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A pediatric case of disseminated American cutaneous leishmaniasis in Rio de Janeiro, Brazil
Sandra Maria Barbosa, Alice Guiotti De Alencar1, Renato Moura Braga
1Fluminense Federal University (UFF), Niteroi, Rio de Janeiro, Brazil. aliceguiotti@gmail.com.
Insights
A rare case of American cutaneous leishmaniasis in a child with HIV exposure highlights increased infection risk. Early diagnosis and treatment are crucial for managing this severe protozoan infection.
Area of Science:
- Infectious Diseases
- Parasitology
- Dermatology
Background:
- American cutaneous leishmaniasis is a protozoan infection with variable clinical presentations.
- Host immune response and parasite virulence influence disease manifestation.
Observation:
- A 2-year-old girl with vertical HIV exposure presented with disseminated papules, ulcers, and scalp lesions.
- Histopathology confirmed Leishmania amastigotes; PCR identified Leishmania species.
Findings:
- The patient received amphotericin B, showing lesion improvement.
- A secondary bacterial infection led to osteomyelitis, requiring antimicrobial treatment.
Implications:
- Children with vertical HIV exposure, even without seroconversion, face elevated infection risks.
- This case underscores the potential for severe, complicated leishmaniasis in immunocompromised or at-risk children.
Abstract:
American cutaneous leishmaniasis is an infectious disease caused by the protozoa of the genus Leishmania. Clinical manifestations vary according to the virulence of the parasite speciesand the host's immune response. We report a case of a 2-year-old girl vertically exposed to HIV who presented painful and itchy papules throughout her lower limbs with further dissemination of vegetative ulcers all over the body and scalp. The histopathological examination evidenced the amastigote form of Leishmania and the polymerase chain reaction was positive for Leishmania sp. in the tissue sample. The patient was treated with amphotericin B and demonstrated improvement of lesions. Despite successful treatment for American cutaneous leishmaniasis, she developed osteomyelitis related to a bacterial secondary infection over the site of a previous ulcer on the left ankle and required a 6-week course of intravenous antimicrobial treatment. Children with vertical exposure to HIV, even without seroconversion, are at greater risk of infections if compared to non-exposed children. This is perhaps the reason for such an exuberant and rare case of complicated eishmaniasis.
