BACKGROUND Leishmaniasis, considered by the World Health Organization as one of the most important tropical diseases, is endemic in the Mediterranean Basin. The aim of this study was to evaluate epidemiological and clinical characteristics of cutaneous (CL) and mucocutaneous leishmaniasis (MCL) in La Fe University Hospital, Valencia, Spain. The particular focus was on diagnosis techniques and clinical differences according to the immunological status of the patients. METHODS An eleven-year retrospective observational study of CL and MCL episodes at the hospital was performed. Epidemiological, clinical and therapeutic variables of each case, together with the microbiological and anatomopathological diagnosis, were analyzed. RESULTS A total of 42 patients were included, 30 of them were male and 28 were immunocompetent. Most of the cases (36/42) were diagnosed in the last 5 years (2013-2017). The incidence of CL and MCL increased from 3.6/100,000 (2006-2012) to 13.58/100,000 (2013-2017). The majority of the patients (37/42) exhibited CL, in 30 cases as single lesions (30/37). Ulcerative lesions were more common in immunosuppressed patients (13/14) than in immunocompetent patients (20/28), (P = 0.2302). The length of lesion presence before diagnosis was 7.36 ± 6.72 months in immunocompetent patients and 8.79 ± 6.9 months in immunosuppressed patients (P = 0.1863). Leishmania DNA detection (92.3%) was the most sensitive diagnostic technique followed by Giemsa stain (65%) and histopathological examination (53.8%). Twelve patients (12/42) had close contact with dogs or were living near to kennels, and 10 of them did not present underlying conditions. Intralesional glucantime (21/42) and liposomal amphotericin B (7/42) were the most common treatments administered in monotherapy. All patients evolved successfully and no relapse was reported. CONCLUSIONS Some interesting clinical and epidemiological differences were found in our series between immunocompetent and immunosuppressed patients. Future studies can take these results further especially by studying patients with biological therapy. Skin biopsies combining NAAT with histological techniques are the most productive techniques for CL or MCL diagnosis.

中文翻译：

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皮肤和粘膜皮肤利什曼病：一家地中海医院的经验。

背景技术利什曼病被世界卫生组织认为是最重要的热带病之一，是地中海盆地的地方病。这项研究的目的是评估西班牙巴伦西亚拉菲大学医院的皮肤（CL）和粘膜皮肤利什曼病（MCL）的流行病学和临床特征。根据患者的免疫状况，特别关注诊断技术和临床差异。方法进行了为期11年的对CL和MCL发作的回顾性观察研究。分析了每种病例的流行病学，临床和治疗变量，以及微生物学和解剖病理学诊断。结果共纳入42例患者，其中男性30例，具有免疫能力28例。大多数病例（36/42）是在最近5年（2013-2017年）诊断的。CL和MCL的发生率从3.6 / 100,000（2006-2012）增加到13.58 / 100,000（2013-2017）。大多数患者（37/42）表现为CL，其中30例表现为单一病变（30/37）。免疫抑制患者（13/14）的溃疡性病变比免疫功能正常的患者（20/28）更常见（P = 0.2302）。免疫功能正常的患者在诊断前病变的存在时间为7.36±6.72个月，免疫抑制的患者为8.79±6.9个月（P = 0.1863）。利什曼原虫DNA检测（92.3％）是最敏感的诊断技术，其次是Giemsa染色（65％）和组织病理学检查（53.8％）。12名患者（12/42）与狗有密切接触或住在狗窝附近，其中10名没有出现潜在疾病。内葡聚糖时间（21/42）和脂质体两性霉素B（7/42）是单一疗法中最常用的治疗方法。所有患者均成功进化，无复发报告。结论在我们的系列中，有免疫能力和免疫抑制的患者之间发现了一些有趣的临床和流行病学差异。未来的研究可以使这些结果更进一步，特别是通过研究生物疗法的患者。结合NAAT和组织学技术的皮肤活检是诊断CL或MCL的最有效技术。结论在我们的系列中，有免疫能力和免疫抑制的患者之间发现了一些有趣的临床和流行病学差异。未来的研究可以使这些结果更进一步，特别是通过研究生物疗法的患者。结合NAAT和组织学技术的皮肤活检是诊断CL或MCL最有效的技术。结论在我们的系列中，有免疫能力和免疫抑制的患者之间发现了一些有趣的临床和流行病学差异。未来的研究可以使这些结果更进一步，特别是通过研究生物疗法的患者。结合NAAT和组织学技术的皮肤活检是诊断CL或MCL的最有效技术。