title: New world mucosal and cutaneous leishmaniasis: an emerging health problem among British travellers.
abstract: BACKGROUND
  Mucosal leishmaniasis (ML) is an important complication of new world cutaneous leishmaniasis (CL) caused by species of the Leishmania Viannia subgenus. Previous reports of ML among travellers to Latin America are few.
  
  
  OBJECTIVE
  To determine the annual number of cases of CL due to L. Viannia species diagnosed at this institution and to correlate this with changing patterns of travel. Secondly, to document the clinical presentation, diagnosis, treatment and outcome of ML at this institution.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Data were collected from a clinical database, laboratory records, patient case notes and an international passenger survey.
  
  
  RESULTS
  Between 1995 and 2003, the annual number of cases of CL (total 79) steadily increased from 4 per year to 18 per year; the estimated number of travellers from the UK to Latin America increased 3.5-fold. Six cases of ML were diagnosed among British travellers in 1995 (1), 1997 (1) and 2002 (4). These infections were acquired in Bolivia (3), Colombia (2) and Belize (1). Nasopharyngeal symptoms developed 0-15 months after returning to the UK. Four patients had concurrent CL at diagnosis. Diagnosis of ML was delayed up to 6 months from the onset of symptoms. Mucosal biopsies from all 6 patients were PCR-positive for L. (Viannia) DNA; microscopy and culture were less sensitive. ML relapsed in one patient following treatment.
  
  
  CONCLUSIONS
  Increasing travel to Latin America from the UK was associated with an increasing number of diagnoses of L. Viannia CL. ML is likely to emerge as a more frequently imported infection among such travellers. Familiarity with these diseases is important for prompt diagnosis and optimal management.
authors.affiliation: Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT. stevelawn@yahoo.co.uk
authors.forename: S D
authors.initials: SD
authors.lastname: Lawn
authors.forename: J
authors.initials: J
authors.lastname: Whetham
authors.forename: P L
authors.initials: PL
authors.lastname: Chiodini
authors.forename: J
authors.initials: J
authors.lastname: Kanagalingam
authors.forename: J
authors.initials: J
authors.lastname: Watson
authors.forename: R H
authors.initials: RH
authors.lastname: Behrens
authors.forename: D N J
authors.initials: DN
authors.lastname: Lockwood
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D005260:Female; D006801:Humans; D007843:Latin America; D007891:Leishmania / Q000302:isolation & purification*; D007897:Leishmaniasis, Mucocutaneous / Q000175:diagnosis / Q000453:epidemiology* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D014195:Travel; D006113:United Kingdom / Q000453:epidemiology