title: Visceral leishmaniasis and immunocompromise as a risk factor for the development of visceral leishmaniasis: a changing pattern at the hospital for tropical diseases, london.
abstract: RESULTS
  A retrospective study of imported VL to the HTD, London including patients diagnosed and/or managed at the HTD between January 1995 and July 2013. We analyse patient demographics, risk factors for developing VL, diagnosis, investigation, management and outcome. Twenty-eight patients were treated for VL at the HTD over an 18 year period. The median age at VL diagnosis was 44 years (range 4-87 years) with a male to female ratio of 2:1. Most patients were British and acquired their infection in the Mediterranean basin. The median time from first symptom to diagnosis was six months with a range of 1-12 months and diagnosis included microscopic visualisation of leishmania amastigotes, positive serological tests (DAT and k39 antibody) or identification of leishmania DNA. Nineteen patients had some form of immunocompromise and this has increased proportionally compared to previously described data. Within the immunocompromised group, the ratio of those with autoimmune disease has increased. Immunocompromised patients had lower cure and higher relapse rates.
  
  
  CONCLUSIONS
  The rise of VL in patients with immunocompromise secondary to autoimmune disease on immunomodulatory drugs presents new diagnostic and therapeutic challenges. VL should be a differential diagnosis in immunocompromised patients with pyrexia of unknown origin returning from travel in leishmania endemic areas.
authors.affiliation: Hospital for Tropical Diseases and London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Fletcher
authors.affiliation: Hospital for Tropical Diseases and London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Rita
authors.initials: R
authors.lastname: Issa
authors.affiliation: Hospital for Tropical Diseases and London School of Hygiene & Tropical Medicine, London, United Kingdom; The Hospital for Tropical Diseases, University college Foundation Trust, London, WC1E 6AU, United Kingdom.
authors.forename: D N J
authors.initials: DN
authors.lastname: Lockwood
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006782:Hospitals, Special; D006801:Humans; D016867:Immunocompromised Host; D007898:Leishmaniasis, Visceral / Q000453:epidemiology / Q000276:immunology* / Q000469:parasitology; D008131:London; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014330:Tropical Medicine; D055815:Young Adult
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