Leishmaniases in Northern Greece: seroprevalence of the infection and incidence of the disease during the period 2001–2006

  • E. DizaEmail author
  • A. Kansouzidou
  • S. Gerou
  • E. Vezyri
  • S. Metallidis
  • A. Antoniadis
Concise Article


Increasing risk factors are making leishmaniases a growing public health concern for many countries around the world. The aim of this study was to assess the seroprevalence of Leishmania infantum infection in the general population and in HIV infected subjects of Northern Greece, bordering the Mediterranean basin where leishmaniasis is endemic. The clinical cases of the disease during the last 6 years (2001–2006) are also presented. A low frequency of L. infantum antibodies was found by IFA and ELISA in 1,525 healthy individuals (2.8%), aged 18–80 years, living in the 16 prefectures of Northern Greece (Macedonia and Thrace regions), and in 167 HIV positive subjects (0.6%). Fifty-seven clinical cases were diagnosed in the same area and an approximate annual incidence of 0.34/100,000 was estimated. No endemic foci were identified and the cases of the disease were sporadic. Most presented with the visceral form (VL), few with the cutaneous, and one with VL-HIV co-infection. A significant shift in the age of people at risk was observed, with children less affected than adults (children/adults ratio: 0.36). No relevant data from previous studies are available to demonstrate a possible change of the infection in Northern Greece. The results of this study could be used as a reference for leishmaniasis surveillance in the area.


Visceral Leishmaniasis Leishmaniasis Brucellosis Cutaneous Leishmaniasis Leishmania Infection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Yannakopoulos K (1879) On some endemic diseases on the island of Spetses. Galenus 65–68Google Scholar
  2. 2.
    Tetsis JA (1881) Tsanaki or putrefied illness of children in Hydra. Galenus 3(21):369–371Google Scholar
  3. 3.
    Tselentis Y, Gikas A, Chaniotis B (1994) Kala-azar in Athens basin. Lancet 343(8913):1635PubMedCrossRefGoogle Scholar
  4. 4.
    Maltezou MC, Siafas C, Mavrikou M, Spyridis P, Stavrinadis C, Karpathios T, Kafetsis DA (2000) Visceral leishmaniasis during childhood in southern Greece. Clin Infect Dis 31(5):1139–1143PubMedCrossRefGoogle Scholar
  5. 5.
    Papadopoulou C, Kostoula A, Dimitriou D, Panagiou A, Bobojianni C, Antoniades G (2005) Human and canine leishmaniasis in asymptomatic and symptomatic population in Northwestern Greece. J Infect 50:53–60PubMedCrossRefGoogle Scholar
  6. 6.
    Antoniou M, Doulgerakis C, Pratlong F, Dedet JP, Tselentis Y (2004) Short report: treatment failure due to mixed infection by different strains of the parasite Leishmania infantum. Am J Trop Med Hyg:71–72Google Scholar
  7. 7.
    Papadopoulos B, Tselentis Y (1994) Sandflies in the greater Athens region, Greece. Parasite 1(2):131–140PubMedGoogle Scholar
  8. 8.
    Chaniotis B, Spyridaki I, Scoulika E, Antoniou M (2000) Colonization of phlebotomus neglectus (Diptera: psychodidae), the major vector of visceral leishmaniasis in Greece. J Med Entomol 37(3):346–348PubMedCrossRefGoogle Scholar
  9. 9.
    Ashford RW (2000) The leishmaniases as emerging and reemerging zoonoses. Int J Parasitol 30:1269–1281PubMedCrossRefGoogle Scholar
  10. 10.
    Desjeux P (2004) Leishmaniasis: current situation and new perspectives. Com Immunol Microbiol Infect Dis 27(5):305–318CrossRefGoogle Scholar
  11. 11.
    World Health Organization (2000) Leishmania/HIV co-infection south-western Europe, 1990–1998: retrospective analysis of 965 cases. WHO, Geneva, LEISH/2000:42Google Scholar
  12. 12.
    Leontides LS, Saridomechelakis MN, Billinis C, Kontos V, Koutinas AF, Galatos AD, Mylonakis ME (2002) A cross-sectional study of Leishmania spp. infection in clinically healthy dogs with polymerase chain reaction and serology in Greece. Vet Parasitol 16(1090):19–27CrossRefGoogle Scholar
  13. 13.
    Haralabidis S, Daffas G, Epivatianos P (1992) Detection of specific IgG, IgM and IgE immunoglobulins against parasites from inhabitants of Macedonia, Greece. Acta Microbiol Hellenica 37(3):365–367Google Scholar
  14. 14.
    Frydas S, Theodoridis Y, Rollis TS, Hatzistilianou I, Adama-Moraitou KK, Paludi D, Di luzio S, Castellani L, Gritli A, Di Gioacchino M (2001) Leishmania antibodies in children serum samples in correlation with disease in dogs. Int J Immunopathol Pharmacol 14(3):173–178PubMedGoogle Scholar
  15. 15.
    Anonymous (2002) Statistical yearbook of Greece. National Statistical Service of Greece, Athens, p 71Google Scholar
  16. 16.
    Spanakos G, Patsoula E, Kremastinou T, Saroglou G, Vakalis N (2002) Development of a PCR-based method for diagnosis of Leishmania in blood samples. Mol Cellul Probes 16:415–420CrossRefGoogle Scholar
  17. 17.
    Lachaud L, Marchergui-Hammami S, Chabbert E, Dereure J, Dedet JP, Bastien P (2002) Comparison of six PCR methods using peripheral blood for detection of canine visceral leishmaniasis. J Clin Microbiol 40:210–215PubMedCrossRefGoogle Scholar
  18. 18.
    Pizzuto M, Piazza M, Senese D, Scalamonga C, Calattini S, Corsico L, Persico T, Adriani B, Magni C, Guaraldi G, Gaiera G, Ludovici A, Gramiccia M, Galli M, Moroni M, Corbellino M, Antinori S (2001) Role of PCR in diagnosis and prognosis of visceral Leishmaniasis in patients coinfected with human immunodeficiency virus type 1. J Clin Microbiol (39)357–361Google Scholar
  19. 19.
    Gari-Toussaint M, Lelievre A, Marty P, Le Fichoux Y (1994) Contribution of serological tests to the diagnosis of visceral leishmaniasis in patients infected with human immunodeficiency virus. Trans R Soc Trop Med Hyg 88:301–302PubMedCrossRefGoogle Scholar
  20. 20.
    Costa C, Stewart J, Gomes R, Garcez L, Ramos P, Bozza M, Satoskar A, Dissanayake S, Santos R, Silva M, Shaw J, David J, Maguire J (2002) Asymptomatic human carriers of Leishmania chagasi. Am J Trop Med Hyg 66(4):334–337PubMedGoogle Scholar
  21. 21.
    Choudhry A, Puri A, Guru PY, Saxena RP, Saxena KC (1992) An indirect fluorescent antibody (IFA) test for the serodiagnosis of Kala-Azar. J Commun Dis 24(1):32–36PubMedGoogle Scholar
  22. 22.
    Le Fichoux Y, Quaranta JF, Aufeuvre JP, Lelievre A, Marty P, Suffia I, Rousseau D, Kubar J (1999) Occurrence of Leishmania infantum parasitemia in asymptomatic blood donors living in an area of endemicity in southern France. J Clin Microbiol 37(6):1953–1957PubMedGoogle Scholar
  23. 23.
    Riera C, Fisa R, Udina M, Gallego M, Portus M (2004) Detection of Leishmania infantum cryptic infection in asymptomatic blood donors living in an endemic area (Eivissa, Balearic Islands, Spain) by different diagnostic methods. Trans R Soc Trop Med Hyg 98(2):102–110PubMedCrossRefGoogle Scholar
  24. 24.
    Ali A, Ashford RW (1994) Visceral leishmaniasis in Ethiopia. IV. Prevalence, incidence and relationship between infection and disease in an endemic area. Ann Trop Med Parasitol 88:289–293PubMedGoogle Scholar
  25. 25.
    Badaro R, Jones TC, Carvalho JM, Sampaio D, Reed SG, Barral A, Teixeira R, Johnson WD (1986) New perspectives on a subclinical form of visceral leishmaniasis. J Infect Dis 154:1003–1011PubMedGoogle Scholar
  26. 26.
    Antoniou M, Economou I, Wang X, Psaroulaki A, Spyridaki I, Papadopoulos B, Christidou A, Tsafantakis E, Tselentis Y (2002) Fourteen-year seroepidemiological study of zoonoses in a Greek village. Am J Trop Med Hyg 66(1):80–85PubMedGoogle Scholar
  27. 27.
    Kyriakou DS, Alexandrakis MG, Passam FH, Kourelis TV, Foundouli P, Matalliotakis E, Maniatis AN (2003) Quick detection of Leishmania in peripheral blood by flow cytometry. Is prestorage leucodepletion necessary for leishmaniasis prevention in endemic areas? Transfus Med 13(2):59–62PubMedCrossRefGoogle Scholar
  28. 28.
    Federico G, Damiano F, Caldarola G, Fantini C, Flocchi V, Ortona LA (1991) Seroepidemiological survey on Leishmania infantum infection. Eur J Epidemiol 7(4):380–383PubMedCrossRefGoogle Scholar
  29. 29.
    Marty P, Lelievre A, Quaranta JF, Rahal A, Gari-Toussaint M, Le Fichoux Y (1994) Use of leishmanin skin test and western blot analysis for epidemiological studies in visceral leishmaniasis areas: experience in a highly endemic focus in Alpes-Martimes (France). Trans R Soc Trop Med Hyg 88(6):658–659PubMedCrossRefGoogle Scholar
  30. 30.
    Garrote J, Gutierrez MP, Izquierdo RL, Duenas MA, Zarzosa P, Canavate C, Bali ME, Almaraz A, Bratos M, Berbel C, Rodriguez-Torres A, Domingo AO (2004) Seroepidemiologic study of Leishmania infantum infection in Castilla-Leon, Spain. Am J Trop Med Hyg 7(4):403–406Google Scholar
  31. 31.
    Pineda J, Gallardo J, Macias J, Delgado J, Regordan C, Morillas F, Relimpio F, Martin-Sanchez J, Sanchez-Quijano A, Leal M, Lissen E (1998) Prevalence of and factors associated with visceral leishmaniasis in human immunodeficiency virus type 1-infected patients in southern Spain. J Clin Microbiol 36(9):2419–2422PubMedGoogle Scholar
  32. 32.
    Garcia-Garcia JA, Martin-Sanchez J, Gallego M, Rivero-Roman A, Camacho A, Morillas-Marquez F, Vergara S, Macias J, Pineda JA (2006) Use of noninvasive markers to detect Leishmania infection in asymptomatic human immunodeficiency virus-infected patients. J Clin Microbiol 44(12):4455–4458PubMedCrossRefGoogle Scholar
  33. 33.
    Lindgren E, Naucke T, Menne B (2004) Climate variability and visceral leishmaniasis in Europe. In: Report of the scientific working group on leishmaniasis. WHO, Geneva. Document TDR/SWG/04:88–92Google Scholar
  34. 34.
    Moral L, Rubio EM, Moya M (2002) A leishmanin skin test survey in the human population of l’Alacanti region (Spain): implications for the epidemiology of leishmania infantum infection in southern Europe. Trans R Soc Trop Med Hyg 96(20):129–132PubMedCrossRefGoogle Scholar
  35. 35.
    Del Giudice P, Mary-Krauze M, Pradier C, Grabar S, Dellamonica P, Marty P, Gastaut JA, Costagliola D, Rosenthal E, French Hospital Database on HIV Clinical Epidemiologic Group (2002) Impact of highly active antiretroviral therapy on the incidence of visceral leishmaniasis in a French cohort of patients infected with human immunodeficiency virus. J Infect Dis 186(9):1366–1370PubMedCrossRefGoogle Scholar
  36. 36.
    Lazanas MC, Tsekes GA, Papandreou S, Harhalakis N, Scandalaki A, Nikiforakis E, Saroglou G (1993) Liposomal amphotericin B for leishmaniasis treatment of AIDS patients unresponsive to antimonium compounds. AIDS 7:1018–1019PubMedCrossRefGoogle Scholar
  37. 37.
    Campino L, Abranches P (2002) Cutaneous leishmaniasis. Unusual disease in Portugal? Acta Med Port 15(5):387–390PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • E. Diza
    • 1
    Email author
  • A. Kansouzidou
    • 2
  • S. Gerou
    • 1
  • E. Vezyri
    • 1
  • S. Metallidis
    • 3
  • A. Antoniadis
    • 1
  1. 1.First Department of Microbiology, Medical SchoolAristotle University of ThessalonikiThessalonikiGreece
  2. 2.Laboratory of Clinical MicrobiologyHospital of Infectious DiseasesThessalonikiGreece
  3. 3.Infectious Diseases Division, First Internal Medicine DepartmentAHEPA University HospitalThessalonikiGreece

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