Concomitant visceral and localized cutaneous leishmaniasis in two Moroccan infants

Abstract

BackgroundLeishmaniases are vector-borne diseases caused by the protozoa of the Leishmania genus. The clinical spectrum of these diseases extends from benign dermal lesions to visceral forms. In the Mediterranean region, zoonotic visceral leishmaniasis (ZVL) is caused by L. infantum. If untreated within two years, the disease usually leads to death. In Morocco, ZVL is endemic in the north, with a hundred cases notified each year, mostly in children aged below five years. Here, we report on two clinical observations in infants presenting unusual concomitant VL and cutaneous leishmaniasis (CL) in Morocco.Case presentationIn this case study, we report on two infants aged nine and 12 months old. They both have a history of febrile splenomegaly, anemia, and pallor of mucous membranes. Visceral leishmaniasis was confirmed by parasitological diagnosis (positive bone marrow smear and screening of anti-L. infantum antibodies). However, the clinical examination also showed cutaneous lesions that suggested the presence of CL. This was reinforced by the patients having a history of living or traveling to endemic foci. Thus, direct examination, culture, and PCR-RFLP (ITS1-Hae 3) were carried out on the patients’ dermal exudates. In one of the infants, CL was associated with L. infantum, while in the other it was associated with L. tropica. The infants were treated as according to the recommendations of the Ministry of Health. Both patients were cured in two months; defervescence, reduction of splenomegaly, and healing of cutaneous lesions were all observed.ConclusionsThese singular patients illustrate the clinical polymorphism of CL and the necessity of updating the differential diagnosis of leukemia-like syndromes, including VL, in children living in or travelling to known endemic areas. These observations suggest a change in the Mediterranean VL phenotype that may be associated with CL.Electronic supplementary materialThe online version of this article (10.1186/s40249-018-0413-8) contains supplementary material, which is available to authorized users.

Imported leishmaniasis in travelers: a 7-year retrospective from a Parisian hospital in France

“…Moreover, the distribution areas of the species also frequently overlap [ 3 ]. This highlights the importance of molecular identification for both epidemiological purposes and to avoid misdiagnosing L. infantum CL, which can lead to secondary VL [ 34 ], or alternatively, to reinsure patients in cases of L. major lesions, which do not disseminate in the case of HIV infection [ 11 ].…”

Genetic Diversity and Population Structure of Leishmania infantum in Morocco as Revealed by Multilocus Sequence Typing (MLST) Approach

“…The cutaneous lesions caused by L. infantum are usually represented as a small single ulcerated or lupoid lesion on the face that lastsup to three years [ 10 , 11 , 12 ]. Nevertheless, clinical polymorphism has been observed with erythematous, papular or nodular lesions [ 13 , 14 ].…”