Case report Is leishmaniasis an “unusual suspect” of infection in allogeneic transplantation? A. Komitopoulou, T. Tzenou, J. Baltadakis, J. Apostolidis, D. Karakasis, N. Harhalakis. Is leishmaniasis an “unusual suspect” of infection in allogeneic transplantation?. Transpl Infect Dis 2014: 16: 1012–1018. All rights reserved Abstract: Leishmaniasis is a disease of the immunocompetent population, more often affecting infants and young children. However, the number of leishmaniasis cases associated with immunosuppression has increased over the last 20 years. The visceral form of the disease, visceral leishmaniasis (VL), is identified as an opportunistic infection in immunosuppressed individuals, occurring mainly after solid organ transplantation, especially in renal transplant recipients. Limited data are available about VL after hematopoietic stem cell transplantation (HSCT). We report the cases of 3 patients with late VL after allogeneic HSCT, and review the literature. A. Komitopoulou, T. Tzenou, J. Baltadakis, J. Apostolidis, D. Karakasis, N. Harhalakis Department of Haematology and Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece Key words: visceral leishmaniasis; immunosuppression; allogeneic hematopoietic stem cell transplantation Correspondence to: Anna Komitopoulou, MD, PhD, Haematologist, Department of Hematology and Bone Marrow Transplantation Unit, Evangelismos Hospital, 45-47 Ipsilantou St., Athens 10676, Greece Tel: +30 6944317870 E-mails: annakom@yahoo.com; or theokom@otenet.gr Received 21 February 2014, revised 1 June 2014, 12 August 2014, accepted for publication 13 September 2014 DOI: 10.1111/tid.12316 Transpl Infect Dis 2014: 16: 1012–1018 The presence of fever in patients who have undergone allogeneic hematopoietic stem cell transplantation (HSCT) constitutes a complex diagnostic problem. Severe multifactorial immunosuppression may be the reason for the appearance of multiple opportunistic or other infections. The term “leishmaniasis” designates a group of parasitic diseases caused by intracellular protozoa of genus Leishmania (1). Leishmaniasis clinically presents with visceral, cutaneous, mucocutaneous, and diffuse cutaneous manifestations depending on the Leishmania species and the host’s immune response (2–7). Visceral leishmaniasis (VL) is considered endemic in 88 countries in South Asia, East Africa, South America, and the Mediterranean area. It is caused primarily by Leishmania donovani complex, which includes L. dono- vani and Leishmania infantum (synonym Leishmania chagasi) (2–5). Specifically, L. infantum is the main pathogen in the Mediterranean countries. In our country, the mean annual incidence of reported leish- maniasis cases is 0.36 per 100,000 population, 93% of which is stated as visceral (8). Generally, leishmaniasis transmission occurs through the bites of sand flies of the genus Phlebotomus (in the Old World) and Lutzomya (in the New World), or by blood transfusions or contaminated syringes (2, 9, 10). The sand fly is the vector of the disease and its life cycle contains several phases (11, 12). The phase of amasti- gotes is the form seen in the human host (3, 13, 14). Leishmaniasis is mainly a disease of the immuno- competent population, more often affecting infants and young children. However, the number of leishmaniasis 1012 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Transplant Infectious Disease, ISSN 1398-2273