Begoña Monge-Maillo

Autochthonous mucocutaneous leishmaniasis caused by Leishmania infantum is an under-recognised but established manifestation of endemic leishmaniasis in Spain. This review identified 65 confirmed autochthonous cases reported since 1990, showing a relatively consistent clinical pattern. Most patients were adults, predominantly men in the fifth or sixth decade of life. Nearly half were immunosuppressed, mainly due to HIV infection, corticosteroid use, biologic therapy, autoimmune diseases, or solid organ transplantation, although immunocompetent individuals were also affected. The laryngeal, nasal, and oral mucosa were the most commonly involved sites, with occasional tracheal and bronchial disease. Clinical presentation was typically chronic and non-specific, including ulcerative, nodular, polypoid, or tumour-like lesions that frequently mimicked malignancy or inflammatory disorders, often delaying diagnosis. Unlike classical New World mucocutaneous leishmaniasis, Spanish cases generally lacked a preceding cutaneous lesion, supporting recognition as a distinct form of L. infantum infection. Diagnosis required microbiological confirmation, ideally with species identification through culture or molecular methods, while serology showed limited reliability. Treatment approaches varied considerably, reflecting the absence of standardised protocols, although systemic therapy (particularly liposomal amphotericin B) was most commonly used. Improved recognition, surveillance, and inclusion in clinical guidelines are needed to reduce diagnostic delay and therapeutic variability.

Background: Leishmaniasis, a vector-borne disease caused by the parasite Leishmania, is a public health concern in Europe. Although Spain is an endemic country, it lacks a national surveillance network. To address this, the creation of a research and surveillance network is proposed, which would integrate data from various fields and enhance control and public health strategies. Objectives: The first objective is to gather epidemiological data on vectors, reservoirs, and transmission rates in Spain, with a particular focus on the role of dogs and wildlife as primary reservoirs. The plan includes establishing forums, databases, and specialised training programmes. The second objective is to improve case surveillance and reporting by establishing a comprehensive national registry. Implementing molecular diagnostics and bioinformatics tools will aid analysis of retrospective data and tracking of disease evolution. The third objective is to develop a standardised method for the molecular characterisation of Leishmania, using techniques such as PCR and genomic sequencing to detect virulence and resistance patterns. Key actions include collecting isolates, sharing analytical tools and providing genomic training. The fourth objective is to identify new therapeutic targets in response to toxicity and resistance to current treatments by studying specific enzymes (FeSOD, HDAC), metabolic pathways, and natural products. Ultimately, establishing the Leishmaniasis Surveillance Network will support a “One Health” approach and promote interdisciplinary collaboration towards a national control plan. Methods: We created the Working Group on Leishmaniasis funded by the Spanish Society of Tropical Medicine and International Health as a leishmaniasis forum for meetings and discussions on weaknesses and gaps we find in the knowledge and management of the infection based on the background of each academic and healthcare research group. Expected Impact: This study will promote the articulation of a Leishmaniasis Surveillance Network aiming to bring together the main stakeholders in the research and management of leishmaniasis in Spain.

Leishmaniasis, a vector-borne disease caused by the parasite Leishmania, is a public health concern in Europe. Although Spain is an endemic country, it lacks a national surveillance network. To address this, the creation of a research and surveillance network is proposed, which would integrate data from various fields and enhance control and public health strategies. The first objective is to gather epidemiological data on vectors, reservoirs and transmission rates in Spain, with a particular focus on the role of dogs and wildlife as primary reservoirs. The plan includes establishing forums, databases, and specialised training programmes. The second objective is to improve case surveillance and reporting by establishing a comprehensive national registry. Implementing molecular diagnostics and bioinformatics tools will aid analysis of retrospective data and tracking of disease evolution. The third objective is to develop a standardised method for the molecular char-acterisation of Leishmania, using techniques such as PCR and genomic sequencing to de-tect virulence and resistance patterns. Key actions include collecting isolates, sharing an-alytical tools and providing genomic training. The fourth objective is to identify new therapeutic targets in response to toxicity and resistance to current treatments by studying specific enzymes (FeSOD, HDAC), metabolic pathways and natural products. Ultimately, establishing the Leishmaniasis Surveillance Network will support a 'One Health' ap-proach and promote interdisciplinary collaboration towards a national control plan.

Altered lipid profiles have been observed in acute malaria, though mechanisms remain unclear. The impact of asymptomatic submicroscopic malaria infection (AMI) on lipids is unexploredAn observational, comparative, retrospective study was conducted of 1278 asymptomatic Sub-Saharan African migrants (ASSAMs) screened for malaria and lipid profiles during health exams (2010–2022). A systematic screening protocol for infectious disease was performed, including screening for Plasmodium spp. infection by polymerase chain reaction (PCR).Among 800 ASSAMs screened for malaria, 104 (13%) were PCR-positive: P. falciparum (68.72%), P. malariae (18.27%), P. ovale (9.62%), and mixed infections (3.8%). Participants with AMIs exhibited lower baseline lipid levels: total cholesterol (146 vs. 163 mg/dL; p < 0.001), HDL (43 vs. 47 mg/dL; p < 0.001), and LDL (87.5 vs. 98 mg/dL; p < 0.001), with no differences in triglycerides. After treatment, lipid levels partially equalized: total cholesterol (156 vs. 166; p = 0.01), HDL (44 vs. 47.5; p = 0.05), LDL (102 vs. 108.5; p = 0.31), with no changes in triglycerides. Patients with AMI showed higher rates of co-infections (Strongyloides 20.61% vs. 14.35%; p < 0.001; filariae 7.69% vs. 1.91%; p = 0.02) and lower mean corpuscular volume (87.2 vs. 85; p < 0.001). Conclusions: These findings suggest that cholesterol reductions in AMI are not solely due to acute inflammation but may reflect chronic inflammatory processes triggered by asymptomatic malaria. This supports a potential link between AMI and lipid profile changes, underscoring its role in subclinical chronic inflammation.

Highly active antiretroviral therapy (HAART) has reduced the incidence of VL/HIV dramatically. However, HAART only partially prevents relapses, with one-year relapse rates ranging from 30 to 60%. Consequently, secondary prophylaxis is recommended for patients with Leishmania antigen was assessed in 2022 and 2023 in three cases of VL/HIV coinfection with long-term follow-up (17, 8 and 19 years). PCR and rK-39 results for Leishmania, HIV viral load, CD4 cell count, proliferation index, IFN-γ, IL-2, IP-10, IL-10 and TNF-α were determined. Heterogeneous results were obtained, with only one patient having developed specific cellular immunity against Leishmania. No cases of relapse were observed. The heterogeneity of lymphoproliferative test results in the three cases described highlights the need to identify surrogate markers of cure to guide maintenance or withdrawal of prophylaxis.

Background: Chronic schistosomiasis can lead to significant morbidity. Serology is highly sensitive; however, its role in assessing treatment response is controversial. This study aimed to analyze serological values following treatment of chronic imported schistosomiasis. Methods: A retrospective observational study was performed including patients treated for chronic imported schistosomiasis from 2018 to 2022 who had at least one serological result at baseline and during follow-up. Demographic, clinical, and laboratory data were evaluated. Generalized estimating equation (GEE) models and Kaplan–Meier curves were used to analyze the evolution of serological values. Results: Of the 83 patients included, 72 (86.7%) were male, and the median age was 26 years (IQR 22–83). Most patients, 76 (91.6%), were migrants from sub-Saharan Africa. While 24 cases (28.9%) presented with urinary symptoms, the majority (59; 71.1%) were asymptomatic. Schistosoma haematobium eggs were observed in five cases (6.2%). Eosinophilia was present in 34 participants (40.9%). All patients had an initial positive Schistosoma ELISA serology, median ODI 2.3 (IQR 1.5–4.4); the indirect hemagglutination (IHA) test was positive/indeterminate in 34 cases (43.1%). Following treatment with praziquantel, serology values significantly decreased: −0.04 (IC95% −0.073, −0.0021) and −5.73 (IC95% −9.92, −1.53) units per month for ELISA and IHA, respectively. A quarter of patients (25%) had negative ELISA results 63 weeks after treatment. All symptomatic cases were clinically cured. Conclusions: Serial serological determinations could be helpful for monitoring chronic schistosomiasis in non-endemic regions. The ideal timing for these follow-up tests is yet to be determined. Further research is needed to determine the factors that influence a negative result during follow-up.

Background: In non-endemic countries, malaria can be transmitted through blood donations from imported cases. To ensure standards of quality and safety of human blood, the European Union and Spanish national law, requires a deferral period, or a screening by immunological or genomic test among those donors with potential risk of malaria. Scientific societies, European Committee on Blood Transfusion, and Spanish Society of Haematology and Haemotherapy, refer only to the result of the immunological test. Methods: An observational retrospective study was performed in potential donors with a positive immunological test for malaria done in the Regional Transfusion Center in Madrid and referred to the National Reference Unit for Tropical Diseases in Madrid between 2015–2020. At consultation a Polymerase Chain Reaction (PCR) for malaria was performed. Results: During the study period, 121 possible donors attended for consultation at NRU-Trop. Median age: 38.5 (IQR:33–48); median time to consultation was 32 months (IQR:12.5–110). Eighty-two (67.8%) donors were migrants and thirty-nine were travellers (32.2%). ELISA values were available for 109 subjects (90.1%), 56 individual left malaria endemic area > 3 years before. All donors tested negative for Plasmodium spp PCR test (n = 121, 100%). Conclusions: None of the subjects with a positive immunologic test deferred as blood donors had a positive genomic test. The presence of Plasmodium spp in collected blood was not detected by molecular techniques. To avoid the loss of potential blood donors, especially those with low incidence red blood cell antigens, as more precise microbiology techniques become available, updating the existing legislation becomes necessary to increase the availability of donated blood.

Chagas disease is currently present in many non-endemic countries and remains a neglected tropical disease globally. A review of the literature identified significant gaps and scarcity of updated information from European countries, with most studies reporting data from Spain and Italy. The index of underdiagnosis may be as high as 70%, affecting mainly females of child-bearing age. Standardized screening of fertile, non-pregnant, women from endemic countries and subsequent treatment is considered an essential strategy to control transmission and prevent new cases, yet no uniform legislation for screening risk groups exists. There is heterogeneity in Europe in terms of preventive strategies to avoid transfusion-related transmission of Chagas disease, not necessarily in line with the European directives, with some countries conducting systematic screening for T. cruzi infection in blood donors, whilst others rely on pre-transfusion questionnaires. The growing burden of the infection in resource-rich areas may provide an opportunity for progress in certain aspects of control and prevention. Options for improving screening strategies, management and linkage to care are reviewed.

A frequency of HbS or haemoglobin C trait of 15% was found in a cohort of recently arrived, mainly asymptomatic, young sub-Saharan Africans, using a simple point-of-care screening test. Screening allows early diagnosis of haemoglobinopathies in vulnerable populations facilitating linkage to care, genetic counselling and implementation of treatment and prevention strategies.

Purpose of review: Cystic echinococcosis (CE) has a wide world distribution causing important morbidity. Osseous involvement is present in less than 4% of the CE cases. Its diagnosis and therapeutic management is full of challenges and low grade of evidence. Recent findings: The study summarizes literature evidence on the management of osseous CE with particular emphasis on new data regarding diagnosis and treatment. Summary: Clinical presentation of osseous CE depends on the skeletal area affected. Diagnosis is mostly based on radiological findings and serology. Recent advances with qPCR on osseous tissue samples seem to be a good option for diagnosis confirmation. Complete resection of the cystic lesion is the only curative option, but it is usually not possible performing palliative surgery and prolonged albendazole intake in most cases. Radiotherapy could be an option, but experience to date is only based on clinical cases.