Use of liposomal anfotericin B in diseminated cutaneous leishmaniasis caused by Leishmania braziliensis in a pediatric patient with Down syndrome
DOI:
https://doi.org/10.17843/rpmesp.2023.401.11481Keywords:
Síndrome de Down, Leishmaniasis, Anfotericina B, Leishmania braziliensisAbstract
We present a case of disseminated cutaneous leishmaniasis with extensive manifestation in a pediatric
patient with Down syndrome. The case was confirmed by parasitological and immunological tests. The
species was identified as Leishmania (Viannia) braziliensis by polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP). The immune deficit that occurs as part of Down syndrome
may have been the reason for the aggressive and prolonged clinical manifestations as well as the poor response to stibogluconate and deoxycholate amphotericin. The patient was treated with liposomal amphotericin B and at the end of therapy, showed clinical improvement of the lesions. This report highlights
the challenges of the diagnosis and treatment of cutaneous leishmaniasis in immunosuppressed pediatric
patients, especially under difficult social, economic and geographic conditions. Leishmaniasis should be
considered as a differential diagnosis when treating atypical chronic dermatologic ulcers; the use of liposomal
amphotericin in immunocompromised patients should also be considered in these cases.
Downloads
References
Cunha J, Carrillo E, Moreno J, Cordeiro-da-Silva A. Can Attenuated
Leishmania Induce Equally Effective Protection as Virulent Strains in
Visceral Leishmaniasis? En: Leishmaniasis - Trends in Epidemiology,
Diagnosis and Treatment [Internet]. 2014 [citado el 4 de julio de 2022] Disponible en: http://www.intechopen.com/books/leishmaniasis-trends-in-epidemiology-diagnosis-and-treatment.
Centers for Disease Control and Prevention. CDC - Leishmaniasis
[Internet]. 2021 [citado el 4 de julio de 2022]. Disponible en: https://www.cdc.gov/parasites/leishmaniasis/.
Organización Panamericana de Salud. Leishmaniasis [Internet]. 2020
[citado el 6 de julio de 2022]. Disponible en: https://www.paho.org/es/temas/leishmaniasis.
Bailey F, Mondragon-Shem K, Haines LR, Olabi A, Alorfi A, Ruiz-Postigo
JA, et al. Cutaneous leishmaniasis and co-morbid major depressive disorder: A systematic review with burden estimates. PLoS Negl Trop Dis. 2019;13(2):e0007092. doi: 10.1371/journal.pntd.0007092.
Bains A, Vedant D, Gupta P, Tegta GR. Unusual presentation of mucocutaneous leishmaniasis in HIV-infected patient. Indian J Sex Transm
Dis AIDS. 2016;37(2):193-196. doi: 10.4103/0253-7184.192118.
Van der Auwera G, Dujardin JC. Species typing in dermal leishmaniasis.
Clin Microbiol Rev. 2015;28(2):265-94. doi: 10.1128/CMR.00104-14.
Melgarejo C, Bravo F, Salomón M, Puell L, Feria K, Ramos C, et al.
Leishmaniasis cutánea difusa transformada por corticoides. Folia dermatol Peru. 2011;22(1):35–9.
Fresneda Villibor F, Marchesini G, Roselino Ribeiro AL, Oliveira Guaré R. Cutaneous leishmaniasis in an indigenous infant with Down’s syndrome: A case report. Asian Pac J Trop Med. 2019;12(12):574–6. doi: 10.4103/1995-7645.272488.
Fraga J, Veland N, Montalvo Alvarez AM, Praet N, Boggild AK, Valencia
BM, et al. Accurate and rapid species typing from cutaneous and mucocutaneous leishmaniasis lesions of the New World. Diagn Microbiol Infect Dis. 2012;74(2):142-50. doi: 10.1016/j.diagmicrobio.2012.06.010.
Arteaga-Livias K, Santos-Huerta M, Dámaso-Mata B, Panduro-Correa
V, Gonzales-Zamora JA, Rodriguez-Morales AJ. Disseminated Cutaneous Leishmaniasis in a Pediatric Patient from Peru. J Trop Pediatr.
;67(3):fmaa051. doi: 10.1093/tropej/fmaa051.
Rincón MY, Silva SY, Dueñas RE, López-Jaramillo P. Leishmaniasis
cutánea diseminada: Reporte de dos casos en Santander, Colombia. Rev
Salud Publica. 2009;11(1):145–50.
Vélez ID, Jiménez A, Vásquez D, Robledo SM. Disseminated Cutaneous
Leishmaniasis in Colombia: Report of 27 Cases. Case Rep Dermatol.
;7(3):275-86. doi: 10.1159/000441120.
Bittencourt A, Barral A, Costa JML, Saldanha AC, Badaro F, Barral-
netto M, et al. Diffuse Cutaneous Leishmaniasis. Int J Dermatol.
;31(8):568–70.
Vélez I, Agudelo S, Robledo S, Jaramillo L, Segura I, Soccol V, Restrepo S.
Diffuse cutaneous leishmaniasis with mucosal involvement in Colombia,
caused by an enzymatic variant of Leishmania panamensis. Trans R Soc
Trop Med Hyg. 1994;88(2):199. doi: 10.1016/0035-9203(94)90294-1.
Rosa MEA, Machado PRL. Disseminated Leishmaniasis: Clinical, immunological, and therapeutic aspects. Drug Dev Res. 2011;72(6):437-441.
doi: 10.1002/ddr.20450.
Scorza BM, Carvalho EM, Wilson ME. Cutaneous manifestations of
human and murine leishmaniasis. Int J Mol Sci. 2017;18(6). doi: 10.3390/
ijms18061296.
Hashiguchi Y, Gomez EL, Kato H, Martini LR, Velez LN, Uezato H. Diffuse
and disseminated cutaneous leishmaniasis: clinical cases experienced in
Ecuador and a brief review. Trop Med Health. 2016;44:2. doi: 10.1186/s41182-016-0002-0.
Machado GU, Prates FV, Machado PRL. Disseminated leishmaniasis: clinical, pathogenic, and therapeutic aspects. An Bras Dermatol. 2019;94(1):9-
doi: https://doi.org/10.1590/abd1806-4841.20198775.
Lindoso JA, Cunha MA, Queiroz IT, Moreira CH. Leishmaniasis-HIV
coinfection: current challenges. HIV AIDS (Auckl). 2016;8:147-156. doi:
2147/HIV.S93789.
Calvopina M, Gomez EA, Sindermann H, Cooper PJ, Hashiguchi Y. Relapse
of new world diffuse cutaneous leishmaniasis caused by Leishmania
(Leishmania) mexicana after miltefosine treatment. Am J Trop Med Hyg.
;75(6):1074-7.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Revista Peruana de Medicina Experimental y Salud Pública
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
