Visceral leishmaniasis caused by Leishmania infantum in a Spanish patient in Argentina: What is the origin of the infection? Case report

A 71-year-old Spanish woman who has been living in Mendoza, Argentina, during the last 40 years presented with a history of high fever and shivering, anemia, leukopenia and splenomegaly over two years. Argentinian doctors did not suspect visceral leishmaniasis even when the histological analysis revealed the presence of "intracytoplasmatic spheroid particles compatible with fungal or parasitic infection". After a serious deterioration in her health, she was taken to Spain where she was evaluated and visceral leishmaniasis was established. Specific identification of the parasite was done by PCR-ELISA, isoenzyme electrophoresis and RAPD-PCR.We would like to point out that: i) cases such as the one described here, which appear in non-endemic areas, can pass unnoticed by the clinical physician. ii) in countries in which these introduced cases reside, in-depth parasitological studies are required into vectors and possible reservoirs to rule out the rare case of local infection and, once infection has taken place, to ensure that this does not spread by anthroponotic transmission or a competent reservoir.Leishmaniasis is a parasitic infection caused by the obligate intracellular protozoa Leishmania and is transmitted by the bite of the sand fly. Leishmania currently infects about 12 million people in 88 countries, with an approximated incidence of 0.5 million cases of visceral leishmaniasis and 1.5 million cases of cutaneous leishmaniasis http://www.who.int/tdr/diseases/leish/diseaseinfo.htm webcite. The different clinical forms of leishmaniasis are the result of infection by different species of the parasite. Visceral leishmaniasis, fatal if left untreated, is typically caused by L. donovani, L. infantum and L. chagasi (synonimous to L. infantum). Visceral leishmaniasis due to L. infantum is a zoonosis in which dogs are the main reservoirs. In adition to the conventional zoonotic cycle, L. infantum infection could, in some cases, spread following an anthroponotic cycle. L