Be Aware of the Risk of Phlebotominae

Actually, L. infantum is the one most often associated with visceral leishmaniasis (VL) and it is transmitted through infected phlebotomine sandflies bites. VL should be suspected in children with prolonged fever of unknown origin, hepatosplenomegaly and/or pancytopenia. To our knowledge, our case series represented the only cluster (5 cases in 5 months) in these last 10 years in Italy, except for another cases series in 2013 in Bologna within a 6-month period (14 patients with VL but only 4 of them presented HLH), a case report described in Rome and the other 2 cases described in twins from the Germany-Switzerland border, after travelling to Tuscany in 2018. Interestingly, a higher prevalence of Leishmania in dogs was recorded in 2021 in Tuscany8 (our patients had reported previously contact with dogs), and an increased number of leishmaniasis (both in adults and in children) was reported to the Tuscany Public Health Services in 2021 (personal communication). This epidemiologic link suggests that close monitoring of Leishmaniasis cases is necessary to understand the epidemiologic situation of each country, with the aim to implement prevention strategies. Moreover, considering the risk of VL in travellers to Southern Europe is pivotal to increasing awareness not only among local physicians but also globally to avoid misdiagnosis in nonendemic countries. In conclusion, due to its high fatality rate, prompt diagnosis and early appropriate treatment have crucial importance and a multidisciplinary approach is pivotal to obtaining a full recovery.