Imported Leishmaniasis in Europe (2000-2024): A systematic review of travel-related case reports

Background: This review aims to systematically analyze imported leishmaniasis cases reported between 2000 and 2024, focusing on geographic origin, host demographics, clinical manifestations, diagnostic approaches, and species distribution. Methods: A systematic review was conducted in accordance with the PRISMA guidelines across PubMed, Scopus, and Web of Science. Inclusion criteria encompassed case reports and series in English or Spanish that described laboratory-confirmed human leishmaniasis acquired outside of Europe. The risk of bias was assessed using the JBI Critical Appraisal Tool. Data was extracted and analyzed using RStudio (v4.3.1) for statistical exploration, including subgroup analysis and temporal trends. The protocol was registered in PROSPERO (CRD420251128116). Results: Twelve studies documenting 127 published cases were reviewed, mainly from Germany, Spain, Poland, and Austria. The most common form was cutaneous leishmaniasis (63%), followed by mucocutaneous (27%) and visceral (10%). Visceral leishmaniasis was significantly linked to lower odds of being a tourist (OR: 0.24; 95% CI: 0.07-0.87; p = 0.027). Diagnostic methods varied, including PCR, histology, and microscopy. The main species were L. braziliensis, L. panamensis, and L. donovani. Treatments involved liposomal amphotericin B and systemic antimonials, though resistance and outcomes were inconsistently reported. Conclusions: The importation of leishmaniasis in Europe highlights a growing health challenge. Diagnostic variability, underreporting, and limited clinician awareness cause delays and mismanagement. Enhancing surveillance, standardizing diagnostics, and adding pre-travel advice to routine care are vital. Future research should focus on species resistance, coinfections, and long-term effects for better guidelines.