title: Leishmaniasis acquired by travellers to endemic regions in Europe: a EuroTravNet multi-centre study.
abstract: BACKGROUND
  Leishmaniasis is a disease caused by protozoan parasites of the genus Leishmania. Clinical manifestations of leishmaniasis include cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL). About 90% of cases occur in the tropics or subtropics but the disease is also endemic in the Mediterranean area. No systematic analysis on leishmaniasis in travellers visiting endemic areas in Europe is available.
  
  
  METHODS
  Within the European travel medicine network EuroTravNet, we performed a retrospective analysis in travellers who acquired leishmaniasis within Europe diagnosed between 2000 and 2012.
  
  
  RESULTS
  Forty cases of leishmaniasis (30 CL and 10 VL) were identified; the majority were acquired in Spain (n = 20, 50%), Malta and Italy (each n = 7, 18%). Median age was 48 years (range 1-79). Three of eight (37.5%) of the VL patients were on immunosuppressive therapy. The most frequent reason for travel was tourism (83%). Median duration of travel for patients with CL and VL was 2 weeks with ranges of 1-21 weeks in CL and 1-67 weeks in VL, respectively (P = 0.03).
  
  
  CONCLUSIONS
  Health professionals should include leishmaniasis in the differential diagnosis in patients returning from southern Europe - including short-term travellers - with typical skin lesions or systemic alterations like fever, hepatosplenomegaly and pancytopenia.
authors.affiliation: Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany.
authors.forename: Urs
authors.initials: U
authors.lastname: Ehehalt
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University of Munich, Leopoldstrasse 5, 80802 Munich, Germany.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Schunk
authors.affiliation: Department of Infectious Diseases, Oslo University Hospital and University of Oslo, Post Box 4956 Nydalen, NO-0424 Oslo, Norway.
authors.forename: Mogens
authors.initials: M
authors.lastname: Jensenius
authors.affiliation: Institute for Tropical Diseases, Harbor Hospital, Haringvliet 72, 3011 TG Rotterdam, The Netherlands.
authors.forename: Perry J J
authors.initials: PJ
authors.lastname: van Genderen
authors.affiliation: Department of Infectious Diseases, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: Effrossyni
authors.initials: E
authors.lastname: Gkrania-Klotsas
authors.affiliation: Division of International and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Chappuis
authors.affiliation: Division of Epidemiology and Communicable Disease, Institute for Social and Preventive Medicine, World Health Organization Collaborating Centre for Travellers' Health, University of Zurich Centre for Travel Medicine, Hirschengraben 84, 8001 Zurich, Switzerland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Schlagenhauf
authors.affiliation: University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Castelli
authors.affiliation: Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Carretera de Colmenar 9,1, 28034 Madrid, Spain.
authors.forename: Rogelio
authors.initials: R
authors.lastname: Lopez-Velez
authors.affiliation: University Hospital Institute in Infectious Diseases, Tropical Medicine Unit, Aix-Marseille-Université and Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Parola
authors.affiliation: Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany; Section Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany.
authors.forename: Gerd D
authors.initials: GD
authors.lastname: Burchard
authors.affiliation: Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany; Section Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany. Electronic address: cramer@bni-hamburg.de.
authors.forename: Jakob P
authors.initials: JP
authors.lastname: Cramer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D019353:Endemic Diseases; D005060:Europe; D005260:Female; D006801:Humans; D007223:Infant; D016773:Leishmaniasis, Cutaneous / Q000453:epidemiology*; D007898:Leishmaniasis, Visceral / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014195:Travel / Q000706:statistics & numerical data*; D057236:Travel Medicine; D055815:Young Adult
keywords: Cutaneous; Europe; Leishmaniasis; Traveller; Visceral