{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T09:26:01Z","timestamp":1787304361296,"version":"build-2736575974"},"reference-count":46,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Trop. Med. Infect. Dis.","TropicalMed"],"abstract":"<jats:p>Autochthonous mucocutaneous leishmaniasis caused by Leishmania infantum is an under-recognised but established manifestation of endemic leishmaniasis in Spain. This review identified 65 confirmed autochthonous cases reported since 1990, showing a relatively consistent clinical pattern. Most patients were adults, predominantly men in the fifth or sixth decade of life. Nearly half were immunosuppressed, mainly due to HIV infection, corticosteroid use, biologic therapy, autoimmune diseases, or solid organ transplantation, although immunocompetent individuals were also affected. The laryngeal, nasal, and oral mucosa were the most commonly involved sites, with occasional tracheal and bronchial disease. Clinical presentation was typically chronic and non-specific, including ulcerative, nodular, polypoid, or tumour-like lesions that frequently mimicked malignancy or inflammatory disorders, often delaying diagnosis. Unlike classical New World mucocutaneous leishmaniasis, Spanish cases generally lacked a preceding cutaneous lesion, supporting recognition as a distinct form of L. infantum infection. Diagnosis required microbiological confirmation, ideally with species identification through culture or molecular methods, while serology showed limited reliability. Treatment approaches varied considerably, reflecting the absence of standardised protocols, although systemic therapy (particularly liposomal amphotericin B) was most commonly used. Improved recognition, surveillance, and inclusion in clinical guidelines are needed to reduce diagnostic delay and therapeutic variability.<\/jats:p>","DOI":"10.3390\/tropicalmed11080235","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:14:01Z","timestamp":1787300041000},"page":"235","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Addressing the Gaps and Challenges of Autochthonous Mucocutaneous Leishmaniasis in Spain"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3513-1900","authenticated-orcid":false,"given":"Diego","family":"Gayoso-Cantero","sequence":"first","affiliation":[{"name":"National Referral Centre for Tropical Diseases, Infectious Diseases Department, University Hospital Universitario Ram\u00f3n y Cajal, Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS), 28034 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"World Health Organization Collaborative Centre for Clinical Management of Leishmaniasis (SPA-55), 28034 Madrid, Spain"},{"name":"Health Sciences, University of Alcal\u00e1, 28871 Alcal\u00e1 de Henares, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2409-4876","authenticated-orcid":false,"given":"Bego\u00f1a","family":"Monge-Maillo","sequence":"additional","affiliation":[{"name":"National Referral Centre for Tropical Diseases, Infectious Diseases Department, University Hospital Universitario Ram\u00f3n y Cajal, Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS), 28034 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"World Health Organization Collaborative Centre for Clinical Management of Leishmaniasis (SPA-55), 28034 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8735-4124","authenticated-orcid":false,"given":"Jose A.","family":"Perez-Molina","sequence":"additional","affiliation":[{"name":"National Referral Centre for Tropical Diseases, Infectious Diseases Department, University Hospital Universitario Ram\u00f3n y Cajal, Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS), 28034 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"World Health Organization Collaborative Centre for Clinical Management of Leishmaniasis (SPA-55), 28034 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"ref_1","first-page":"471","article-title":"Global leishmaniasis surveillance, 2022: Assessing trends over the past 10 years","volume":"98","year":"2023","journal-title":"Wkly. Epidemiol. Rec."},{"key":"ref_2","unstructured":"Gradoni, L., L\u00f3pez-V\u00e9lez, R., and Mourad, M. (2017). Manual on Case Management and Surveillance of the Leishmaniases in the WHO European Region, WHO Regional Office for Europe. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789289052511."},{"key":"ref_3","first-page":"2016","article-title":"Estimating human leishmaniasis burden in Spain using the capture-recapture method, 2016\u20132017","volume":"16","author":"Herrador","year":"2021","journal-title":"PLoS ONE"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1111\/jtm.12089","article-title":"LeishMan Recommendations for Treatment of Cutaneous and Mucosal Leishmaniasis in Travelers, 2014","volume":"21","author":"Blum","year":"2014","journal-title":"J. Travel Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"OPS (2022). Organizaci\u00f3n Panamericana de la Salud. Directrices para el Tratamiento de las Leishmaniasis en la Regi\u00f3n de las Am\u00e9ricas, OPS. [2nd ed.].","DOI":"10.26633\/RPSP.2023.43"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1097\/01.md.0000076009.64510.b8","article-title":"Localized mucosal leishmaniasis due to Leishmania (Leishmania) infantum: Clinical and microbiologic findings in 31 patients","volume":"82","author":"Aliaga","year":"2003","journal-title":"Medicine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.ijid.2016.08.003","article-title":"Localized mucosal leishmaniasis caused by Leishmania infantum mimicking cancer in the rhinolaryngeal region","volume":"50","author":"Cobo","year":"2016","journal-title":"Int. J. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Eggers, Y., Holtfreter, M., M\u00fcller-Stoever, I., Mischlinger, J., Hammacher, A., Hemmerlein, B., Kreuter, A., Oellig, F., Tappe, D., and Luedde, T. (2025). A rare case of lingual mucosal leishmaniasis caused by reactivation of Leishmania infantum infection. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-025-10592-4"},{"key":"ref_9","first-page":"512276","article-title":"Mucocutaneous leishmaniasis with upper airway involvement: A report of three cases","volume":"77","year":"2025","journal-title":"Acta Otorrinolaringol. Esp."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.eimc.2014.11.012","article-title":"Mucocutaneous leishmaniasis caused by Leishmania infantum var Lombardi in an immunocompetent patient, Spain","volume":"33","author":"Bermejo","year":"2015","journal-title":"Enfermedades Infecc. Microbiol. Cl\u00edn."},{"key":"ref_11","first-page":"3","article-title":"ENT Involvement in Leishmania Infections","volume":"72","year":"2021","journal-title":"Acta Otorrinolaringol. Engl. Ed."},{"key":"ref_12","first-page":"E281","article-title":"Localized Leishmaniasis of the oral mucosa. A report of three cases","volume":"12","author":"Lainez","year":"2007","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s13071-020-3901-1","article-title":"Cutaneous and mucocutaneous leishmaniasis: Experience of a Mediterranean hospital","volume":"13","year":"2020","journal-title":"Parasit. Vectors"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Guery, R., Walker, S.L., Harms, G., Neumayr, A., Van Thiel, P., Gangneux, J.P., Clerinx, J., S\u00f6birk, S.K., Visser, L., and Lachaud, L. (2021). Clinical diversity and treatment results in Tegumentary Leishmaniasis: A European clinical report in 459 patients. PLoS Negl. Trop. Dis., 15.","DOI":"10.1371\/journal.pntd.0009863"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100465","DOI":"10.1016\/j.opresp.2025.100465","article-title":"Tracheal-Bronchial Leishmaniasis: A Rare Mucosal Presentation in Three Cases From a Single Center in Spain","volume":"7","author":"Baixeras","year":"2025","journal-title":"Open Respir. Arch."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.4269\/ajtmh.17-0162","article-title":"Case Report: Old World Mucosal Leishmaniasis: Report of Five Imported Cases to the Hospital for Tropical Diseases, London, United Kingdom","volume":"97","author":"Patel","year":"2017","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1093\/rheumatology\/kes030","article-title":"Mucocutaneous leishmaniasis in a patient treated with anti-TNF-\u03b1 therapy","volume":"51","author":"Guidelli","year":"2012","journal-title":"Rheumatology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1007\/s40265-013-0132-1","article-title":"Therapeutic Options for Old World Cutaneous Leishmaniasis and New World Cutaneous and Mucocutaneous Leishmaniasis","volume":"73","year":"2013","journal-title":"Drugs"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1111\/1469-0691.12556","article-title":"Leishmaniasis in immunosuppressed individuals","volume":"20","author":"Carrillo","year":"2014","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_20","first-page":"255","article-title":"Leishmaniasis in peninsular Spain. A historical-bibliographic review (1912\u20131985)","volume":"67","year":"1993","journal-title":"Rev. Sanid. Hig. Publica"},{"key":"ref_21","unstructured":"WHO Collaborating Centre for Clinical Management of Leishmaniasis (SPA-55) (2026, August 03). Country Profile: Spain. Available online: https:\/\/leishinfowho-cc55.es\/country-profiles."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1186\/s13071-020-04081-7","article-title":"Latest trends in Leishmania infantum infection in dogs in Spain, Part I: Mapped seroprevalence and sand fly distributions","volume":"13","author":"Montoya","year":"2020","journal-title":"Parasit. Vectors"},{"key":"ref_23","unstructured":"Centro Nacional de Epidemiolog\u00eda, Instituto de Salud Carlos III, and CIBERESP (2026, August 03). Informe Epidemiol\u00f3gico Sobre la Situaci\u00f3n de la Leishmaniasis en Espa\u00f1a, 2023. Madrid. Available online: https:\/\/cne.isciii.es\/documents\/d\/cne\/informe_renave_leishmania-2023-1."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e202","DOI":"10.1093\/cid\/ciw670","article-title":"Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)","volume":"63","author":"Aronson","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1126\/science.1199326","article-title":"Leishmania RNA virus controls the severity of mucocutaneous leishmaniasis","volume":"331","author":"Ives","year":"2011","journal-title":"Science"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"6734","DOI":"10.1128\/IAI.70.12.6734-6740.2002","article-title":"Up-regulation of Th1-type responses in mucosal leishmaniasis patients","volume":"70","author":"Bacellar","year":"2002","journal-title":"Infect. Immun."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.cyto.2013.12.016","article-title":"The role of inflammatory and anti-inflammatory cytokines in the pathogenesis of human tegumentary leishmaniasis","volume":"66","author":"Oliveira","year":"2014","journal-title":"Cytokine"},{"key":"ref_28","unstructured":"World Health Organization (2023). Leishmaniasis, World Health Organization. WHO Fact Sheet; Updated 12 January 2023."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"614","DOI":"10.4269\/ajtmh.1990.43.614","article-title":"Mucocutaneous leishmaniasis due to Leishmania (Leishmania) infantum: Biochemical characterization","volume":"43","author":"Alvar","year":"1990","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/S0035-9203(97)90273-X","article-title":"Oral leishmaniasis in an HIV-positive patient caused by two different zymodemes of Leishmania infantum","volume":"91","author":"Barrio","year":"1997","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3315\/jdcr.2013.1135","article-title":"Old World cutaneous leishmaniasis: Diagnosis and treatment","volume":"7","author":"Masmoudi","year":"2013","journal-title":"J. Dermatol. Case Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1111\/jdv.15034","article-title":"Comparison of PCR -based methods for the diagnosis of cutaneous leishmaniasis in two different epidemiological scenarios: Spain and Morocco","volume":"32","author":"Tercedor","year":"2018","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"De Lima, C.M.F., Magalh\u00e3es, A.S., Costa, R., Barreto, C.C., Machado, P.R.L., Carvalho, E.M., Lessa, M.M., and Carvalho, L.P. (2021). High Anti-Leishmania IgG Antibody Levels Are Associated with Severity of Mucosal Leishmaniasis. Front. Cell Infect. Microbiol., 11.","DOI":"10.3389\/fcimb.2021.652956"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Freire, M.L., R\u00eago, F.D., Cota, G., Pascoal-Xavier, M.A., and Oliveira, E. (2021). Potential antigenic targets used in immunological tests for diagnosis of tegumentary leishmaniasis: A systematic review. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0251956"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1111\/1346-8138.12564","article-title":"A case of mucocutaneous leishmaniasis diagnosed by serology","volume":"41","author":"Okumura","year":"2014","journal-title":"J. Dermatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.ad.2021.02.008","article-title":"Leishmaniasis cut\u00e1nea y mucocut\u00e1nea","volume":"112","author":"Diago","year":"2021","journal-title":"Actas Dermo-Sifiliogr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.actatropica.2018.03.016","article-title":"Liposomal amphotericin B treatment of Old World cutaneous and mucosal leishmaniasis: A literature review","volume":"182","author":"Mosimann","year":"2018","journal-title":"Acta Trop."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Guery, R., Henry, B., Martin-Blondel, G., Rouzaud, C., Cordoliani, F., Harms, G., Gangneux, J.-P., Foulet, F., Bourrat, E., and Baccard, M. (2017). Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea. PLoS Negl. Trop. Dis., 11.","DOI":"10.1371\/journal.pntd.0006094"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1007\/s40257-022-00726-8","article-title":"Cutaneous Leishmaniasis: A 2022 Updated Narrative Review into Diagnosis and Management Developments","volume":"23","author":"Schallig","year":"2022","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_40","first-page":"763","article-title":"Treatment of mucocutaneous leishmaniasis\u2014A systematic review","volume":"22","author":"Fischer","year":"2024","journal-title":"JDDG J. Dtsch. Dermatol. Ges."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1093\/cid\/civ004","article-title":"Miltefosine for Visceral and Cutaneous Leishmaniasis: Drug Characteristics and Evidence-Based Treatment Recommendations","volume":"60","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"804","DOI":"10.4269\/ajtmh.23-0234","article-title":"Clinical Presentation of American Tegumentary Leishmaniasis in a Leishmania (Viannia) braziliensis Endemic Hotspot: A 35-Year History","volume":"109","author":"Cajal","year":"2023","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/S0140-6736(18)31204-2","article-title":"Leishmaniasis","volume":"392","author":"Burza","year":"2018","journal-title":"Lancet"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Kmetiuk, L.B., Tirado, T.C., Biondo, L.M., Biondo, A.W., and Figueiredo, F.B. (2022). Leishmania spp. in indigenous populations: A mini-review. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.1033803"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/j.det.2015.03.018","article-title":"New World and Old World Leishmania Infections","volume":"33","author":"Kevric","year":"2015","journal-title":"Dermatol. Clin."},{"key":"ref_46","unstructured":"Estudio Integral del Brote Comunitario de Leishmaniasis en la Comunidad de Madrid (2026, May 24). Una Visi\u00f3n Completa de 10 a\u00f1os de Investigaci\u00f3n en el CNM. Available online: http:\/\/hdl.handle.net\/20.500.12105\/16686."}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/11\/8\/235\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:46:14Z","timestamp":1787301974000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/11\/8\/235"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":46,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["tropicalmed11080235"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed11080235","relation":{},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]}}}