Leishmaniasis is caused by the protozoan Leishmania, which belongs to the class Kinetoplastida, the order Tryanosomatida and the family Trypanosomatidae. Leishmania is transmitted by sandfly bites, and depending on the species, dogs, rodents and humans are common reservoirs (1).
The manifestation depends on immune status and Leishmania species. It varies from a fatal course in visceral leishmaniasis if it goes untreated, to extensive lesions in the face and throat in the case of the mucocutaneous form, and to self-healing lesions with the cutaneous form (1).
Visceral leishmaniasis is endemic in 78 countries (2). The incidence has declined in recent years, and in 2018 about 17 000 new cases were reported. Of these, 90 % were in Brazil, Sudan, South-Sudan, Ethiopia, Kenya, Somalia and India (2). However, infections also occur in southern Europe. A study of travellers in Europe in the period 2000–2012 found 10 cases of visceral leishmaniasis and 30 cases of cutaneous leishmaniasis, the places of exposure being Spain, Malta and Italy (3). The mucocutaneous form, which is usually caused by the subgenus Leishmania (Viannia), is found mainly in South and Central America, while the cutaneous form is most common in South and Central America, Africa and Asia. The incidence of cutaneous leishmaniasis is increasing (2).
The Infectious Diseases Society of America (IDSA) has published guidelines for diagnosis and treatment in 2016 (4), and a European group of experts published recommendations for cutaneous leishmaniasis in 2014 (5). Polymerase chain reaction (PCR) testing and sequencing are recommended for species identification, which provides a basis for choice of treatment. This was not available in Norway as routine diagnostic testing before 2015.
Liposomal amphotericin B is recommended for visceral and mucocutaneous leishmaniasis, while local treatment is recommended for the cutaneous form in suitable cases (4, 5). Treatment for cutaneous leishmaniasis must be individualised, as there is no evidence providing a basis for universal recommendations. Drugs for local treatment do not have market authorisation in Norway and must be imported for compassionate use.
As this disease is rare in Norway, and the drugs are not readily available or are associated with potential adverse effects, there is a risk of inappropriate management. The aim of this study was to investigate the number of cases diagnosed, performance of diagnostic methods used and treatment of leishmaniasis at five university hospitals in Norway.