Evolución de la incidencia de leishmaniasis visceral y leishmaniasis cutánea durante 30 años en un área sanitaria de la comunidad de Madrid

espanolLa incidencia real de la leishmaniasis visceral (LV) y cutanea (LC) por Leishmania infantum en Espana no es bien conocida. Desde el ano 2009 se desarrolla un brote epidemico en el sudoeste de la Comunidad de Madrid. Se realizo un estudio retrospectivo de los casos diagnosticados de LV y LC en otra area sanitaria del este de la Comunidad de Madrid, durante el periodo 1987-2016. Se revisaron los registros Salud Publica y del centro sanitario de referencia, el Hospital Universitario Principe de Asturias de Alcala de Henares. En 30 anos se registraron 69 casos diagnosticados de leishmaniasis, 43 viscerales (62,3%) y 26 cutaneas (37,7%), una de ellas mucocutanea. La tasa de incidencia global anual se ha mantenido estable oscilando entre 0 y 1,90 casos por 100.000 habitantes. Los casos de LV y coinfeccion con VIH han ido disminuyendo gracias a los tratamientos antirretrovirales de gran actividad pero han aumentado los de pacientes con otros tipos de inmunodepresion. La incidencia de LC similar a la LV en los ultimos 15 anos aunque mas irregular. Se notificaron a Salud Publica el 35,7% % de las LV y el 5,5% de LC por lo que se debe reforzar el sistema de notificacion de leishmaniasis de cara a su control y deteccion de aumentos de incidencia. A nivel de paises europeos endemicos, la incidencia de LV ha permanecido estable en Espana hasta el brote del ano 2009, en Italia esta disminuyendo despues de otro brote epidemico y en Francia se mantiene estable. EnglishThe actual incidence of visceral leishmaniasis (VL) and cutaneous (CL) by Leishmania infantum in Spain is not well known. Since 2009, an epidemic outbreak has been developing in the southwest of the Community of Madrid. A retrospective study of the diagnosed cases of LV and LC was carried out in another health area of the eastern region of Madrid during the period 1987-2016. Reference hospital, University Hospital Prince of Asturias of Alcala de Henares and Public Health records were reviewed. In these 30 years, 69 cases of leishmaniasis were diagnosed, 43 visceral (62.3%) and 26 cutaneous (37.7%), one of them mucocutaneous. The annual global incidence rate has remained stable ranging from 0 to 1.90 cases per 100,000 inhabitants. Number of cases with VL and HIV coinfection has been decreasing due to highly active antiretroviral treatments but patients with other types of immunosuppression have increased. The incidence of LC was more irregular but similar to VL in the last 15 years. Only 35.7% of VL and 5.5% of CL were reported to Public Health, so the leishmaniasis notification system should be strengthened in order to control and detect incidence increases. At the level of European endemic countries, the incidence of VL has remained stable in Spain until the outbreak of the year 2009, in Italy it is declining after another epidemic outbreak and in France remains stable.