Cutaneous leishmaniasis imported from Colombia to Northcentral Venezuela: Implications for travel advice

Background: Imported leishmaniasis could be defined as any case acquired outside of a defined area in which the diagnosis of leishmaniasis is made. This definition has been used for the diagnosis of disease in a patient who arrives from an endemic area and displays symptoms or seeks medical attention in a nonendemic zone. However, this phenomenon can also occur between two endemic zones. Methods: We evaluated the epidemiologic features of imported cases of cutaneous leishmaniasis imported from Colombia into Northcentral Venezuela from 2001 to 2006. A total of 29 patients with the clinical diagnosis of cutaneous leishmaniasis arriving from Colombia were evaluated at our referral center. Different diagnostic methods were used to confirm the diagnosis (the Montenegro skin test; an indirect immunofluorescence test and smear of cutaneous lesion). Clinical and epidemiological features of cutaneous leishmaniasis among these patients were evaluated. Results: We identified that most identified patients were male with a mean age of 35 years (age range was 7-64); all cases were from northern departments of Colombia. These patients presented a mean clinical evolution of 3 months. Most patients presented with one cutaneous lesion (17%), which were located mostly in extremities (20%). Of the 29 patients, in 16 (55%) cutaneous leishmaniasis was confirmed by different diagnostic techniques. In 2 patients the diagnosis was made by smear. In the rest, 14 (100%) patients were positive by the Montenegro skin test and 11 (79%) were positive by the indirect immunofluorescence test (79% were positive simultaneously by both tests). Discussion: The identification of imported cutaneous leishmaniasis in our setting becomes important, given the differences in the epidemiology of the disease and the clinical severity of leishmaniasis between both zones (ecological characteristics, circulating Leishmania spp., and population characteristics) and the risk of the mucocutaneous forms of the disease.