A cross-sectional study on sociodemographic, clinical, and therapeutic characteristics of a pediatric population with cutaneous leishmaniasis

Abstract

Objective: To characterize the pediatric population with cutaneous leishmaniasis treated at a research center and to determine the therapeutic response and safety of the treatment.

Methods: A cross-sectional study was designed, in which data related to sociodemographic information, history of leishmaniasis, clinical characteristics, treatment, therapeutic response and adverse events were collected from the review of the clinical records.

Results: The analysis was conducted in 156 pediatric patients with median age of 10.5 (6-14) years. Regarding clinical and therapeutic characteristics, the lesions in these patients were mostly single ulcers, primarily located on the upper and lower extremities. A total of 114 patients were managed at Programa de Estudio y Control de Enfermedades Tropicales (PECET), and 26 of them received more than one treatment. Upon administration of the first therapeutic option, intralesional meglumine antimoniate had a cure rate of 43.18% (19/44 patients), followed by systemic meglumine antimoniate with a cure rate of 40% (8/20) and topical investigational medication with a cure rate of 25% (5/20). The most frequent adverse events were: arthralgia and myalgia for systemic meglumine antimoniate; nausea and vomiting for miltefosine; and local pain, edema, erythema and rash for topical treatment.

Conclusions: Although more prospective studies are needed to generate evidence-based recommendations and management protocols, miltefosine appears to be a favorable, safe and well- tolerated therapeutic option for the pediatric population. Despite the high percentage of loss to follow-up, the success achieved in pediatric patients with local treatments suggests that local therapies could also be considered for managing this condition in this population.

Keywords

Cutaneous leishmaniasis / Pediatric population / Systemic treatment / Local treatment / Combined treatment / Tropical neglected disease / Safety / Therapeutic response

Conflicts of interest statement

All authors declare there is no conflict of interest.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors’ contributions

LLC and CB participated in the conceptualization; LLC and SRE participated in the methodology; LLC, SRE and JQP participated in the validation; LLC and SRE participated in the formal analysis; SRE participated in the data curation; SRE, LLC, and JQP participated in the writing—original draft preparation; SRE, LLC, JQP and CB participated in the writing—review and editing, and LLC participated in the supervision. All authors have read and agreed to the published version of the manuscript.

Publisher’s note

The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Edited by Lei Y, Pan Y, Zhang Q

References

[1] Alvar J, Vélez ID, Bern C, Herrero M, Desjeux P, Cano J, et al. Leishmaniasis worldwide and global estimates of its incidence. PLoS One 2012; 7(5): e35671.

[2] Instituto Nacional de Salud. Informe de evento Leishmaniasis, Colombia, 2022.[Online]. Available from: https://www.ins.gov.co/buscador-eventos/Informesdeevento/LEISHMANIASIS%20INFORME%202022.PDF. [Accessed on 15 September 2024].Accessed on 15 September 2024].

[3] World Health Organization. Leishmaniasis. 2014. [Online]. Available from: http://www.who.int/mediacentre/factsheets/fs375/es/.4. [Accessed on 15 September 2024].

[4] Pan American Health Organization (PAHO). Leishmaniasis: Informe epidemiológico de las Américas. Num 11. 2022.[Online]. Available from: https://iris.paho.org/bitstream/handle/10665.2/56833/OPASCDEVT220021_spa.pdf?sequence=1&isAllowed=y. [Accessed on 17 September 2024].

[5] Lizarazo F, Echeverri J, Medingana F, Ayala M, Cortes L, Gomez J. Lineamientos de atención clínica integral para Leishmaniasis en Colombia. Guia de practica clínica, Subdirección de Enfermedades Transmisibles, Grupo de Enfermedades Endemoepidémicas. 2023; Version 4. [Online]. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/PAI/Lineamientos-leishmaniasis.pdf. [Accessed on 17 September 2024].

[6] Castro M, Roede J, Machado P, Llanos-Cuentas A, Hueb M, Cota G, et al. Cutaneous leishmaniasis treatment and therapeutic outcomes in special populations: A collaborative retrospective study. PLoS Negl Trop Dis 2023; 17(1): e0011029.

[7] Pan American Health Organization (PAHO). Guideline for the treatment of leishmaniasis in the Americas. 2nd ed. 2022.[Online]. Available from: https://iris.paho.org/handle/10665.2/56120. [Accessed on 17 September 2024].

[8] Rozo N, Quintero J, López L. Therapeutic response and safety of different treatments for cutaneous leishmaniasis in patients: A retrospective cross-sectional study. Asian Pac J Trop Med 2023; 16(7): 305-312.

[9] Gupta M. Cutaneous leishmaniasis in children: A case series. Indian J Paediatr Dermatol 2018; 19: 379.

[10] Velez ID, Hendrickx E, Robledo SM, del Pilar Agudelo S. Leishmaniosis cutánea en Colombia y género [Gender and cutaneous leishmaniasis in Colombia]. Cad Saude Publica 2001; 17(1): 171-180. Spanish.

[11] Paniz-Mondolfi AE, Talhari C, García Bustos MF, Rosales T, Villamil- Gomez WE, Marquez M, et al. American cutaneous leishmaniasis in infancy and childhood. Int J Dermatol 2017; 56(12): 1328-1341.

[12] Dorlo TPC, Huitema ADR, Beijnen JH, De Vries PJ. Optimal dosing of miltefosine in children and adults with visceral leishmaniasis. Antimicrob Agents Chemother 2012; 56(7): 3864-3872.

[13] Cruz A, Rainey PM, Herwaldt BL, Stagni G, Palacios R, Trujillo R, et al. Pharmacokinetics of antimony in children treated for leishmaniasis with meglumine antimoniate. J Infect Dis 2007; 195(4): 602-608.

[14] Ortega ME, Terán G, Belizario D, Galindo W, Guevara JR. Leishmaniasis cutánea en niños entre 0-10 años. Instituto de Biomedicina Dr. Jacinto Convit. Archivos venezolanos de puericultura y pediatría. Caracas, Venezuela 2020; 83(2): 35-41.

[15] Castro MdM, Rode J, Machado PRL, Llanos-Cuentas A, Hueb M, Cota G, et al. Cutaneous leishmaniasis treatment and therapeutic outcomes in special populations: A collaborative retrospective study. PLoS Negl Trop Dis 2023; 17(1): e0011029.

[16] Rubiano LC, Miranda MC, Muvdi Arenas S, Montero LM, Rodríguez- Barraquer I, Garcerant D, et al. Noninferiority of miltefosine versus meglumine antimoniate for cutaneous leishmaniasis in children. J Infect Dis 2012; 205(4): 684-692.

[17] Soto J, Rojas E, Guzman M, Verduguez A, Nena W, Maldonado M, et al. Intralesional antimony for single lesions of bolivian cutaneous leishmaniasis. Clin Infect Dis 2013; 56(9): 1255-1260.

[18] Rather S, Yaseen A, Younus F, Wani M, Krishan K, Zirak S. Pediatric cutaneous leishmaniasis: A clinico-epidemiological study from North India. Indian Dermatol Online J 2021; 12(6): 852-859.