The enemy at home: leishmaniasis in the Mediterranean basin, Italy on the focus

ABSTRACT

Introduction

Leishmaniasis represents one of the most dangerous neglected tropical diseases. The parasite used to show a well-defined geographical distribution; however, during the last decade the parasite has spread into new areas. This change in the worldwide distribution of the parasite and in leishmaniasis epidemiology is the result of man’s ill-considered interventions in the environment and of the consequent global warming.

Areas covered

The present review focuses on Leishmaniasis incidence in the Mediterranean basin and underlines the pressing need to raise awareness toward the real burden of the disease in the European region. The research was undertaken using Pubmed and including all studies up to January 2020.

Expert opinion

Environmental and climatic transformations have allowed the shifting northward of sand fly European geographical distribution, affecting areas traditionally considered as Leishmania-free, including Northern Italy, Germany, and even Belgium. The large-scale migration from the Middle East and Africa to Europe, and particularly to Italy for its central position in the Mediterranean basin, represents an additional and critical risk factor for the spread not only of leishmaniasis but also of other potentially life-threatening diseases. These factors highlight how the current epidemiological European scenario could drastically evolve in the next future.

KEYWORDS:

• Leishmaniasis
• neglected tropical diseases
• Mediterranean basin
• Italy
• global warming

Article highlights

• Leishmaniasis is a growing public health concern for many countries due to the changes in the worldwide distribution of the vector.

• Several conditions represent risk factors for leishmaniasis, including not only low socioeconomic conditions, malnutrition, environmental and climate changes, but also immunosuppression increases the risk to develop the disease.

• Although leishmaniasis represents a rare parasite disease in some European countries, it is endemic in others, and particularly in the Mediterranean basin, including Italy, highlighting the need of an adequate monitoring, harmonization of notification among countries, and comprehensive set of strategies.

• Leishmaniasis, as well as other NTDs, disproportionately affects the poorest populations worldwide, and poverty can worsen the consequences of this infectious disease.

Acknowledgments

We acknowledge Professor Alicia Ponte-Sucre and Christian Janzen for critical revision of the manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.