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Visceral leishmaniasis in Croatia from 1996 - 2018

INTRODUCTION: Visceral leishmaniasis (VL) is a potentially fatal disease endemic in Asia, East Africa, South America and the Mediterranean Region. Early diagnosis and treatment of VL are mandatory in order to prevent fatal outcome of the disease. The aim of the study was to evaluate the data on diagnosis, treatment and outcome of VL in Croatia from 1996 – 2018. METHODS: We conducted a retrospective survey by collecting and analyzing data gathered from reporting forms distributed to the infectious diseases specialists in Croatia. RESULTS: Since 1996 to the end of 2018, 61 patients were treated for visceral leishmaniasis (VL) in Croatia (25 (40.9%) were children <18 years old). In 39 patients the infection was acquired in Southern Croatia where they live, while 16 patients, out of 22 who live outside of the VL endemic areas, recalled travelling to VL endemic countries outside of Croatia and in Croatia as well. There were 6 cases of HIV- Leishmania co-infection ; one patient had a chronic leishmania infection with four clinical relapses. VL was diagnosed based on bone marrow aspirate cytology (performed in 57 patients, 46 positive), serology (40 patients, 37 positive) and PCR (performed in 12, patients, 10 positive). 38 patients were treated with sodium stibogluconate, 4 patients with amphotericin B colloidal dispersion, 13 patients with liposomal amphotericin B and 5 patients with conventional amphotericin B, six patients received combination treatment including allopurinol and fluconazole. Side effects were reported in 11 patients (18%), mainly pancreatitis due to sodium stibogluconate treatment. 55 patients were cured. Four patients died. CONCLUSION: VL is still a sporadic disease in Croatia. In order to reduce the side effects of treatment, duration and cost of hospitalisation, the current recommendations on VL treatment (liposomal amphotericin B as a first line treatment) should be implemented in our clinical practice.

Visceral leishmaniasis ; Croatia ; Epidemiology ; Treatment

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