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Pediatric Cutaneous Leishmaniasis: A Case Series in a Montreal Tertiary Care Hospital
Michelle Aaron1, Jordan Benzur1, Hedwige Auguste2
1Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
Insights
Pediatric cutaneous leishmaniasis (CL) in non-endemic Canada presents diagnostic challenges. Early awareness and prompt treatment are crucial for better outcomes in children with CL.
Area of Science:
- Medical Parasitology
- Pediatric Infectious Diseases
- Dermatology
Background:
- Cutaneous leishmaniasis (CL) diagnosis and management are challenging in pediatric patients.
- Pediatric CL cases in non-endemic regions require specific clinical considerations.
Purpose of the Study:
- To determine the clinical characteristics of cutaneous leishmaniasis in children diagnosed in Montreal, Canada.
- To highlight diagnostic delays and treatment outcomes for pediatric CL.
Main Methods:
- Retrospective analysis of demographic and clinical data from pediatric CL patients (2004-2023).
- Utilized medical records from Sainte-Justine University Medical Center.
- Diagnostic confirmation through histopathology and polymerase chain reaction (PCR).
Main Results:
- Fourteen pediatric CL cases identified, primarily in immigrant children, with lesions on faces and legs.
- Mean diagnostic delay was 3 months due to healthcare access issues and misdiagnoses.
- Treatment involved fluconazole, liposomal amphotericin B, or meglumine antimoniate, with a mean resolution time of 5 months, often resulting in scarring.
Conclusions:
- Increased awareness of pediatric CL in non-endemic countries is essential for earlier diagnosis.
- Prompt treatment can lead to improved outcomes for children with cutaneous leishmaniasis.
- Recognizing CL in children in regions like Canada can prevent prolonged diagnostic delays and reduce sequelae.
Background:
The diagnosis and management of cutaneous leishmaniasis (CL) pose important challenges in the pediatric population.
Objective:
We determined CL clinical characteristics in infected children in Montreal, Canada.
Methods:
Demographic and clinical data from medical records of children with CL were retrieved retrospectively (2004-2023) at Sainte-Justine University Medical Center.
Results:
Fourteen children (9 boys and 5 girls) with CL were first- (9) or second- (5) generation immigrants who immigrated from or travelled to their country of origin. CL developed post arrival/return to Canada (mean 6.6 months). The mean age at onset was 8.4 years (range 3-16 years). Lesions were multiple in 10 cases, with faces and legs more frequently involved. The mean diagnostic delay was 3 months, largely due to limited access to healthcare and initial misdiagnoses (range: 1-7 months). Histopathology (12), polymerase chain reaction (8), or both (7) confirmed the diagnosis. Two patients cleared CL without treatment, while 2 others showed clinical improvement with antileishmanial agent treatment alone. Patients were treated with fluconazole (7), liposomal amphotericin B (6), either alone or in association, and intralesional meglumine antimoniate (2). The mean time between CL onset and resolution was 5 months (range 1-10 months), resulting in atrophic scars in 10 patients with known outcome.
Conclusion:
Awareness of the occurrence of CL in children living in non-endemic countries should result in earlier diagnosis and treatment and better outcomes.
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