Cutaneous leishmaniasis in travellers and migrants: a 10-year case series in a Canadian reference centre for tropical diseases.

Autor:	Lemieux A; Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que., Lagacé F; Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que., Billick K; Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que., Ndao M; Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que., Yansouni CP; Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que., Semret M; Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que., Libman MD; Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que., Barkati S; Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que. sapha.barkati2@mcgill.ca.
Jazyk:	angličtina
Zdroj:	CMAJ open [CMAJ Open] 2022 Jun 21; Vol. 10 (2), pp. E546-E553. Date of Electronic Publication: 2022 Jun 21 (Print Publication: 2022).
DOI:	10.9778/cmajo.20210238
Abstrakt:	Background: Cutaneous leishmaniasis is increasingly encountered in returned travellers and migrants to nonendemic countries. We sought to describe the clinical characteristics and treatment outcomes of cases of cutaneous leishmaniasis diagnosed at our reference centre over a 10-year period. Methods: This case series included all laboratory-confirmed cases of cutaneous leishmaniasis in travellers and migrants for whom complete clinical data were available, diagnosed between January 2008 and October 2018 at the J.D. MacLean Centre for Tropical Diseases in Montréal. We examined the number of cases each year. We used descriptive statistics to summarize variables (e.g., demographic characteristics, travel history, clinical presentation, diagnostic methods, treatments, adverse events) extracted from the patients' electronic medical records. The primary outcome for evaluating clinical response to treatment was defined as the complete re-epithelialization of the wound surface at 1 year. Results: We identified 48 patients who received diagnoses of cutaneous leishmaniasis in the 10-year study period, including 33 exposed in the Americas and 15 exposed in other regions (median age 43.5 [range 1-75] yr); 28 [58%] males). The annual number of cases increased from 9 in 2008/09 to 16 in 2017/18. The median time from onset to diagnosis was 89 (IQR 58-134) days. Liposomal amphotericin B was the most commonly used initial treatment (20 [53%] patients). Thirty-five patients completed their follow-up, and 11 had successful response to 1 course of liposomal amphotericin B. Adverse events (including acute kidney injury, increased pancreatic enzymes and fatigue) were reported in 6 (30%) patients. Clinical cure was achieved within 1 year for 32 (91%) of the 35 patients who completed follow-up. Interpretation: This study showed an increase in the number of cases of cutaneous leishmaniasis seen in our centre over the study period, likely because of increased travel and migration. This diagnosis should be considered in travellers and migrants with a chronic cutaneous lesion. Competing Interests: Competing interests: Momar Ndao reports funding from the McGill Interdisciplinary Initiative in Infection and Immunity. Cédric Yansouni reports funding from Fonds de recherche du Québec, consulting fees from Medicago, participation on an independent data monitoring committee for a phase 3 trial of a SARS-CoV-2 vaccine and a role as scientific advisor with the COVID-19 Immunity Task Force. Makeda Semret reports participation with data safety monitoring boards for SARS-CoV-2 vaccine studies and with the COVID-19 Immunity Task Force. Michael Libman reports funding from the Centers for Disease Control and Prevention, consulting fees for participation with an advisory board on education in travel medicine and a role as chair of the Committee to Advise on Tropical Medicine and Travel with the Public Health Agency of Canada. All competing interests are outside the submitted work. No other competing interests were declared. (© 2022 CMA Impact Inc. or its licensors.)
Databáze:	MEDLINE
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