P1016 Leishmaniasis in patients with inflammatory bowel disease: a national multicenter study of GETECCU
Authors: Madero Velázquez L , Minguez A , Mayorga L , Ramírez J J , Moreno N , Amorós C , Nicolás I , Mena R , Benitez J M , Gimeno L , Maroto N , Suria C , Rodriguez-Moranta F , Ordás I , Ruiz L , García-Brenes M A , Martín A , Rubín C , Cárdenas K , Ginard D , Medina L , Pedrero N , Plaza R , Salmoral R , Martínez T , Algara V , Merino E , Zabana Y , Gutierrez Casbas A 
Published: January 2025

Background

Leishmaniasis (LI) is a vector-borne illness caused by a protozoan of the genus Leishmania. Data on the features of LI in patients with inflammatory bowel disease (IBD) are scarce.

Aim

To describe the characteristics of patients with IBD who present LI, the infection outcomes and the risk factors associated with developing visceral leishmaniasis (VL).

Methods

Observational, retrospective study performed in 26 hospitals in Spain, including all adult patients with IBD who developed LI from 2012 to 2022.

Results

A total of 73 patients were included. The clinical and demographic characteristics areshown in Table 1. Sixty patients (82%) presented localized cutaneous LI (CL) 2 (2.7%) diffuse CL, 3 (4%) mucocutaneous L (MCL) and 8 (11%) VL.The time-lapse between the starting of symptoms and the diagnosis of LI was 4.7±4.5 months (range 0-24). All patients were under biologics [69(94%)] or immunosuppressants (IMM) [4(6%)] at LI diagnosis. AntiTNF was the biologic drug used in 97%, while 2 patients (3%) were receiving ustekinumab. Twenty-seven out of 69 patients (39%) received combotherapy with IMM and 6 (8%) with corticosteroids. LI resolution was achieved by 35 (48%) and 70 (96%) patients at 1 and 12 months, respectively. Biologic withdrawal after LI diagnosis was not statistically related with increased rates of infection resolution among patients with localized CL. Biologic therapy was permanently discontinued in 21 patients (30%) among the whole cohort. Age was the only risk factor associated with VL (OR 1.2, 95%CI 1.04-1.39; p=0.012), while biological therapy was associated with an increased risk of CL or MCL (OR 39.7, 95%CI 1.2-1220.2; p=0.035).

Conclusion

LI in patients with IBD presents a favourable clinical outcome, even in those who continue on biological therapy, being age the only risk factor for developing VL. This infection should be considered for immunosuppressed patients with IBD dwelling in endemic areas who exhibit compatible symptoms.

References

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3.Kirchgesner J, Lemaitre M, Carrat F, Zureik M, Carbonnel F, Dray-Spira R. Risk of Serious and Opportunistic Infections Associated With Treatment of Inflammatory Bowel Diseases. Gastroenterology. 2018 Aug;155(2):337-346.