Although leishmaniasis has generated increasing concern in Spain during recent years, the incidence of reported cases has changed little during the past 25 years. The following data are abstracted from the GIDEON e-book series [1,2].

Time and Place:
Visceral leishmaniasis is most common in the southern region.
- Seroprevalence among dogs in this region is lowest during April, peaking during October.
- A restricted focus has been identified in the Piorat region of northeastern Spain.
- A single autochthonous case has been reported from Minorca.

Graph Notes:
1. 1,180 hospitalizations were reported for leishmaniasis during 1999 to 2003 (0.4 per 100,000 population).
2. 11 cases (0 fatal) were identified among immunocompetent children in southern Madrid during 1994 to 2007.
3. 60 deaths were ascribed to leishmaniasis during 1980 to 1994.
4. In 2005, three cases were reported among Romanian workers returning from Spain.

Leishmaniasis and HIV infection:
- 450 AIDS/Leishmania coinfections were reported nationwide during 1990 to 1995 (52.4% of the world’s total coinfections); 412 during 1996 to 1998; 1,099 as of 2001.
- 835 cases of HIV-Leishmania coinfection were reported during January 1990 to June 1998; 412 during January 1996 to June 1998; 1,099 during January 1990 to January 2001; 130 during January 2001 to December 2006.
- Spain accounted for 58% of all such coinfections in southwestern Europe during 1990 to 1998.
- 2.49% of AIDS patients in the Madrid region are coinfected with visceral leishmaniasis.
- 228 episodes of visceral leishmaniasis were diagnosed in 155 HIV-infected patients in Valencia and Murcia during 1988 to 2001.

Transmission through sharing of needles by injecting drug abusers has been reported.
- Approximately 30% of IVDA in southern Spain are seropositive.
- Evidence for Leishmania is found in 52% of discarded syringes collected in southern Madrid (1998) and 34% from southwestern Madrid (2000 to 2001).

Leishmania infantum has been identified in some cases of cutaneous and mucosal leishmaniasis.

Prevalence surveys:
2.4% of asymptomatic blood donors in Elvissa (Belearic Islands) have been found to have cryptic infection by ELISA – 7.6% by Western blot (2004 publication)
20.5% of wolves (Canis lupus), 14.1% of foxes (Vulpes vulpes), 28.6% of Egyptian mongooses (Herpestes ichneumon), 1 of 4 genets (Geneta geneta), and 1 of 4 Iberian lynxes (Lynx pardinus) (2008 publication)
29.4% of dogs in the Barcelona region (PCR, 2009 publication)
19.6% of seronegative blood samples in a canine blood bank. (Leishmanial DNA, Barcelona, 2008 publication)

Seroprevalence surveys:
3.1% of blood donors from the Balearic Islands. (Majorca, Formentera, and Minorca, 2008 publication)
4.9% of the general population in Castilla Leon, and 64.0% of HIV-positive patients (1996)
11.5% of children and 52.8% of adults in Alicante, southeastern region are skin test-positive (1997 to 1998)
5.25% of dogs in the Madrid area
7.8% of stray dogs in the Madrid region (1996 to 2006)
13% of dogs on Mallorca are infected; 3.7% in northwestern Spain (2004 publication)
30% of dogs in northeastern Spain (2006 publication)
22% of dogs in Crevillente town, Alicante (1999)
13.0% of dogs in the Alpujarras region of southeastern Spain – with highest rates in larger, older dogs which live outdoors (2006)
8.1% of dogs in the Madrid region (2006 to 2007)
5.3% of shelter dogs in central Spain (2010 publication)
3% of cats in Barcelona (2007 publication)
1.29% of cats in Madrid (2005 to 2006)
6.29% of cats in the northeastern Iberian Peninsula and Balearic Islands (2007 publication)

Leishmania infantum has been identified in captive wolves (Canis lupus) in northern Spain (2008 publication)

Vectors:
The vectors in Spain are Phlebotomus (Larroussius) ariasi and Ph. (La.) perniciosus.

References:
1. Berger SA. Infectious Diseases of Spain. http://www.gideononline.com/ebooks/country/infectious-diseases-of-spain/ , 516 pp. 2010, Gideon Informatics, Inc.
2. Berger SA. Visceral Leishmaniasis: Global Status. http://www.gideononline.com/ebooks/disease/visceral-leishmaniasis-global-status/ , 84 pp. 2010, Gideon Informatics, Inc.

Quoted in ProMED:

Visceral leishmaniasis was 1st described in Brazil in 1934 and 1st reported from Rio de Janeiro state in 1977.

90 percent of cases are reported from the north (mouth of the Amazon) and eastern regions. The disease is endemic to Alagoas, Bahia, Ceara, Espirito Santo, Goias, Maranhao, Mato Grosso do Sul, Minas Gerais, Para, Paraiba, Pernambuco, Piaui, Rio Grande do Norte, Roraima and Sergipe. Urban transmission was 1st reported in 1981, from Teresina (Piaui State). A large focus extends from Roraima into Venezuela and Guyana.

The reported incidence has increased from 164 cases (35 fatal) in 1980 to 3220 (223 fatal) in 2005; see graph . A total of 44 289 cases were reported during 1980 to 2000, 39 823 of these from the northeast. Brazil accounts for over 90 percent of cases in the New World.
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