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Treating pediatric cutaneous Leishmania tropica with systemic liposomal amphotericin B: A retrospective,
Yehonatan Noyman1,2, Assi Levi1,2, Dan Ben Amitai2,3
1Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel.
Insights
Intravenous liposomal amphotericin B (LAmB) shows limited efficacy and significant adverse events in treating pediatric cutaneous leishmaniasis caused by Leishmania tropica. Further research is needed to optimize treatment for this vulnerable population.
Area of Science:
- Dermatology
- Infectious Diseases
- Pediatrics
Background:
- Cutaneous leishmaniasis (CL) caused by Leishmania tropica (L. tropica) presents significant challenges in pediatric patients, often exhibiting high morbidity and poor therapeutic response.
- Intravenous liposomal amphotericin B (LAmB) is used off-label for L. tropica CL, but robust data on its pediatric use is scarce.
Purpose of the Study:
- To evaluate the efficacy and safety of intravenous LAmB in treating pediatric patients diagnosed with L. tropica CL.
- To identify factors influencing treatment outcomes and adverse events in this specific patient group.
Main Methods:
- Retrospective review of electronic medical records for 24 pediatric patients with L. tropica CL treated with IV LAmB between 2014-2020.
- Analysis of treatment completion rates, response to therapy, and occurrence of infusion-related adverse events (IRAEs).
Main Results:
- Of 14 patients who completed treatment, only 6 (43%) achieved a complete response, while 8 (57%) did not respond.
- Ten patients (42%) experienced IRAEs, leading to treatment discontinuation.
- Lesions located in the mid-facial area showed a lower response rate.
Conclusions:
- IV LAmB demonstrated a relatively low efficacy and a high incidence of IRAEs in pediatric patients with L. tropica CL.
- Potential contributing factors to low response include suboptimal dosing, short follow-up, and challenging lesion locations.
- The risk of IRAEs necessitates careful consideration by clinicians when deciding on LAmB treatment for children.
Abstract:
Leishmania tropica (L. tropica) cutaneous leishmaniasis (CL) is associated with high morbidity and low response rate to therapy, especially in pediatric patients. Intravenous (IV) liposomal amphotericin B (LAmB) has been used off-label as a treatment for L. tropica CL for many years. However, data regarding its efficacy and safety in children is lacking. In order to evaluate the efficacy and safety of IV LAmB for treating pediatric patients with L. tropica, we retrospectively reviewed electronic medical records of 24 children who were diagnosed with L. tropica CL and treated with IV LAmB during 2014-2020, at a tertiary medical center in Israel. Fourteen (58%) completed the treatment protocol and 10 (42%) experienced an infusion-related adverse event (IRAE) leading to treatment termination. Complete response was noted in 6/14 (43%) patients, while 8/14 (57%) failed to respond. Lower response rate was noted in lesions involving the mid-facial area. The relatively low response rate is speculated to result from a low dose of LAmB, short follow-up period, and difficult to treat anatomic locations. The observation of a lower response rate for mid-facial lesions should be validated in larger cohorts. The highrisk of IRAE should be considered in physician decisions regarding this treatment.
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