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How Common Is Imported Cutaneous Leishmaniasis in Romania? Two Case Reports
Victoria Birlutiu1,2, Gabriela Iancu1,3, Rares-Mircea Birlutiu4,5
1Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania.
Microorganisms
|June 27, 2025
Summary
Two imported cutaneous leishmaniasis (CL) cases were diagnosed in non-endemic Romania. These cases highlight the need for increased clinician awareness and surveillance for this neglected tropical disease.
Area of Science:
- Medical Entomology
- Tropical Medicine
- Parasitology
Background:
- Leishmaniasis, a vector-borne zoonotic disease caused by *Leishmania* protozoa, is typically endemic to the Mediterranean Basin and Balkans.
- Romania is considered a non-endemic country, but climate change and travel raise concerns for autochthonous cases.
- Competent sandfly vectors (*Phlebotomus* spp.) have been documented in Romania.
Observation:
- Two imported cutaneous leishmaniasis (CL) cases were diagnosed in central Romania.
- Case 1: A 31-year-old male with travel history to Spain presented with ulcerated lesions, diagnosed via histopathology and PCR.
- Case 2: An 11-year-old boy with travel history to Italy developed rapidly progressing ulcerative lesions, confirmed by PCR despite initial negative smear.
Findings:
- Miltefosine treatment was effective for Case 1 with minimal hepatic toxicity.
- Fluconazole therapy led to clinical improvement in Case 2, complicated by *Pseudomonas aeruginosa* superinfection.
- PCR proved crucial for diagnosing CL in both cases, especially when smears were negative.
Implications:
- These cases underscore diagnostic and therapeutic challenges of CL in non-endemic regions.
- Leishmaniasis should be considered in the differential diagnosis of chronic, non-healing skin lesions in travelers.
- Enhanced clinician awareness, diagnostic tools, and surveillance are vital for managing imported leishmaniasis, a WHO priority disease.
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