title: Imported leishmaniasis: a heterogeneous group of diseases.
abstract: BACKGROUND
  Leishmaniasis is endemic in many countries. The existence of different species combined with host factors may condition clinical presentation, treatment options, and disease outcome. In an endemic country, a predominance of certain species and presentations may be expected, whereas from the perspective of a tropical medicine referral unit a wider variety of cases from diverse geographical areas may be observed.
  
  
  METHODS
  Retrospective study of imported leishmaniasis cases diagnosed at a Tropical Medicine referral unit in Spain, during the period of January 1995 to June 2008.
  
  
  RESULTS
  In total, 18 cases were diagnosed: 12 cutaneous leishmaniasis (CL), 4 mucocutaneous leishmaniasis (ML), and 2 visceral leishmaniasis (VL) cases. Two patients were immunosuppressed. The majority of CL cases (9/12) occurring in travelers were acquired in New World countries and were treated with pentavalent antimonials. Three ML cases were acquired in the New World, two received initial treatment with pentavalent antimonials and two with liposomal amphotericin B (LAmB). For all four ML cases, a change in drug choice and multiple treatment courses were necessary, and one remained refractory to treatment. Both VL cases were acquired in Africa and responded well to LAmB treatment.
  
  
  CONCLUSIONS
  The management of leishmaniasis in non-endemic countries is still a challenge for physicians. With the variety of cases presented, both in immigrants and travelers from different geographical areas, this series illustrates the great diversity of imported leishmaniasis in terms of presentation, treatment options, and outcome. We consider this entity is becoming increasingly more frequent and clinicians should be aware of strategies for its correct management.
authors.affiliation: Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Pérez-Ayala
authors.forename: Francesca
authors.initials: F
authors.lastname: Norman
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Pérez-Molina
authors.forename: Juan María
authors.initials: JM
authors.lastname: Herrero
authors.forename: Begoña
authors.initials: B
authors.lastname: Monge
authors.forename: Rogelio
authors.initials: R
authors.lastname: López-Vélez
mesh_terms: D000328:Adult; D000349:Africa; D000935:Antifungal Agents / Q000008:administration & dosage*; D000965:Antimony / Q000008:administration & dosage*; D000981:Antiprotozoal Agents / Q000008:administration & dosage*; D001208:Asia; D004641:Emigration and Immigration; D019353:Endemic Diseases; D005060:Europe; D005260:Female; D006801:Humans; D007167:Immunotherapy; D007843:Latin America; D007891:Leishmania / Q000302:isolation & purification; D007896:Leishmaniasis / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008877:Middle East; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D013030:Spain; D014195:Travel; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D000981:Antiprotozoal Agents; D000965:Antimony