Visceral leishmaniasis in an immunocompetent Hungarian adult patient


Visceral leishmaniasis caused by L. infantum Nicolle 1908 (Kinetoplastida, Trypanosomatidae) is very rare in immunocompetent adults. Clinical manifestation of the infection occurs in children and immune-compromised patients associated with AIDS, haemopoietic malignancies or after renal, liver, and heart transplantations in Europe. Hungary is regarded free of leishmaniasis. Except for a single infection in a small girl without a travel history, only a few imported cases have been recorded among Hungarians returning from endemic areas. Case presentation: Visceral leishmaniasis was diagnosed in a 32 years old immumocompetent Hungarian man who had spent his holidays during the previous 3 years in Dalmatian territories (Dubrovnik, Makarska and Trogir) of Croatia. He had two months history of fever, chills, and night sweating associated with weight loss. Physical examination showed mild hepatomegaly and extreme splenomegaly. The protozoon infection was confirmed by parasitological, serological and molecular biological methods. Clinical recovery of the patient was observed after treatment with amphotericin B. Conclusion: We want to highlight the effects of climate changes and to call attention of health care professionals in Central and Eastern European countries to consider the possibility of leishmaniasis as an emerging disease of tourists returned from endemic re-gions.

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Péterfi, Z. , Nemes, Z. , Vigvári, S. , Szomor, Á. , Kereskai, L. , Kucsera, I. , Tánczos, B. and Ternák, G. (2011) Visceral leishmaniasis in an immunocompetent Hungarian adult patient. Health, 3, 1-5. doi: 10.4236/health.2011.31001.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Colomba, C., Saporito, L., Vitale, F., Reale, S., Vitale, G., Casuccio, A., Tolomeo, M., Maranto, D., Rubino, R., Di Carlo, P.and Titone, L. (2009) Cryptic leishmania infantum infection in Italian HIV infected patients. BMC Infectious Disesase, 9, 199.
[2] Collin, N., Gomes, R., Teixeira, C., Cheng, L., Laughinghouse, A., Ward, J.M., Elnaiem, D.E., Fischer, L., Valenzuela, J.G. and Kamhawi, S. (2009) Sand fly salivary proteins induce strong cellular immunity in a natural reservoir of visceral leishmaniasis with adverse consequences for leishmania. PLoS Pathogens, 5, e1000441. doi:10.1371/journal.ppat.1000441
[3] Dujardin, J.C., Campino, L., Ca?avate, C., Dedet, J.P., Gradoni, L., Soteriadou, K., Mazeris, A., Ozbel, Y. and Boelaert, M. (2008) Spread of vector-borne diseases and neglect of Leishmaniasis, Europe. Emerging Infectious Disease, 14, 1013-1018. doi:10.3201/eid1407.071589
[4] Desjeux, P. (1991) Information on the epidemiology and control of the leishmaniasis by country or territory. Geneva: World Health Organization [WHO/LEISH/91.30], 30, 10-34.
[5] Kovats, S., Menne, B., McMichael, A., Bertollini, R. and Soskolne, C. (2000) Climate change and stratospheric ozone depletion. Early effects on our health in Europe. WHO Regional Publications, European Series, No 88. World Health Organization Regional Office, Copenhagen, 88, 43-44.
[6] Lindgren, E., Naucke, T. and Menne, B. (2004) Climate variability and visceral leishmaniasis report of the scientific working group on leishmaniasis, TDR/SWG/04 Geneva, 88-93.
[7] Rioux, J.A., Aboulker, J.P., Lanotte, G., Killick-Kendrick, R. and Martini-Dumas, A. (1985) Ecology of leishmaniasis in the south of France. 21. Influence of temperature on the development of Leishmania infantum Nicolle, 1908 in Phlebotomus ariasi Tonnoir, 1921. Experimental study. Annales de Parasitologie Humaine et Comparée, 60, 221-229.
[8] Ready, P.D. (2008) Leishmania manipulates sandfly feeding to enhance its transmission. Trends in Parasitology, 24, 151-153. doi:10.1016/
[9] Gramiccia, M. and Gradoni, L. (2005) The current status of zoonotic leishmaniases and approaches to disease control. International Journal of Parasitology, 35, 1169- 1180. doi:10.1016/j.ijpara.2005.07.001
[10] L?rincz F. and Szentkirályi Z. (1933) Occurrence of phlebotomus macedonicus in Hungary [in Hungarian]. állattani K?zlemények, 3-4, 160-169.
[11] Punda-Polic, V., Sardelic, S. and Bradaric, N. (1998) Visceral leishmaniasis in southern Croatia. The Lancet, 351, 188. doi:10.1016/S0140-6736(05)78208-8
[12] Khoshdel, A., Alborzi, A., Rosouli, M., Taheri, E., Kiany, S. and Javadian, M.H. (2009) Increased levels of IL-10, IL-12, and IFN-γ in patients with visceral leishmaniasis. Brazilian Journal of Infectious Disease, 13, 44-46. doi:10.1590/S1413-86702009000100010
[13] Davidson, R.N. (1999) Visceral leishmaniasis in cinical practice. Journal of Infection, 39, 112-116. doi:10.1016/S0163-4453(99)90001-4
[14] Bosnic, S., Gradoni, L., Khoury, C. and Maroli, M. (2006) A review of leishmaniasis in Dalmatia (Croatia) and results from recent surveys on phlebotomine sandflies in three southern counties. Acta Tropica, 99, 42-49. doi:10.1016/j.actatropica.2006.06.009
[15] Várnai F., Fül?p é. and Bánhegyi D. (1985) Leishmania cutaneous cases imported by Hungarian citizens [in Hungarian]. Orvosi Hetilap, 126, 2535-2539.
[16] Fried K., Todorova R. and Pintér E. (2003) Human visceral leishmaniasis in Hungary. [in Hungarian]. Epinfo, 10, 1.
[17] Lachaud, L., Marchergui-Hammami, S., Chabbert, E., Dereure, J., Dedet, J.P. and Bastien, P. (2002) Comparison of six PCR methods using peripheral blood for detection of canine visceral leishmaniasis. Journal of Clinical Microbiology, 40, 210-215. doi:10.1128/JCM.40.1.210-215.2002
[18] Ben-Ami, R., Schnurc, L.F., Golanb, Y., Jaffec, C.L., Mardia, T. and Zeltser, D. (2002) Cutaneous involvement in a rare case of adult visceral leishmaniasis acquired in Israel. Journal of Infection, 44, 181-184. doi:10.1053/jinf.2002.0953
[19] Dereure, J., Duong Thanh, H., Lavabre-Bertrand, T., Cartron, G., Bastides, F., Richard-Lenoble, D. and Dedet, J.P. (2003) Visceral leishmaniasis. Persistence of parasites in lymph nodes after clinical cure. Journal of Infection, 47, 77-81. doi:10.1016/S0163-4453(03)00002-1
[20] Makara G. (1942) Intresting parasitological cases. leishmania donovani infection in Hungary. [in Hungarian] Orvosi Hetilap, 83, 562.
[21] Antoniou, M., Messaritakis, I., Christodoulou, V., Ascoksilaki, I., Kanavakis, N., Sutton, A.J., Carson, C. and Courtenay, O. (2009) Increasing incidence of zoonotic visceral leishmaniasis on crete, Greece. Emerging Infectious Disease, 15, 932-934. doi:10.3201/eid1506.071666
[22] European Centre for Disease Prevention and Control. (2007) Environmental Change and Infectious Diseases Workshop. Meeting Report, Stockholm, 40-42.
[23] Lindgren, E., Naucke, T., Marty, P. and Menne, B. (2006) Leishmaniasis: Influences of climate and climate change epidemiology, ecology and adaptation measures. In: Menne, B. and Ebi, K.L., Eds., Climate change and adaptation: strategies for human health, Steinkopff Verlag, WHO, Darmstadt, 131-156.

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