Cutaneous and mucocutaneous leishmaniasis in travellers and migrants: a 20-year GeoSentinel Surveillance Network analysis
Author:
Boggild Andrea K123, Caumes Eric4, Grobusch Martin P567, Schwartz Eli8, Hynes Noreen A910, Libman Michael11ORCID, Connor Bradley A12, Chakrabarti Sumontra1313, Parola Philippe1415, Keystone Jay S13, Nash Theodore16, Showler Adrienne J117, Schunk Mirjam18, Asgeirsson Hilmir1920, Hamer Davidson H2122, Kain Kevin C1323, , von Sonnenburg Frank, Rothe Camilla, Jordan Sabine, Vinnemeier Christof, Yansouni Cedric, McCarthy Anne, Jensenius Mogens, Goorhuis Abraham, Coyle Christina, Mockenhaupt Frank, Harms-Zwingengerger Gundel, Leung Daniel, Benson Scott, Gautret Philippe, Javelle Emilie, Chappuis Francois, Rapp Christophe, Ficko Cecile, van Genderen Perry, Glans Hedvig, Beadsworth Michael, Beeching Nicholas, Castelli Francesco, Matteelli Alberto, Plewes Katherine, Mirzanejad Yazdan, Lopez-Velez Rogelio, Chamorro Sandra, Waggoner Jesse, Wu Henry, Leder Karin, Torresi Joseph, Bottieau Emmanuel, Huits Ralph, Chen Lin, Bourque Daniel, Alpern Jonathan, Stauffer William, Cahill John, Wyler Ben, Haulman Jean, Terry Anne, Licitra Carmelo, Taylor Ashley, Perret Perez Cecilia, Weitzel Thomas, Gkrania-Klotsas Effrossyni, Warne Ben, Schlagenhauf Patricia, Weber Rainer, Schade Larsen Carsten, Wejse Christian, Barnett Elizabeth, Hochberg Natasha, Barkati Sapha, Vincelette Jean, Molina Israel, Malvy Denis, Duvignaud Alexandre, Mendelson Marc, Parker Salim, Johnston Victoria, Field Vanessa, Kuhn Susan, Piyaphanee Watcharapong, Silachamroon Udomsak, Diaz-Menendez Marta, Kelly Paul, Blumberg Lucille, de Frey Albie, Pandey Prativa, Amatya Bhawana, Mavunda Kunjana, Saio Mauro
Affiliation:
1. Tropical Disease Unit, Division of Infectious Diseases, University Health Network-Toronto General Hospital, Toronto, Canada 2. Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada 3. Department of Medicine, University of Toronto, Toronto, Canada 4. Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), 75013, Paris, France 5. Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Academic Medical Centers, University of Amsterdam, Amsterdam, The Netherlands 6. Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany 7. Centre de Recherches Médicales en Lambaréné (CERMEL), Lambaréné, Gabon 8. Institute of Geographic Medicine and Tropical Diseases, Sheba Medical Center Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel 9. School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA 10. Bloomberg School Public Health, Johns Hopkins University, Baltimore, Maryland, USA 11. J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal Canada 12. Department of Medicine, Weill Cornell Medical College, New York, USA 13. Trillium Health Partners, Mississauga, Canada 14. Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France 15. IHU-Méditerranée Infection, Marseille, France 16. Clinical Parasitology Section, Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA 17. Georgetown University, Washington, DC 18. Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany 19. Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden 20. Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden 21. Department of Global Health, Boston University School of Public Health, Boston, MA, USA 22. Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA 23. SAR Laboratories, Sandra Rotman Centre for Global Health, Toronto, Canada
Abstract
Abstract
Background
Cutaneous leishmaniasis (CL) may be emerging among international travellers and migrants. Limited data exist on mucocutaneous leishmaniasis (MCL) in travellers. We describe the epidemiology of travel-associated CL and MCL among international travellers and immigrants over a 20-year period through descriptive analysis of GeoSentinel data.
Methods
Demographic and travel-related data on returned international travellers diagnosed with CL or MCL at a GeoSentinel Surveillance Network site between 1 September 1997 and 31 August 2017 were analysed.
Results
A total of 955 returned travellers or migrants were diagnosed with travel-acquired CL (n = 916) or MCL during the study period, of whom 10% (n = 97) were migrants. For the 858 non-migrant travellers, common source countries were Bolivia (n = 156, 18.2%) and Costa Rica (n = 97, 11.3%), while for migrants, they were Syria (n = 34, 35%) and Afghanistan (n = 22, 22.7%). A total of 99 travellers (10%) acquired their disease on trips of ≤ 2 weeks. Of 274 cases for which species identification was available, Leishmania Viannia braziliensis was the most well-represented strain (n = 117, 42.7%), followed by L. major (n = 40, 14.6%) and L. V. panamensis (n = 38, 13.9%). Forty cases of MCL occurred, most commonly in tourists (n = 29, 72.5%) and from Bolivia (n = 18, 45%). A total of 10% of MCL cases were acquired in the Old World.
Conclusions
Among GeoSentinel reporting sites, CL is predominantly a disease of tourists travelling mostly to countries in Central and South America such as Bolivia where risk of acquiring L. V. braziliensis and subsequent MCL is high. The finding that some travellers acquired leishmaniasis on trips of short duration challenges the common notion that CL is a disease of prolonged travel. Migrants from areas of conflict and political instability, such as Afghanistan and Syria, were well represented, suggesting that as mass migration of refugees continues, CL will be increasingly encountered in intake countries.
Funder
National Institutes of Health International Society of Travel Medicine Centers for Disease Control and Prevention Public Health Agency of Canada
Publisher
Oxford University Press (OUP)
Cited by
50 articles.
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