1887
Surveillance Open Access
Like 0

Abstract

Background

Human leishmaniasis is a protozoan disease transmitted by sand flies and endemic in the Mediterranean region. In Italy, leishmaniasis is present in the south and the western coastal regions, with an epidemic peak detected in northern Italy in the early 1970s.

Aim

To examine temporal trends, and demographic, clinical, geographical and environmental features of human leishmaniasis cases recorded by the local health unit (LHU) of Bologna, northern Italy.

Methods

In this retrospective observational study, we analysed human leishmaniasis cases recorded from 2004 to 2022 within the Bologna LHU. We also conducted serological investigations for canine leishmaniasis in owned dogs living near the place of infection of human cases.

Results

In total, 173 cases of human leishmaniasis were detected, and 154 cases were considered autochthonous. An increase of human cases was observed since 2004, with incidence peaks above 2 cases/100,000 inhabitants in 2013, 2018 and 2022; epidemic peaks were preceded by dry summers. Most cases lived in the plain and hilly areas less than 400 m above sea level and many resided in isolated housing, in city outskirts, and/or near uncultivated areas, watercourses and railway sections. The incidence of canine leishmaniasis did not increase in the study period.

Conclusion

An epidemic of human leishmaniasis with fluctuating annual numbers of cases, probably related to environmental and climatic factors, was identified in the Bologna LHU. Understanding the risk factors and the environmental characteristics related to places of infection is crucial to evaluate the public health implications of leishmaniasis.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2024.29.4.2300190
2024-01-25
2024-12-24
/content/10.2807/1560-7917.ES.2024.29.4.2300190
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/29/4/eurosurv-29-4_3.html?itemId=/content/10.2807/1560-7917.ES.2024.29.4.2300190&mimeType=html&fmt=ahah

References

  1. World Health Organization (WHO). Control of the leishmaniases: report of a meeting of the WHO Expert Committee on the Control of Leishmaniases. Geneva: WHO; 2010. Available from: https://apps.who.int/iris/bitstream/handle/10665/44412/WHO_TRS_949_eng.pdf;jsessionid=C8F6BF44C88D370A5B47380A742D17E9?sequence=1
  2. Gramiccia M, Scalone A, Di Muccio T, Orsini S, Fiorentino E, Gradoni L. The burden of visceral leishmaniasis in Italy from 1982 to 2012: a retrospective analysis of the multi-annual epidemic that occurred from 1989 to 2009. Euro Surveill. 2013;18(29):20535.  https://doi.org/10.2807/1560-7917.ES2013.18.29.20535  PMID: 23929120 
  3. Gradoni L. The Leishmaniases of the Mediterranean Region. Curr Trop Med Rep. 2017;4(1):21-6.  https://doi.org/10.1007/s40475-017-0099-1 
  4. World Health Organization/Regional office for Europe (WHO/Europe). Manual on case management and surveillance of the leishmaniases in the WHO European Region. Copenhagen: WHO/Europe; 2017. Available from: https://www.who.int/publications/i/item/9789289052511
  5. Normativa (Presidency of the Council of Ministers). REGIO DECRETO, n. 1265. [ROYAL DECREE, No. 1265. Approval of the consolidated text of health laws. (034U1265)]. Rome: Presidency of the Council of Ministers; 1934. [Accessed: 14 Jul 2023]. Italian. Available from: https://www.normattiva.it/uri-res/N2Ls?urn:nir:stato:regio.decreto:1934-07-27;1265!vig=
  6. Pampiglione S, La Placa M, Schlick G. Studies on mediterranean Leishmaniasis. I. An outbreak of visceral leishmaniasis in Northern Italy. Trans R Soc Trop Med Hyg. 1974;68(5):349-59.  https://doi.org/10.1016/0035-9203(74)90148-5  PMID: 4458145 
  7. Pampiglione S. Aspetti epidemiologici del focolaio di leishmaniosi viscerale dell’Emilia-Romagna 1971-72. [Epidemiological aspects of the focus of visceral leishmaniasis in Emilia-Romagna 1971-72. Journal of Infectious and Parasitic Diseases]. Giornale di Malattie Infettive e Parassitarie. 1982;34(11bis):1475-1480. Italian.
  8. Cardoso L, Schallig H, Persichetti MF, Pennisi MG. New epidemiological aspects of animal leishmaniosis in Europe: the role of vertebrate hosts other than dogs. Pathogens. 2021;10(3):307.  https://doi.org/10.3390/pathogens10030307  PMID: 33800782 
  9. Pampiglione S, Manson-Bahr PE, Giungi F, Giunti G, Parenti A, Canestri Trotti G. Studies on Mediterranean leishmaniasis. 2. Asymptomatic cases of visceral leishmaniasis. Trans R Soc Trop Med Hyg. 1974;68(6):447-53.  https://doi.org/10.1016/0035-9203(74)90067-4  PMID: 4460309 
  10. Corradetti A. Phlebotomus and leishmaniasis in north-central Italy (Apennine region). Sci Rep Ist Super Sanita. 1962;2:103-9.
  11. Padovani A, Grenni A. Piano Specifico sorveglianza malattie trasmesse da vettori (leishmaniosi). Il Piano Regionale Integrato della Regione Emilia-Romagna 2020-2022. [Specific Plan for the surveillance of vector-borne diseases (leishmaniasis). The Integrated Regional Plan of the Emilia-Romagna Region 2020-2022.] Bologna: Directorate-General for Personal Care, Health and Welfare of the Emilia-Romagna Region; 2022. Italian. Available from: https://salute.regione.emilia-romagna.it/normativa-e-documentazione/rapporti/contributi/1_piano-integrato-definitivo.pdf
  12. Varani S, Cagarelli R, Melchionda F, Attard L, Salvadori C, Finarelli AC, et al. Ongoing outbreak of visceral leishmaniasis in Bologna Province, Italy, November 2012 to May 2013. Euro Surveill. 2013;18(29):20530.  https://doi.org/10.2807/1560-7917.ES2013.18.29.20530  PMID: 23929116 
  13. Franceschini E, Puzzolante C, Menozzi M, Rossi L, Bedini A, Orlando G, et al. Clinical and microbiological characteristics of visceral leishmaniasis outbreak in a northern Italian nonendemic area: a retrospective observational study. BioMed Res Int. 2016;2016:6481028.  https://doi.org/10.1155/2016/6481028  PMID: 27999807 
  14. Gaspari V, Gritti T, Ortalli M, Santi A, Galletti G, Rossi A, et al. Tegumentary leishmaniasis in Northeastern Italy from 2017 to 2020: a neglected public health issue. Int J Environ Res Public Health. 2022;19(23):16047.  https://doi.org/10.3390/ijerph192316047  PMID: 36498130 
  15. Gaspari V, Zaghi I, Macrì G, Patrizi A, Salfi N, Locatelli F, et al. Autochthonous cases of mucosal leishmaniasis in northeastern Italy: clinical management and novel treatment approaches. Microorganisms. 2020;8(4):588.  https://doi.org/10.3390/microorganisms8040588  PMID: 32325735 
  16. Italian Ministry of Health. Prevenzione e Controllo della Leishmaniosi in Italia. [Prevention and control of leishmaniasis in Italy]. Rome: Italian Ministry of Health; 2020. [Accessed: 14 Jul 2023]. Italian. Available from: https://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2020&codLeg=77839&parte=1%20&serie=null
  17. Varani S, Ortalli M, Attard L, Vanino E, Gaibani P, Vocale C, et al. Serological and molecular tools to diagnose visceral leishmaniasis: 2-years’ experience of a single center in Northern Italy. PLoS One. 2017;12(8):e0183699.  https://doi.org/10.1371/journal.pone.0183699  PMID: 28832646 
  18. Rugna G, Carra E, Corpus F, Calzolari M, Salvatore D, Bellini R, et al. Distinct Leishmania infantum strains circulate in humans and dogs in the Emilia-Romagna Region, Northeastern Italy. Vector Borne Zoonotic Dis. 2017;17(6):409-15.  https://doi.org/10.1089/vbz.2016.2052  PMID: 28301296 
  19. World Organisation for Animal Health (WOAH). Leishmaniosis. In: Manual of diagnostic tests and vaccines for terrestrial animals. Paris: WOAH 2021. [Accessed: 18 Dec 2023]. Available from: https://www.woah.org/fileadmin/Home/eng/Health_standards/tahm/3.01.11_LEISHMANIOSIS.pdf
  20. Van der Auwera G, Davidsson L, Buffet P, Ruf MT, Gramiccia M, Varani S, et al. Surveillance of leishmaniasis cases from 15 European centres, 2014 to 2019: a retrospective analysis. Euro Surveill. 2022;27(4):20020.  https://doi.org/10.2807/1560-7917.ES.2022.27.4.2002028  PMID: 35086613 
  21. Arce A, Estirado A, Ordobas M, Sevilla S, García N, Moratilla L, et al. Re-emergence of leishmaniasis in Spain: community outbreak in Madrid, Spain, 2009 to 2012. Euro Surveill. 2013;18(30):20546.  https://doi.org/10.2807/1560-7917.ES2013.18.30.20546  PMID: 23929177 
  22. Calzolari M, Romeo G, Callegari E, Bonilauri P, Chiapponi C, Carra E, et al. Co-circulation of phleboviruses and Leishmania parasites in sand flies from a single site in Italy monitored between 2017 and 2020. Viruses. 2021;13(8):1660.  https://doi.org/10.3390/v13081660  PMID: 34452524 
  23. Michelutti A, Toniolo F, Bertola M, Grillini M, Simonato G, Ravagnan S, et al. Occurrence of phlebotomine sand flies (Diptera: Psychodidae) in the northeastern plain of Italy. Parasit Vectors. 2021;14(1):164.  https://doi.org/10.1186/s13071-021-04652-2  PMID: 33761950 
  24. Fischer D, Moeller P, Thomas SM, Naucke TJ, Beierkuhnlein C. Combining climatic projections and dispersal ability: a method for estimating the responses of sandfly vector species to climate change. PLoS Negl Trop Dis. 2011;5(11):e1407.  https://doi.org/10.1371/journal.pntd.0001407  PMID: 22140590 
  25. Torretta E, Orioli V, Bani L, Mantovani S, Dondina O. En route to the North: modelling crested porcupine habitat suitability and dispersal flows across a highly anthropized area in northern Italy. Mamm Biol. 2021;101(6):1067-77.  https://doi.org/10.1007/s42991-021-00155-w 
  26. Lucas PS, Gomes de Carvalho R, Grilo C. Railway disturbances on wildlife: types, effects, and mitigation measures. In: Borda-de-Água L, Barrientos R, Beja P, Pereira H. (eds) Railway Ecology. 2017. 81-99. Springer, Cham.
  27. National Aeronautics and Space Administration (NASA). 2009: Second warmest year on record; end of warmest decade. Climate change: vital signs of the planet. Washington DC: NASA. [Accessed: 18 Jan 2023]. Available from: https://climate.nasa.gov/news/249/2009-second-warmest-year-on-record-end-of-warmest-decade
  28. Alten B, Maia C, Afonso MO, Campino L, Jiménez M, González E, et al. Seasonal dynamics of phlebotomine sand fly species proven vectors of Mediterranean leishmaniasis caused by Leishmania infantum. PLoS Negl Trop Dis. 2016;10(2):e0004458.  https://doi.org/10.1371/journal.pntd.0004458  PMID: 26900688 
  29. Miró G, Petersen C, Cardoso L, Bourdeau P, Baneth G, Solano-Gallego L, et al. Novel areas for prevention and control of canine leishmaniosis. Trends Parasitol. 2017;33(9):718-30.  https://doi.org/10.1016/j.pt.2017.05.005  PMID: 28601528 
  30. Rugna G, Carra E, Bergamini F, Calzolari M, Salvatore D, Corpus F, et al. Multilocus microsatellite typing (MLMT) reveals host-related population structure in Leishmania infantum from northeastern Italy. PLoS Negl Trop Dis. 2018;12(7):e0006595.  https://doi.org/10.1371/journal.pntd.0006595  PMID: 29975697 
  31. Taddei R, Bregoli A, Galletti G, Carra E, Fiorentini L, Fontana MC, et al. Wildlife hosts of Leishmania infantum in a re-emerging focus of human leishmaniasis, in Emilia-Romagna, Northeast Italy. Pathogens. 2022;11(11):1308.  https://doi.org/10.3390/pathogens11111308  PMID: 36365059 
  32. Magri A, Galuppi R, Fioravanti M, Caffara M. Survey on the presence of Leishmania sp. in peridomestic rodents from the Emilia-Romagna Region (North-Eastern Italy). Vet Res Commun. 2023;47(1):291-6.  https://doi.org/10.1007/s11259-022-09925-4  PMID: 35412180 
  33. Carrillo E, Moreno J, Cruz I. What is responsible for a large and unusual outbreak of leishmaniasis in Madrid? Trends Parasitol. 2013;29(12):579-80.  https://doi.org/10.1016/j.pt.2013.10.007  PMID: 24275160 
/content/10.2807/1560-7917.ES.2024.29.4.2300190
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error