Pos0705 Increase of Leishmania Infections in Patients With Anti-TNF Therapy in Endemics Areas

Background: Leishmaniasis is an infectious disease caused by protozoa that occurs endemically in the Mediterranean Basin[1].Leishmaniasis disease can manifest as cutaneous (CL), mucocutaneous (ML) or visceral (VL) disease [2].The number of infections produced by lesihmaniasis in patients being treated with anti-TNF inhibitor drugs has increased in the last recent years [1,2] Objectives: To evaluate the risk of leishmania infection as well as its evolution in immunosuppressed patients with anti-TNF therapy in leishmania endemic areas. Methods: A descriptive, retrospective, single-center study was performed in a hospital in the southeast of Spain. Data was collected from a microbiology database from patients with positive biopsy for leishmaniasis from january 2020 to december 2023. Variables analyzed were: age, gender, presence of immunosuppressive disease and presence of biological treatment (BT) at the time of diagnosis of leishmaniasis.The treatment received for leishmaniasis and the disease outcome were also reviewed. Results: A total of 16 patients with leishmaniasis were included, whose characteristics are summarized in a table (Table 1). Of the 16 patients, 12 (75%) were receiving BT at the time of diagnosis of leishmaniasis, 11 were on antiTNF therapy and one of them was receiving antiL17 treatment (Figure 1), however this patient had received antiTNF recently. BT was stopped in all patients when they were diagnosed with leismaniasis, except for 3 patients with CL. Patients who did not discontinue antiTNF had primary failure to local treatment and recurrence of infection. These 3 patients subsequently stopped antiTNF and required amphotericin B intravenous (L-AmB iv) until remission infection.Three patients reintroduced treatment with antiTNF when they were in remission of leishmaniasis, one of them received prophylactic fluconazole and another one prophylactic L-AmB iv. Currently, those three patients continue in remission 12 months after reintroducing antiTNF therapy. Conclusion: AntiTNF therapy is a potential risk for leishmaniasis disease in endemic areas.The best approach for CL treatment seems to be systemic treatment and discontinuation of antiTNF treatment at least until clinical recovery. In patients at high risk of leishmania, other immunosuppression options could be considered. REFERENCES: [1] Bosch-Nicolau P et al.Leishmaniasis and tumor necrosis factor alpha antagonists in the Mediterranean basin.A switch in clinical expression.PLoS Negl Trop Dis.2019 [2] Hammarström H et al.Leishmania infantum infection after visiting southern Spain in patients on biological treatment;an observational,longitudinal,cohort study.Travel Med Infect Dis. 2023 Acknowledgements: NIL. Disclosure of Interests: None declared.