Pediatric Cutaneous Leishmaniasis: A Case Series in a Montreal Tertiary Care Hospital.

Abstract

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.