Cutaneous leishmaniasis in travellers and migrants: a 10-year case series in a Canadian reference centre for tropical diseases

Abstract

Cutaneous and mucosal leishmaniasis are protozoan infections transmitted by the bite of female sandflies. This tropical disease affects 700 000 to 1 million new individuals annually. 1 Close to 20 species of Leishmania, belonging to 2 main subgenera (Leishmania and Viannia), are involved in human leishmaniasis. Cases of cutaneous leishmaniasis mainly occur in the Americas (New World leishmaniasis), as well as in the Mediterranean basin, the Middle East and Central Asia (Old World leishmaniasis).The clinical presentation of cutaneous leishmaniasis depends on various factors, including the acquired species, strains and virulence factors, as well as host characteristics, such as age, gender and immune status. 2,3 The lack of awareness of this disease among physicians in nonendemic countries, as well as varied clinical manifestations, may result in delayed diagnosis. 4

Treatment of pediatric cutaneous leishmaniasis with liposomal amphotericin B

“…Although the dose of IV L‐AmB used in CL is still controversial, administration of 3 mg/kg per day for 5 consecutive days and 6 doses on the 10th day, with a total cumulative dose not exceeding 18 mg/kg, was found to be effective 1,24 . However, different efficacy rates were also found in 15–32.5 mg/kg total dose applications 9,10,12–14,25–28 . (Table 2) In our study, we applied IV L‐AmB treatment as 3 mg/kg for 5 consecutive days and on the 10th day, in a total of 6 doses (18 mg/kg total dose).…”

“…When patients with delayed recovery (after 3 months) and patients who needed a second course of IV L‐AmB were included, the success rate was found to be 63% 13 . Lemieux et al, in the JD MacLean Center for Tropical Diseases at McGill University, reported that a 69% cure rate was found when IV L‐AmB was used as a first‐line agent for CL and 75% cure rate when IV L‐AmB was used as a first or second‐line agent 25 . In the study of Solomon et al, 13 patients with CL caused by L. tropica were treated with 6 doses of 3 mg/kg/day IV L‐AmB in the first 5 days and on the tenth day, a clinical improvement of 84% was reported, and the no recurrence was observed in the 11‐month follow‐up 24 .…”

“…13 Lemieux et al, in the JD MacLean Center for Tropical Diseases at McGill University, reported that a 69% cure rate was found when IV L-AmB was used as a first-line agent for CL and 75% cure rate when IV L-AmB was used as a first or second-line agent. 25 In the study of Solomon et al, 13 patients with CL caused by L. tropica were treated with 6 doses of 3 mg/kg/day IV L-AmB in the first 5 days and on the tenth day, a clinical improvement of 84% was reported, and the no recurrence was observed in the 11-month follow-up. 24 The authors noted that it is necessary to use a higher dose of L-AmB (>1.5 mg/kg/day) to achieve better results.…”

Windows into leishmaniasis epidemiology in the United States: September 2021 through August 2022

“…Also consistent with previous observations, positive cases were associated with recent travel to Central and South America, particularly Costa Rica, where there is a high incidence of leishmaniasis (Table 1, Table S2) (12,28,29,31). 11.7% of cases in this work were in children younger than 10 and 6.4% in the 10-18 age range, adding to reports of pediatric infection in the U.S. (12,13,29,32,33) Migration-related leishmaniasis has increased globally, but U.S.-specific data has been limited to sporadic case studies (28,(34)(35)(36)(37). This work identifies 7 cases (7.4% of all positive) of likely migration-related infection originating from multiple continents, highlighting a need for increased clinician awareness in this vulnerable population (Table 1, Table S3).…”

Prevalence of Cutaneous Leishmaniasis in Northern West Districts of Khyber Pakhtunkhwa

“…[22][23][24] Factors like poverty, immune deficiencies, migration, gender inequality, and housing conditions significantly affect transmission and prevalence. [25][26][27][28][29][30][31][32][33][34][35] Deforestation further exacerbates the disease's spread by altering vector behavior and disease pattern a cross regions. 35 Further research is needed in Khyber Pakhtunkhwa to understand Cutaneous leishmaniasis prevalence and affected demographics for effective policy planning.…”