%0 Journal Article
%T Leishmaniasis and tumor necrosis factor alpha antagonists in the Mediterranean basin. A switch in clinical expression
%A Adri¨˘n S¨˘nchez-Montalv¨˘
%A Alba Erra
%A Elena Sulleiro
%A Fernando Salvador
%A Gloria Aparicio
%A Israel Molina
%A Maria Ubals
%A Pablo Martinez de Salazar
%A Pau Bosch-Nicolau
%J -
%D 2019
%R 10.1371/journal.pntd.0007708
%X Background Tumor necrosis factor alpha (TNF-¦Á) 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-¦Á 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-¦Á 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-¦Á 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-¦Á blockers and one treated with miltefosine) and one patient with VL treated with L-AmB maintaining TNF-¦Á blockers.   Conclusions This data supports the assumption that the blockage of TNF-¦Á 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-¦Á blockers therapy until clinical resolution
%K Leishmaniasis
%K Leishmania
%K Biopsy
%K Leishmania infantum
%K Bone marrow
%K Parasitic diseases
%K Cytokines
%K Rheumatoid arthritis
%U https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0007708