# Trends in Leishmaniasis: A 32-Year Review in an Endemic Area in the South of Madrid Region

## TL;DR

This study reviews 32 years of leishmaniasis cases in an endemic area of Madrid, showing changes in patient demographics, diagnosis, and treatment over time.

## Contribution

The study provides a long-term analysis of leishmaniasis trends in a specific endemic region, including shifts in patient groups and medical practices.

## Key findings

- Visceral leishmaniasis (VL) shifted from affecting HIV patients to elderly and non-HIV immunosuppressed individuals.
- Diagnostic methods evolved from microscopy to molecular and chemiluminescence assays.
- Amphotericin B became the preferred treatment for VL over meglumine antimoniate.

## Abstract

In Spain, Leishmania infantum causes both cutaneous (CL) and visceral leishmaniasis (VL). This study aimed to analyse trends in the clinical presentation, diagnosis, management, and epidemiology of leishmaniasis at Severo Ochoa University Hospital in Leganés, an endemic area in Southern Madrid affected by Europe’s largest outbreak (2009–2015). A retrospective study was conducted, including all confirmed cases from January 1992 to December 2024, using clinical records. Cases were stratified into pre-outbreak, outbreak, and post-outbreak periods. A total of 151 cases were identified, including 129 VL, 21 CL, and 1 simultaneous VL/CL. VL predominated among adults during the HIV epidemic, later shifting to elderly and non-HIV immunosuppressed patients, while paediatric cases remained stable. Diagnostic methods evolved from bone marrow microscopy, culture, and IFAT to molecular and chemiluminescence assays. VL treatment also evolved, with amphotericin B gradually replacing meglumine antimoniate as first-line VL treatment. Most patients required hospitalisation, with 8.5% mortality, mainly among immunocompromised or elderly individuals. A persistent concentration of cases near recently urbanised areas adjacent to the parks of Polvoranca and Bosquesur was observed. Despite advances in diagnosis and therapy, endemic transmission and underreporting continue, highlighting the need for ongoing surveillance and preventive measures. Hospital record review proved useful for monitoring compliance with mandatory VL notification, though its applicability to cutaneous cases remains limited.