Leishmaniasis in Malta and the Mediterranean basin.

Leishmaniasis is a public-health problem in most countries bordering the Mediterranean littoral. In Malta, where the disease has been recognized for many years, Phlebotomus perniciosus is the established vector and dogs act as reservoir hosts. Visceral leishmaniasis (VL) was the only form of the disease recorded in Malta until the early 1980s, when cutaneous leishmaniasis (CL) was recognized. Although the incidence of CL has recently increased, the overall numbers of cases of leishmaniasis have markedly decreased since the 1960s. Prior to 1963, almost all cases were aged < 10 years. Although leishmaniasis in Malta is still mainly a disease of children, adult cases are increasingly being recognized. HIV-VL co-infection is being seen more and more frequently in the Mediterranean basin, especially in Spain, France and Italy. During diagnosis, leishmaniasis should be suspected on the basis of the clinical picture in endemic areas and on the travel history of those patients from non-endemic areas. In Malta, VL and CL are generally confirmed by detection of the parasites in smears, of bone-marrow or, rarely, splenic aspirates and of lesions, respectively. Antimonials are the standard therapeutic agents for VL, although liposomal amphotericin B is a very effective but expensive alternative, with no significant adverse effects. In Malta, the treatment of choice for CL is cryotherapy.