Clinical features and therapeutic response in adult and pediatric patients with American tegumentary leishmaniasis in Rio de Janeiro

Abstract

Background American tegumentary leishmaniasis (ATL) is a neglected disease with wide territorial distribution. Knowledge is scarce in children and adolescents. This study aims to compare the clinical features and response to antimony treatment in pediatric and adult patients with cutaneous leishmaniasis. Methods A retrospective cohort study was performed with 659 patients who attended a reference centre in Rio de Janeiro, Brazil, from 2000 to 2015. The pediatric cohort consisted of 131 (20%) patients and the adult cohort consisted of 528 (80%) patients. Results The epidemiological profile, antimony therapeutic response and incidence of adverse events (AE) were different in the pediatric cohort compared with the adult cohort. Mucosal form was less frequent in the pediatric cohort (RR:0.49, p=0.011). Lesions in the head, neck and trunk were more frequent in the pediatric cohort (RR:1.49, p=0.043). The effectiveness of antimony treatment was superior in the pediatric cohort (88.3% vs 76.6%) with a shorter healing time (RR:0.49, p=0.009). Pediatric patients had lower proportions of moderate to severe AE compared with adults (RR:0.45, p=0.027). Clinical AE predominated in the adult cohort (RR:0.40, p=0.000) and laboratory AE in the pediatric cohort (RR:1.50, p=0.023). Conclusions This study adds to the body of knowledge on differences that exist between different age groups in ATL.

Cutaneous leishmaniasis treatment and therapeutic outcomes in special populations: A collaborative retrospective study

“…As expected, safety data showed a higher frequency of patients presenting ADRs in older adults than in children. The proportion of children with ADRs in this study is lower than the 50% described in another retrospective study with a pediatric cohort treated with systemic antimonials [46]. Serious adverse drug reactions in children were rare.…”

“…Serious adverse drug reactions in children were rare. As previously described [ 10 , 46 ], among those with ADRs, children were more likely to present mild ADRs than older adults (92.6% versus 78.0% in the current study) reflecting the higher elimination rate in children and co-morbidities in older adults. The proportion of patients on miltefosine with ADRs was respectively 51.1% in children and 68.9% in older adults, similar to that previously reported [ 30 ].…”

“…Brazil, Colombia, Peru, and Bolivia are the countries reporting most CL cases in the Americas, and together with Nicaragua represented 81% of all cases reported from the region in 2020 [ 2 ]. The ten study sites are reference centers for CL in these countries, treating a proportion of pediatric cases similar to that previously reported in the region ( S2 Table ) [ 2 ], and the demographic and clinical characteristics of our study participants were aligned with those described in studies of CL in the region [ 22 , 41 , 46 , 48 – 51 ].…”

Influence of Intestinal Helminth Burden on Clinical Manifestations, Therapeutic Response, and Leishmania braziliensis Load in Patients with New World Cutaneous Leishmaniasis

“…23 Additionally, the success rate of pentavalent antimony in the Corte de Pedra region in the treatment of CL has been observed to be lower than that of other regions in Brazil, a finding that the current study corroborates. 36 Although host, environmental, and medical factors may be contributing to this disparity of outcomes, the observation that L. braziliensis in this region is polymorphic remains an important one. 37,38 In fact, it has been shown that genotypic differences among isolates of L. braziliensis are associated not only with clinical form of leishmaniasis but also with treatment failure.…”