Leishmaniasis in the United Kingdom: Experience of a national multidisciplinary team meeting in a non-endemic setting

Abstract

Introduction

Leishmaniasis is a parasitic disease caused by protozoa of the genus Leishmania. Disease phenotypes are heterogenous, and diagnosis is frequently delayed. Treatment is often challenging, and international guidelines recommend consultation with experts. The UK Leishmaniasis Multidisciplinary Team (UKLMDT) meeting provides an accessible online forum for clinicians to discuss cases of leishmaniasis, facilitating access to expertise and enabling local care for patients where possible.

Methods

Three years of UKLMDT discussions, from its inception in November 2021 to October 2024, were reviewed using electronic patient records. An anonymous feedback questionnaire was sent to referrers. Data regarding treatment outcomes for patients discussed up to June 2024 were gathered using a separate questionnaire completed by their responsible clinician.

Results

The UKLMDT contributed to 139 patient discussions involving 80 patients over in total over the study period. Just over half of individuals (45/80; 56.2 %) had cutaneous leishmaniasis, a quarter had visceral leishmaniasis (20/80; 25 %) and a tenth had mucosal leishmaniasis (8/80; 10 %). Seven patients (8.8 %) were found not to have leishmaniasis. In total, 24/80 (30 %) of patients were immunocompromised, but only in four cases (5 %) was HIV the cause of immunosuppression. All visceral leishmaniasis cases were acquired in Europe, and the majority acquired their disease in Spain. Leishmania donovani complex was the commonest causative agent overall, including in visceral and mucosal disease, whereas Leishmania Viannia subgenus was commonest in cutaneous leishmaniasis. Patients with mucosal or visceral leishmaniasis were more frequently immunosuppressed than those with cutaneous leishmaniasis. Outcomes and feedback on the UKLMDT were generally positive.

Discussion

The experience of the UKLMDT specialist forum provides insight into leishmaniasis in the UK, a non-endemic setting. Key findings include that southern Europe is the primary destination where UK-based leishmaniasis is acquired, and that Leishmania donovani complex (most likely Leishmania infantum) in immunosuppressed hosts is an important cause of mucosal leishmaniasis in Europe. The UKLMDT offers equitable access to expertise for a rare disease in the UK, as well as serving as a model for national provision of multidisciplinary advice for other rare diseases.