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Pediatric cutaneous leishmaniasis in an endemic region in India
Saurabh Agrawal1, Kanika Khandelwal1, Ram A Bumb1
1Department of Dermatology, Sardar Patel Medical College, Bikaner, Rajasthan, India; Department of Molecular Biology, Indian Council of Medical Research, New Delhi, India; Department of Pathology and Microbiology, Ohio State University, Columbus, Ohio.
Insights
Pediatric cutaneous leishmaniasis (CL) in India
Area of Science:
- Tropical medicine
- Dermatology
- Medical entomology
Background:
- Cutaneous leishmaniasis (CL) is a significant health concern in endemic regions.
- Pediatric CL presents unique challenges in diagnosis and management.
- The Bikaner region of Rajasthan, India, is a known endemic area for CL.
Purpose of the Study:
- To describe the clinicoepidemiological characteristics of pediatric CL in pre-school children (0-5 years).
- To identify the causative Leishmania species in the Bikaner region.
- To evaluate treatment outcomes for pediatric CL.
Main Methods:
- Retrospective analysis of 151 pediatric CL cases from 2001-2012.
- Clinical examination, parasitological smears, and histopathology for diagnosis.
- Polymerase chain reaction (PCR) for species identification.
- Review of treatment modalities and their effectiveness.
Main Results:
- 151 pediatric CL cases with 217 lesions were reported.
- The face was the most commonly affected site, with plaque or papulonodular lesions.
- Leishmania tropica was identified as the causative species in 13 patients via PCR.
- Intralesional sodium stibogluconate was well-tolerated; oral rifampicin, dapsone, and RFHT also showed efficacy.
Conclusions:
- Pediatric CL in the Bikaner region predominantly affects pre-school children, with facial lesions being common.
- Leishmania tropica is the etiological agent in this endemic area.
- Various treatment options, including intralesional sodium stibogluconate, oral medications, and RFHT, are effective and well-tolerated in pediatric CL management.
Abstract:
Cutaneous leishmaniasis (CL) is endemic in the Bikaner region situated in the Thar Desert of Rajasthan, India. This study describes clinicoepidemiological data of pediatric CL in pre-school children (0-5 years of age) from this region during 2001-2012. In total, 151 patients with 217 lesions were reported during the study period. The mean age of the study group was 3.29 ± 1.43 years (0.25-5 years), with many (41.7%) cases being in the age group of 2-4 years. Face was the most common site involved, and morphologically, the lesions were either plaque type or papulonodular. Smear for parasitologic examination was positive in 84 (70%) of 120 cases, and histopathologic examination confirmed CL in 10 (55.55%) of 18 cases. Parasite species identification conducted for 13 randomly selected patients by polymerase chain reaction identified Leishmania tropica as the causative species. Intralesional sodium stibogluconate was the most commonly used treatment and found to be well-tolerated. Other therapies that were effective included oral rifampicin, oral dapsone, radiofrequency heat therapy (RFHT), and combinations of the three therapies.
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