Changes in the microbiological diagnosis and epidemiology of cutaneous leishmaniasis in real-time PCR era: A six-year experience in a referral center in Barcelona

<h4>Background</h4> Leishmaniasis is a neglected disease caused by different species of the protozoa Leishmania spp. Cutaneous lesions are the most common clinical manifestation. This disease is prevalent in tropical and subtropical areas, including the Mediterranean basin. In Spain, Lei...

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Autores principales:	Aroa Silgado, Mayuli Armas, Adrián Sánchez-Montalvá, Lidia Goterris, Maria Ubals, Jordi Temprana-Salvador, Gloria Aparicio, Carmen Chicharro, Núria Serre-Delcor, Berta Ferrer, Israel Molina, Vicenç García-Patos, Tomas Pumarola, Elena Sulleiro
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/37f6240f0e744b0697b97528e945b945
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id	oai:doaj.org-article:37f6240f0e744b0697b97528e945b945
record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Aroa Silgado Mayuli Armas Adrián Sánchez-Montalvá Lidia Goterris Maria Ubals Jordi Temprana-Salvador Gloria Aparicio Carmen Chicharro Núria Serre-Delcor Berta Ferrer Israel Molina Vicenç García-Patos Tomas Pumarola Elena Sulleiro Changes in the microbiological diagnosis and epidemiology of cutaneous leishmaniasis in real-time PCR era: A six-year experience in a referral center in Barcelona
description	<h4>Background</h4> Leishmaniasis is a neglected disease caused by different species of the protozoa Leishmania spp. Cutaneous lesions are the most common clinical manifestation. This disease is prevalent in tropical and subtropical areas, including the Mediterranean basin. In Spain, Leishmania (L.) infantum is the only endemic species, but imported cases are often diagnosed. Different classical parasitological methods can be performed for cutaneous leishmaniasis (CL) diagnosis; but currently molecular techniques serve as a relevant tool for the detection and characterization of Leishmania parasites. We aimed to evaluate clinical and epidemiological characteristics of CL diagnosed patients by real-time PCR in a tertiary hospital over a six-year period. <h4>Methodology/Principal findings</h4> Clinical, epidemiological and microbiological data were retrospectively collected and analyzed. In our study, CL was confirmed in 59 (31.4%) out of 188 patients by real-time PCR, showing an increase over recent years: 11 cases of CL between 2014 and 2016 and 48 between 2017 and 2019. Real-time PCR was performed on skin swabs and/or biopsies samples, with a positivity of 38.5% and 26.5%, respectively. Results were 100% concordant when biopsy and skin swab were performed simultaneously. L. (L.) infantum was the most frequent species detected (50%), followed by L. (L.) major (45%) and Viannia subgenus (5%), which were detected only in imported cases. L. (L.) major was almost entirely detected in travelers/migrants from Morocco. Multiple and atypical skin lesions were more common in imported cases than in autochthonous cases (44.4% vs. 21.8%). <h4>Conclusions/Significance</h4> An increase in both autochthonous and imported CL cases has been observed in past years in our hospital. Molecular techniques assist in improving CL diagnosis and characterization of the Leishmania species, mainly in imported cases. Author summary Leishmaniasis is a neglected disease caused by different species of the genus Leishmania. This disease is prevalent in tropical and subtropical areas, including the Mediterranean basin. In Spain, the only endemic species is L. (L) infantum, although there are cases of imported leishmaniasis due to travel and migration of people from other endemic areas. Cutaneous lesions are the most common clinical form, but L. (L) infantum can also cause mucosal or visceral involvement. Although microscopic diagnosis and skin biopsy specimens are still used in routine diagnosis for cutaneous leishmaniasis, they are time-consuming and invasive, respectively. Currently, molecular techniques, such as real-time PCR, are very sensitive tools for the detection and identification of Leishmania parasites. In addition, the skin swab sample seems to be a non-invasive alternative for the diagnosis of cutaneous leishmaniasis. In the present work, we describe the clinical characteristics of 59 patients diagnosed by real-time PCR of cutaneous leishmaniasis, as well as the molecular epidemiology of the causative species. We show that there has been an increase in cutaneous leishmaniasis cases, both autochthonous and imported cases, over the study period. The presence of Leishmania species other than L. (L) infantum is also highlighted.
format	article
author	Aroa Silgado Mayuli Armas Adrián Sánchez-Montalvá Lidia Goterris Maria Ubals Jordi Temprana-Salvador Gloria Aparicio Carmen Chicharro Núria Serre-Delcor Berta Ferrer Israel Molina Vicenç García-Patos Tomas Pumarola Elena Sulleiro
author_facet	Aroa Silgado Mayuli Armas Adrián Sánchez-Montalvá Lidia Goterris Maria Ubals Jordi Temprana-Salvador Gloria Aparicio Carmen Chicharro Núria Serre-Delcor Berta Ferrer Israel Molina Vicenç García-Patos Tomas Pumarola Elena Sulleiro
author_sort	Aroa Silgado
title	Changes in the microbiological diagnosis and epidemiology of cutaneous leishmaniasis in real-time PCR era: A six-year experience in a referral center in Barcelona
title_short	Changes in the microbiological diagnosis and epidemiology of cutaneous leishmaniasis in real-time PCR era: A six-year experience in a referral center in Barcelona
title_full	Changes in the microbiological diagnosis and epidemiology of cutaneous leishmaniasis in real-time PCR era: A six-year experience in a referral center in Barcelona
title_fullStr	Changes in the microbiological diagnosis and epidemiology of cutaneous leishmaniasis in real-time PCR era: A six-year experience in a referral center in Barcelona
title_full_unstemmed	Changes in the microbiological diagnosis and epidemiology of cutaneous leishmaniasis in real-time PCR era: A six-year experience in a referral center in Barcelona
title_sort	changes in the microbiological diagnosis and epidemiology of cutaneous leishmaniasis in real-time pcr era: a six-year experience in a referral center in barcelona
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/37f6240f0e744b0697b97528e945b945
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spelling	oai:doaj.org-article:37f6240f0e744b0697b97528e945b9452021-11-18T09:14:49ZChanges in the microbiological diagnosis and epidemiology of cutaneous leishmaniasis in real-time PCR era: A six-year experience in a referral center in Barcelona1935-27271935-2735https://doaj.org/article/37f6240f0e744b0697b97528e945b9452021-11-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8580242/?tool=EBIhttps://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Background</h4> Leishmaniasis is a neglected disease caused by different species of the protozoa Leishmania spp. Cutaneous lesions are the most common clinical manifestation. This disease is prevalent in tropical and subtropical areas, including the Mediterranean basin. In Spain, Leishmania (L.) infantum is the only endemic species, but imported cases are often diagnosed. Different classical parasitological methods can be performed for cutaneous leishmaniasis (CL) diagnosis; but currently molecular techniques serve as a relevant tool for the detection and characterization of Leishmania parasites. We aimed to evaluate clinical and epidemiological characteristics of CL diagnosed patients by real-time PCR in a tertiary hospital over a six-year period. <h4>Methodology/Principal findings</h4> Clinical, epidemiological and microbiological data were retrospectively collected and analyzed. In our study, CL was confirmed in 59 (31.4%) out of 188 patients by real-time PCR, showing an increase over recent years: 11 cases of CL between 2014 and 2016 and 48 between 2017 and 2019. Real-time PCR was performed on skin swabs and/or biopsies samples, with a positivity of 38.5% and 26.5%, respectively. Results were 100% concordant when biopsy and skin swab were performed simultaneously. L. (L.) infantum was the most frequent species detected (50%), followed by L. (L.) major (45%) and Viannia subgenus (5%), which were detected only in imported cases. L. (L.) major was almost entirely detected in travelers/migrants from Morocco. Multiple and atypical skin lesions were more common in imported cases than in autochthonous cases (44.4% vs. 21.8%). <h4>Conclusions/Significance</h4> An increase in both autochthonous and imported CL cases has been observed in past years in our hospital. Molecular techniques assist in improving CL diagnosis and characterization of the Leishmania species, mainly in imported cases. Author summary Leishmaniasis is a neglected disease caused by different species of the genus Leishmania. This disease is prevalent in tropical and subtropical areas, including the Mediterranean basin. In Spain, the only endemic species is L. (L) infantum, although there are cases of imported leishmaniasis due to travel and migration of people from other endemic areas. Cutaneous lesions are the most common clinical form, but L. (L) infantum can also cause mucosal or visceral involvement. Although microscopic diagnosis and skin biopsy specimens are still used in routine diagnosis for cutaneous leishmaniasis, they are time-consuming and invasive, respectively. Currently, molecular techniques, such as real-time PCR, are very sensitive tools for the detection and identification of Leishmania parasites. In addition, the skin swab sample seems to be a non-invasive alternative for the diagnosis of cutaneous leishmaniasis. In the present work, we describe the clinical characteristics of 59 patients diagnosed by real-time PCR of cutaneous leishmaniasis, as well as the molecular epidemiology of the causative species. We show that there has been an increase in cutaneous leishmaniasis cases, both autochthonous and imported cases, over the study period. The presence of Leishmania species other than L. (L) infantum is also highlighted.Aroa SilgadoMayuli ArmasAdrián Sánchez-MontalváLidia GoterrisMaria UbalsJordi Temprana-SalvadorGloria AparicioCarmen ChicharroNúria Serre-DelcorBerta FerrerIsrael MolinaVicenç García-PatosTomas PumarolaElena SulleiroPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 15, Iss 11 (2021)

Changes in the microbiological diagnosis and epidemiology of cutaneous leishmaniasis in real-time PCR era: A six-year experience in a referral center in Barcelona

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