dc.contributor.author |
Bosch-Nicolau, Pau |
dc.contributor.author |
Ubals, Maria |
dc.contributor.author |
Salvador, Fernando |
dc.contributor.author |
Sánchez-Montalvá, Adrián |
dc.contributor.author |
Aparicio, Gloria |
dc.contributor.author |
Erra Duran, Alba |
dc.contributor.author |
Martínez de Salazar, Pablo |
dc.contributor.author |
Sulleiro Igual, Elena |
dc.contributor.author |
Molina Romero, Israel |
dc.contributor.author |
Universitat Autònoma de Barcelona |
dc.date |
2019 |
dc.identifier |
https://ddd.uab.cat/record/223491 |
dc.identifier |
urn:10.1371/journal.pntd.0007708 |
dc.identifier |
urn:oai:ddd.uab.cat:223491 |
dc.identifier |
urn:scopus_id:85072152376 |
dc.identifier |
urn:articleid:19352735v13n8e0007708 |
dc.identifier |
urn:oai:egreta.uab.cat:publications/636eb52c-e071-4457-9511-e880a48238c5 |
dc.identifier |
urn:pmid:31469834 |
dc.identifier |
urn:wos_id:000490919400077 |
dc.identifier |
urn:pmc-uid:6742442 |
dc.identifier |
urn:pmcid:PMC6742442 |
dc.identifier |
urn:oai:pubmedcentral.nih.gov:6742442 |
dc.format |
application/pdf |
dc.language |
eng |
dc.publisher |
|
dc.relation |
PLoS neglected tropical diseases ; Vol. 13 Núm. 8 (2019), p. e0007708 |
dc.rights |
open access |
dc.rights |
Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original. |
dc.rights |
https://creativecommons.org/licenses/by/4.0/ |
dc.subject |
Adolescent |
dc.subject |
Adult |
dc.subject |
Aged |
dc.subject |
Aged, 80 and over |
dc.subject |
Child |
dc.subject |
Female |
dc.subject |
Humans |
dc.subject |
Immunosuppressive Agents |
dc.subject |
Injections, Intramuscular |
dc.subject |
Leishmaniasis |
dc.subject |
Male |
dc.subject |
Mediterranean Region |
dc.subject |
Middle Aged |
dc.subject |
Recurrence |
dc.subject |
Retrospective Studies |
dc.subject |
Systematic Reviews as Topic |
dc.subject |
Tumor Necrosis Factor-alpha |
dc.subject |
Young Adult |
dc.title |
Leishmaniasis and tumor necrosis factor alpha antagonists in the Mediterranean basin. A switch in clinical expression |
dc.type |
Article |
dc.description.abstract |
Background Tumor necrosis factor alpha (TNF-α) blockers are recognized as a risk factor for reactivation of granulomatous infections. Leishmaniasis has been associated with the use of these drugs, although few cases have been reported. Methodology We performed a retrospective observational study including patients with confirmed leishmaniasis acquired in the Mediterranean basin that were under TNF-α blockers therapy at the moment of the diagnosis. Patients diagnosed in our hospital from 2008 to 2018 were included. Moreover, a systematic review of the literature was performed and cases fulfilling the inclusion criteria were also included. Principal findings Forty-nine patients were analyzed including nine cases from our series. Twenty-seven (55.1%) cases were male and median age was 55 years. Twenty-five (51%) patients were under infliximab treatment, 20 (40.8%) were receiving adalimumab, 2 (4.1%) etanercept, one (2%) golimumab and one (2%) a non-specified TNF-α blocker. Regarding clinical presentation, 28 (57.1%) presented as cutaneous leishmaniasis (CL), 16 (32.6%) as visceral leishmaniasis (VL) and 5 (10.2%) as mucocutaneous leishmaniasis (MCL). All VL and MCL patients were treated with systemic therapies. Among CL patients, 13 (46.4%) were treated with a systemic drug (11 received L-AmB, one intramuscular antimonials and one miltefosine) while 14 (50%) patients were given local treatment (13 received intralesional pentavalent antimonials, and one excisional surgery). TNF-α blockers were interrupted in 32 patients (65.3%). After treatment 5 patients (10.2%) relapsed. Four patients with a CL (3 initially treated with local therapy maintaining TNF-α blockers and one treated with miltefosine) and one patient with VL treated with L-AmB maintaining TNF-α blockers. Conclusions This data supports the assumption that the blockage of TNF-α modifies clinical expression of leishmaniasis in endemic population modulating the expression of the disease leading to atypical presentations. According to the cases reported, the best treatment strategy would be a systemic drug and the discontinuation of the TNF-α blockers therapy until clinical resolution. |