Rare detection of dermal Leishmania infantum in two pediatric patients with cutaneous leishmaniasis (CL) in southern Iran

This study highlights the rare detection of dermal Leishmania infantum in two pediatric patients with cutaneous leishmaniasis (CL) in southern Iran. Both patients had a history of visceral leishmaniasis (VL) and presented with atypical facial lesions. Molecular assays confirmed the presence of L. infantum through species PCR targeting the cysteine protease B (cpb) gene, revealing 702/741-bp amplicons. Phylogenetic analysis describes two pediatric CL cases in southern Iran caused by a strain of L. infantum closely related to the LIPA59 genotype. This detection in immunocompetent children challenges the traditional association of L. infantum solely with VL and highlights its capacity for atypical dermal manifestations. These findings underscore the necessity of molecular diagnostics to differentiate Leishmania species, as misidentification risks ineffective treatments and potential disease progression. Enhanced surveillance integrating PCR-based methods is critical to track dermal strains in regions where VL and CL overlap, particularly given potential ecological or genetic drivers of atypical tropism. Addressing this emerging threat requires integrated strategies to mitigate the dual burden of cutaneous and visceral disease in vulnerable populations.