Concomitant visceral and localized cutaneous leishmaniasis in two Moroccan infants
Metadatos
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Mouttaki, Tarik; Maksouri, Hasnaa; El Mabrouki, Jilali; Merino-Espinosa, Gema; Fellah, Hassan; Itri, Mohamed; Martín Sánchez, Joaquina; Soussi-Abdallaoui, Maha; Chiheb, Soumiya; Riyad, MyriamEditorial
BioMed Central
Materia
Visceral leishmaniasis Cutaneous leishmaniasis Leishmania infantum Leishmania tropica Infants Morocco
Fecha
2018-04-12Referencia bibliográfica
Mouttaki et al. Concomitant visceral and localized cutaneous leishmaniasis in two Moroccan infants. Infectious Diseases of Poverty (2018) 7:32 [http://hdl.handle.net/10481/52139]
Resumen
Background: Leishmaniases 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 presentation: In 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.
Conclusions: These 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.