Retrospective PCR-based species identification of Leishmania in two patients with visceral leishmaniasis in Serbia

Systematic Review: Re-emergence of human leishmaniasis in the Balkans

OBJECTIVE

To provide an updated overview of the leishmaniasis epidemiology in the Balkans, as this region presents "blank space" on the map of leishmaniasis knowledge in Europe.

METHODS

Following the PRISMA guideline, literature on the presence and circulation of human leishmaniasis in Balkan countries was screened in PubMed, Google Scholar, Science Direct, Scopus, Web of Science, Matica Srpska Library and the National Library of Serbia.

RESULTS

Sixty nine publications from 1919 until September 2020 were reviewed. Historical records indicate that leishmaniasis was previously present mainly in the southern parts of the Balkans, while newer data demonstrate its northward spread.

CONCLUSIONS

Human leishmaniasis is re-emerging in the Balkans and in some areas is already widespread.

Sandfly surveillance and investigation of Leishmania spp. DNA in sandflies in Kosovo

In the past decade, leishmaniasis seems to be re-emerging in Balkan countries. There are serious implications that Kosovo is a visceral leishmaniasis endemic region with autochthonous transmission; nevertheless, surveillance of vectors, reservoirs or the disease is not yet established. Gaining knowledge about sandfly vector species is a prerequisite for the development of a monitoring and control plan in the future. After a long gap in research of over 70 years, sandfly studies in Kosovo were resumed in 2014. During this presence/absence study, nine sandfly species were detected: Phlebotomus papatasi, Ph. perfiliewi, Ph. tobbi, Ph. neglectus, Ph. simici, Ph. balcanicus, Ph. alexandri, Ph. mascittii and Sergentomyia minuta. Three species are new with regard to the fauna of Kosovo - Ph. alexandri, Ph. balcanicus and Ph. mascittii. Besides increased diversity, changes in the number of collected specimens and distribution range of species were recorded, with Ph. neglectus being the most dominant species with the widest distribution. Testing of randomly chosen females for Leishmania spp. DNA resulted the in detection of L. tropica in a specimen of Ph. neglectus. The presence of numerous vector species in the sandfly fauna of Kosovo pose a threat for the re-emergence of vector-borne diseases. Therefore, continuous surveillance is recommended with regular updates on vector distribution and abundance.