SAT0387 Descriptive analysis of leishmaniasis cases in the fuenlabrada outbreak (SPAIN) associated with the use of bilogical therapy
Authors: M.P.M. Ahijado Guzmán, R.M. Veiga Cabello, M. Cantalejo Moreira, J. Ruiz Ruiz, A. Zapatero Gaviria, L. Cebrian Méndez
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Protozoan parasites of the genus Leishmania can cause opportunistic infections in patients using anti-tumour necrosis factor (anti-TNF) agents, and some authors recommend serological tests for leishmaniasis before using them. An outbreak of cutaneous and visceral leishmaniasis (CL,VL) occurred in the Fuenlabrada area (Spain) in 2010–2012. Some patients were on anti-TNF treatment. <h3>Objectives</h3> We aimed to explore leishmaniasis related to bilogical therapies in the literature, and to obtain data on leishmaniasis cases in patients using antiTNFs referred to our Department of Infectious Diseases <h3>Methods</h3> Literature search of leishmaniasis cases in patients using biological therapies, and to realise descriptive analysis of the clinical features of patients treated with anti-TNFs in our outbreak. <h3>Results</h3> Cases detected in the literature, included our cases, are listed in table 1. In our outbreak of Leishmaniasis, 127 VL and 194 CL cases were detected. Six patients were using anti-TNFs: 2 presented with VL and were using etanercept (33.3%) and 4 using other anti-TNFs had CL (66,6%). (table 2) These results do not coincide with the total data (table 1): CL 55.2%, VL 44.8%, 17 ADA (44,7%), 16 IFM (42,1%), 4 ETN (10.5%), 1 CTZ (2.7%). There are not more cases described with another biologic therapies at the present time. <h3>Conclusions</h3> This preliminary detection of leishmaniasis in patients using anti-TNFs is aimed at examining the safety of TNFα inhibitors in areas where Leishmania is endemic. This is a small series, but the largest described to date. Our preliminary results suggest that the use of either TNFα receptor or other anti-TNFs has the same probability of triggering the disease but etanercept seems to be associated with fewer, although more severe, cases of VL. Nevertheless, adding all the cases, Table number 1, ADA e IFM are the 86.8% of the Leishmaniasis, but perhaps will be due to this therapies are combinated and of the most prevalent use. On the other hand, no leishmaniasis cases related to IBD treatment have been described in the literature, suggesting possible involvement of therapies concomitant with the use of anti-TNF with MTX. We detected 3 additional cases of VL and 1 CL using MTX without anti-TNFs. Serological tests for leishmaniasis before using anti-TNFs might not be useful. <h3>References</h3> [1] Smith VM, Goulden V. Cutaneous leishmaniasis while taking adalimumab for psoriasis. Br J Dermatol [Internet]((Smith V.M.; Goulden V.) Dermatology Department, Leeds Teaching Hospitals, Leeds, United Kingdom)2014;171:100. [2] Guedes-Barbosa LS, Pereira da Costa I, Fernandes V, Henrique da Mota LM, de Menezes I, Aaron Scheinberg M. Leishmaniasis during anti-tumor necrosis factor therapy: report of 4 cases and review of the literature (additional 28 cases). Semin Arthritis Rheum. octubre de 2013;43(2):152–7. <h3>Acknowledgements</h3> To our families <h3>Disclosure of Interest</h3> None declared