is mostly limited to country-specific information from autochthonous infections in the southern part. As at the end of 2021, no integrated analysis has been performed for cases seen across centres in different European countries.AimTo provide a broad perspective on autochthonous and imported leishmaniasis cases in endemic and non-endemic countries in Europe.MethodsWe retrospectively collected records from cutaneous, mucosal and visceral leishmaniasis cases diagnosed in 15 centres between 2014 and 2019. Centres were located in 11 countries: Belgium, France, Germany, Italy, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the United Kingdom. Data on country of infection, reason for travelling, infecting species, age and sex were analysed.ResultsWe obtained diagnostic files from 1,142 cases, of which 76%, 21% and 3% had cutaneous, visceral, and mucosal disease, respectively. Of these, 68% were men, and 32% women, with the median age of 37 years (range: 0-90) at diagnosis. Visceral leishmaniasis was mainly acquired in Europe (88%; 167/190), while cutaneous leishmaniasis was primarily imported from outside Europe (77%; 575/749). Sixty-two percent of cutaneous leishmaniasis cases from outside Europe were from the Old World, and 38% from the New World. Geographic species distribution largely confirmed known epidemiology, with notable exceptions.ConclusionsOur study confirms previous reports regarding geographic origin, species, and traveller subgroups importing leishmaniasis into Europe. We demonstrate the importance of pooling species typing data from many centres, even from areas where the aetiology is presumably known, to monitor changing epidemiology.

Leishmaniasis is endemic in southern Europe, and in other European countries cases are diagnosed in travellers who have visited affected areas both within the continent and beyond. Prompt and accurate diagnosis poses a challenge in clinical practice in Europe. Different methods exist for identification of the infecting Leishmania species. Sixteen clinical laboratories in 10 European countries, plus Israel and Turkey, conducted a study to assess their genotyping performance. DNA from 21 promastigote cultures of 13 species was analysed blindly by the routinely used typing method. Five different molecular targets were used, which were analysed with PCR-based methods. Different levels of identification were achieved, and either the Leishmania subgenus, species complex, or actual species were reported. The overall error rate of strains placed in the wrong complex or species was 8.5%. Various reasons for incorrect typing were identified. The study shows there is considerable room for improvement and standardisation of Leishmania typing. The use of well validated standard operating procedures is recommended, covering testing, interpretation, and reporting guidelines. Application of the internal transcribed spacer 1 of the rDNA array should be restricted to Old World samples, while the heat-shock protein 70 gene and the mini-exon can be applied globally., Competing Interests: Conflicts of Interest: None declared., (This article is copyright of The Authors, 2016.)

In 2000, a reference center was created to systematically record leishmaniases in Germany. We analyzed 58 cases of leishmaniases imported during a 2-year period. These findings will serve as a baseline for the sandfly vector's anticipated northward move because of global warming and as an advisory for immunocompromised persons traveling to leishmaniasis-endemic areas.

In a randomized prospective trial N-methyl-glucamine antimoniate (Glucantime) and human recombinant interferon-gamma were infiltrated around lesions of cutaneous leishmaniasis caused by Leishmania tropica in Syria. A previous trial had shown that intradermal application of interferon-gamma promoted the healing of similar lesions in the study area. Twenty patients with 38 lesions received 1-3 ml Glucantime and 20 patients with 37 lesions received 25 micrograms of interferon-gamma intradermally once weekly for 5 consecutive weeks. While all lesions treated with Glucantime were free of parasites after the third injection, only 69% of those treated with interferon-gamma were parasitologically cured by week 10. Within 10 weeks, lesions treated with Glucantime healed completely in 29/38, and partially in 9/38, cases, whereas 1/37 and 13/37 lesions treated with interferon-gamma healed completely and partially, respectively. Perilesional application of Glucantime was highly effective and superior to interferon-gamma for treatment of cutaneous leishmaniasis caused by L. tropica.

The clinical and immunological evolution of lesions in cutaneous leishmaniasis was assessed after treatment with human recombinant gamma interferon (rIFN-gamma). 3 weeks after rIFN-gamma treatment of lesions due to Leishmania braziliensis guyanensis, 12/13 had become smaller compared with 6/13 control lesions; only 4 treated lesions were free of parasites. 9 of 13 L tropica lesions treated with rIFN-gamma resolved completely within 4-8 weeks of treatment. An acute inflammatory reaction around treated lesions was more common in lesions due to L tropica. There were no other local or systemic adverse reactions. Histological and immunohistochemical studies indicate that local application of rIFN-gamma enhances cell-mediated immune responses and thus promotes healing of cutaneous leishmaniasis.

It has been suggested that T lymphocytes expressing γδ T-cell receptors could play an important role in defence against some intracellular infectious pathogens. The present study was undertaken to characterize the occurrence and variable δ gene expression of T lymphocytes expressing the γδ T-cell receptor in oriental cutaneous leishmaniasis. Eleven cases of oriental cutaneous leishmaniasis were investigated by immunohistological analysis using an alkaline phosphatase-anti-alkaline phosphatase (APAAP) technique. In three cases. we observed an increased percentage of γδ T cells (about 20% of CD3' cells). In these cases γδ T cells generally expressed the γδT segment. and only rarely the VδI gene product. Vδ2 + cells were predominantly localized in the dermis. and were virtually absent in the epidermal compartment. The rare δ T cells observed in the epidermis were almost exclusively V&delt;T . The study demonstrates that an increase of γδT cells may be found in oriental cutaneous leishmaniasis, although it is not a constant feature of the disease. The finding of a preferential expansion of the Vδ2 subset suggests that this subpopulation γδ T-cells might be selectively involved in the recognition of Leishmania antigens. The distinct compartmentahzatuon ol γδ T-cell subpopulations indicates that these subsets may recognize distinct sets of antigens. [ABSTRACT FROM AUTHOR]

The extent of diversity of the γδ T-cell receptor (TCR) in normal human skin and Oriental Cutaneous Leishmaniasis (OCL) was examined by molecular analysis of the variable (V) δ gene segment, junctional (J) δ gene segment and junctional regions. To examine the expression of TCR δ genes, segments of γδ T lymphocytes. DNA isolated from normal human skin and from OCL were subjected to enzymatic gene amplification by the polymerase chain reaction (PCR) method using TCR Vδ- and Jδ-specific oligonucleotides as primers. PCR amplification using these primers indicated that the Vδ2 gene segment was predominantly used by γδ T lymphocytes in both normal human skin and OCL. To determine the extent of junctional diversity in the δ gene of γδ T cells in normal human skin and OCL, we sequenced the nucleic acid sequences corresponding to the Vδ2/Jδ1 junctional regions. Sequence analysis of junctional regions demonstrated broad junctional diversity in normal skin but only limited diversity in OCL. Our findings support the hypothesis that skin γδ T lymphocytes may derive from a fetal subset of γδ T lymphocytes that leaves the thymus early and colonizes the periphery. The limited junctional diversity demonstrated in OCL lesions indicates that γδ T cells can undergo oligoclonal expansion following recognition of a specific ligand and supports the idea that junctional regions are important in the recognition of antigenic determinant. [ABSTRACT FROM AUTHOR]

An enzyme-linked immunosorbent assay was used to quantify soluble interleukin 2 receptor (IL-2R) in the serum of patients with helminthic and protozoal infections. The results demonstrated that levels of IL-2R were normal in patients with helminthic infections limited to the intestinal tract (ascariasis, trichuriasis), but significantly elevated in patients with systemic or long-lasting infections (strongyloidiasis, schistosomiasis, fascioliasis, opisthorchiasis). In patients infected with Schistosoma mansoni levels of IL-2R were higher in those with the hepatosplenic than in those with the intestinal form of the disease. Patients with malaria also showed increased serum levels of IL-2R, irrespective whether the infection was caused by Plasmodium falciparum or P. vivax. No difference was observed between patients with acute or history of malaria. The highest levels of IL-2R were observed in patients with visceral leishmaniasis. Interestingly, in these patients the concentration of IL-2R correlated to specific antibody titre. The results are discussed in the context of preferential activation of T lymphocytes. B lymphocytes and/or macrophages during the course of the different parasitic infections investigated. [ABSTRACT FROM AUTHOR]

Cites a study on visceral leishmaniasis (VL)presenting as subcutaneous nodules in an HIV-positive patient. Description of VL; Case of a 42-year-old HIV-positive German male who had arthralgia and high fever; Marked histiocytic proliferation in the patient; High mortality of VL in HIV-positive patients in northern Europe.

A 25-year-old female patient presented with an isolated cervical lymph node enlargement several, months after having returned from Spain and Latin America. She had no other signs or symptoms of disease. Leishmania infantum/chagasi was identified as the causative agent. With extended travel. activities localized lymph node enlargement due to leishmania infection should be included in the differential. diagnosis of lymphadenopathy of unknown origin. [ABSTRACT FROM AUTHOR]