Table 1 Epidemiological characteristics of seven immunosuppressed patients with visceral leishmaniasis, 2009–2018, Norway
From: Imported visceral leishmaniasis and immunosuppression in seven Norwegian patients
Case no | Sex | Age | Chronic underlying disease | Immunosuppressive treatment | Fever, splenomegaly, weight loss | Other clinical features and duration of symptoms at diagnosis | Travel history | Likely place of transmission |
|---|---|---|---|---|---|---|---|---|
Patient 1 | M | 66 | Rheumatoid arthritis, | MTX 17.5 mg/week for 7 years and adalimumab | Yes | 6 months of constitutional symptoms and oesophageal candidiasis. A chronic skin ulcer acquired in Spain one year ago was diagnosed as CL. Then, a prednisolone course due to worsening of RA was followed by the clinical picture of VL | Recreational travel to Spain > one year ago | Spain |
Patient 2 | M | 78 | Psoriasis arthritis | MTX 20 mg/week for > 5 years and prednisolone | Yes | Weight loss over a year. While in Thailand, fever and asthenia developed hospitalization. Splenectomy was performed after 10 days in hospital due to intractable pancytopenia | Several recreational travels to Thailand the last year; the last five years to Spain. Professional travels to Pakistan, East Africa and India the last 20 years | Unknown |
Patient 3 | M | 79 | Rheumatoid arthritis | MTX12.5 mg/week for several years and prednisolone | Yes | 6 weeks of constitutional symptoms, prior to VL diagnosis. 16 months after treatment, he fell sick from a testis B-cell lymphoma. He then had a relapse of VL, prior to cytostatic treatment | Recreational travels to Spain one year, to Turkey 8 years and to Italy, Spain, Portugal some 20 years ago, respectively | Unknown |
Patient 4 | M | 57 | Myelofibrosis | No | Yes | Salmonella gastroenteritis while in Tanzania. Admitted 2 months later with constitutional symptoms and increasing weight loss 5–15 kg. | Holiday house in Spain. Recreational travel to Tanzania 2 months ago | Spain |
Patient 5 | M | 41 | HIV | No | Yes | Constitutional symptoms and 15 kg weight loss the last two months. On admission he had oesophageal candidiasis; HIV and VL were diagnosed respectively. Relapse of VL after 3 months, CD4, 119/ml | Prior to 2010 he lived in Portugal. He then lived in South Africa 2010–12, in Cape Verde 2012–14; thereafter in Norway. Many recreational and profession travels in Spain. | Spain, Portugal |
Patient 6 | M | 83 | Rheumatoid arthritis | MTX 20 mg/week for 10 months, initially together with prednisolone, but last 6 months MTX alone | Yes | Admitted with constitutional symptoms, two weeks after returning from Spain. Extensive diagnostic work-up and progressive weight loss 4-13 kg until diagnosed VL | Recreational travel to Spain | Spain |
Patient 7 | F | 46 | Ulcerative colitis | Azathioprine and infliximab for 1.5 years – discontinued 6 and 8 months after symptoms respectively | Yes | Splenectomy on the suspicion of lymphoma | Recreational travels to Spain | Spain |