Non-Endemic Leishmaniases Reported Globally in Humans between 2000 and 2021-A Comprehensive Review

Leishmaniases are human and animal parasitic diseases transmitted by phlebotomine sand flies. Globalization is an important driver of the burden and in the current dynamics of these diseases. A systematic review of articles published between 2000 and 2021 was conducted using the PubMed search engine to identify the epidemiology and clinical management of imported human leishmaniases as a fundamental step to better manage individual cases and traveler and migrant health from a global perspective. A total of 275 articles were selected, representing 10,341 human imported cases. Identified drivers of changing patterns in epidemiology include conflict and war, as well as host factors, such as immunosuppression, natural and iatrogenic. Leishmania species diversity associated with different clinical presentations implies diagnostic and treatment strategies often complex to select and apply, especially in non-endemic settings. Thus, diagnostic and management algorithms for medical clinical decision support are proposed. Increased surveillance of non-endemic cases, whether in vulnerable populations such as refugees/migrants and immunocompromised individuals or travelers, could improve individual health and mitigate the public health risk of introducing Leishmania species into new areas.

Automated summary

Leishmaniases are parasitic diseases transmitted by sand flies, and globalization plays a significant role in increasing their burden and changing dynamics. This systematic review analyzed epidemiology and clinical management based on articles published between 2000 and 2021, aiming to improve the management of individual cases and global health perspectives. The study identified drivers of changing epidemiology, including conflict, war, and host factors such as immunosuppression. Moreover, the diversity of Leishmania species and their clinical presentations pose challenges in selecting appropriate diagnostic and treatment strategies.