Imported leishmaniasis cases in Cuba (2006-2016): what have we learned

Imported cases of cutaneous leishmaniasis in Cuba, 2017: role of human movement

Background

Leishmaniasis is a vector-borne disease caused by several species from genus Leishmania. An increase in the number of cases related to human movement has been informed in the last years. Due to the increase of suspicious leishmaniasis cases arriving in Cuba during 2017, a general analysis is presented herein.

Methods

Clinical samples were collected from 5 patients suspicious of leishmaniasis, received from January to December 2017 at the Institute of Tropical Medicine Pedro Kourí, Cuba. Skin lesion samples were analyzed using different diagnostic assays: direct smear, histological examination, and molecular analysis for species identification. Epidemiological and demographic data were requested from each case and analyzed. Treatment and follow up of patient was also performed.

Results

Five cases were confirmed as Leishmania infection according to microscopic observation and molecular methods results. PCR-18S, PCR-N/RFLP and PCR-F/RFLP identified the following species: L. panamensis (2 cases), L. braziliensis (1 case), L.panamensis/L.guyanensis (1 case), L. mexicana complex (1 case). In treated patients, drugs were well tolerated, cure were documented and no relapse have been currently reported (3 years later).

Conclusions

Clinical characteristics, demographic data, and epidemiological features of infection for each case evidence the potential risk related with travel to endemic areas of leishmaniasis.

Keyworks

Cutaneous leishmaniasis, Epidemiology, Imported cases.

Non-Endemic Leishmaniases Reported Globally in Humans between 2000 and 2021—A Comprehensive Review

Leishmaniases are human and animal parasitic diseases transmitted by phlebotomine sand flies. Globalization is an important driver of the burden and in the current dynamics of these diseases. A systematic review of articles published between 2000 and 2021 was conducted using the PubMed search engine to identify the epidemiology and clinical management of imported human leishmaniases as a fundamental step to better manage individual cases and traveler and migrant health from a global perspective. A total of 275 articles were selected, representing 10,341 human imported cases. Identified drivers of changing patterns in epidemiology include conflict and war, as well as host factors, such as immunosuppression, natural and iatrogenic. Leishmania species diversity associated with different clinical presentations implies diagnostic and treatment strategies often complex to select and apply, especially in non-endemic settings. Thus, diagnostic and management algorithms for medical clinical decision support are proposed. Increased surveillance of non-endemic cases, whether in vulnerable populations such as refugees/migrants and immunocompromised individuals or travelers, could improve individual health and mitigate the public health risk of introducing Leishmania species into new areas.

A Case of Leishmaniasis Infantum Kala-Azar in an Immunocompetent 49-Year-Old Man

An immunocompetent 45-year-old Cuban-American man presented with worsening knee pain and swelling despite antibiotic therapy. On physical examination, the patient was ill-appearing, cachectic, with a protuberant abdomen and massive splenomegaly. In addition, he had a 10 cm area of peripheral hyperemia with central necrosis in the medial left knee that was non-tender and non-fluctuant. Initial lab work demonstrated pancytopenia, hyponatremia, hypoalbuminemia, and anemia of chronic inflammation. Peripheral smear showed microcytic, hypochromic red blood cells with mild anisopoikilocytosis. and leukopenia with slight left shift and metamyelocytes. Bone marrow biopsy demonstrated amastigotes and kinetoplasts within white blood cells and extracellular space consistent with leishmaniasis. Centers for Disease Control and Prevention (CDC) testing with PCR returned positive for Leishmaniasis infantum. The patient received two courses of amphotericin B lipid complex (ABLC) with a 28-day course of miltefosine, which resulted in clinical improvement. This case illustrates the unique pathology that can affect immigrants and highlights the need to increase health provider awareness of foreign pathologies in areas with large migrant populations.

Bioactive Essential Oils from Cuban Plants: An Inspiration to Drug Development

Aromatic plants and essential oils are important agents as complementary and alternative medicines in many cultures and geographical locations. In this review, a literature search on essential oils from Cuba, their chemical compositions, and their pharmacological properties was carried out. Out of 171 published scientific articles on essential oils of Cuban plants, a total of 31 documents, focused on both chemical composition and pharmacological properties, were considered for this review. In general, an increase in articles published in the last decade was noted, particularly in recognized international journals in English. Myrtaceae and Piperaceae were the most representative families collected in the occidental area of the country. Leaves and aerial parts were predominantly used, while a wide and variable number of components were identified, including terpenes, aliphatic derivatives, sulfur-containing compounds, phenylpropanoids, alkaloids and amine-type compounds. Finally, different biological activities were reported such as antiprotozoal, antibacterial, antifungal, cytotoxic, anthelmintic, larvicidal and insecticidal. In conclusion, we encourage further studies that would promote the use of essential oils from Cuban plants in new pharmaceutical products.

"Chiclero's Ulcer" Due to Leishmania mexicana in Travelers Returning from Central America: A Case Report and Review of the Literature

Cutaneous leishmaniasis (CL) due to a New World species of Leishmania is increasingly seen among returning international travelers, and most cases arise from travel to Mexico, Central and South America. We described a case of CL in a women presenting a nonhealing ulceration under her right ear with slight increase of size of the left parotid gland under the skin lesion, evolving for 4 months. In her history of travel, she reported a ten-day stay in Mexico during the Christmas vacation in the Yucatan region with only half a day walking in the tropical forest. Diagnosis of CL due to Leishmania mexicana was done via PCR detection and sequencing from swab sampling of the lesion. The patient recovered without antiparasitic treatment. Clinicians should consider diagnosing Chiclero’s ulcer in patients returning from endemic areas such as Central America and Texas who present with chronic ulceration. A noninvasive sampling is sufficient for the PCR-based diagnosis of this disease.

Leishmania spp. and leishmaniasis on the Caribbean islands

The kinetoplastid protozoan Leishmania spp. cause leishmaniasis, which clinically exhibit mainly as a cutaneous, mucocutanous or visceral form depending upon the parasite species in humans. The disease is widespread geographically, leading to 20 000 annual deaths. Here, leishmaniases in both humans and animals, reservoirs and sand fly vectors on the Caribbean islands are reviewed. Autochthonous human infections by Leishmania spp. were found in the Dominican Republic, Guadeloupe and Martinique as well as Trinidad and Tobago; canine infections were found in St. Kitts and Grenada; and equine infections were found in Puerto Rico. Imported human cases have been reported in Cuba. The parasites included Leishmania amazonensis, Le. martiniquensis and Le. waltoni. Possible sand fly vectors included Lutzomyia christophei, Lu. atroclavatus, Lu. cayennensis and Lu. flaviscutellata as well as Phlebotomus guadeloupensis. Reservoirs included rats, rice rats and mouse opossum. An updated study is warranted for the control and elimination of leishmaniasis in the region because some of the data are four decades old.