Interventions to treat cutaneous leishmaniasis in children: A systematic review

Abstract

BackgroundCase management in children with cutaneous leishmaniasis (CL) is mainly based on studies performed in adults. We aimed to determine the efficacy and harms of interventions to treat CL in children.MethodsWe conducted a systematic review of clinical trials and cohort studies, assessing treatments of CL in children (≤12 years old). We performed structured searches in PubMed, CENTRAL, LILACS, SciELO, Scopus, the International Clinical Trials Registry Platform (ICTRP), clinicaltrials.gov and Google Scholar. No restrictions regarding ethnicity, country, sex or year of publication were applied. Languages were limited to English, Spanish and Portuguese. Two reviewers screened articles, completed the data extraction and assessment of risk of bias. A qualitative summary of the included studies was performed.ResultsWe identified 1092 records, and included 8 manuscripts (6 Randomized Clinical Trials [RCT] and 2 non-randomized studies). Most of the articles excluded in full-text review did not report outcomes separately for children. In American CL (ACL), 5 studies evaluated miltefosine and/or meglumine antimoniate (MA). Their efficacy varied from 68–83% and 17–69%, respectively. In Old-World CL (OWCL), two studies evaluated systemic therapies: rifampicin and MA; and one study assessed efficacy of cryotherapy (42%, Per Protocol [PP]) vs intralesional MA (72%, PP). Few studies (4) provided information on adverse events (AEs) for children, and no serious AEs were reported in participants. Risk of bias was generally low to unclear in ACL studies, and unclear to high in OWCL studies.ConclusionInformation on efficacy of treatment for CL in children is scarce. There is an unmet need to develop specific formulations, surveillance of AEs, and guidelines both for the management of CL and clinical trials involving the pediatric population.RegistrationThe protocol of this review was registered in the PROSPERO International register of systematic reviews, number CRD42017062164.

Leishmania naiffi and lainsoni in French Guiana: Clinical features and phylogenetic variability

“…Concerning the other clinical features of L. (V.) lainsoni, our results were similar to previous reports, the predominant presentation being a single ulcer, localized on the face or the extremities [43,45,46]. Among the 4 children with available data on treatment, one had a spontaneous healing and three were cured with pentamidine, contrasting with several studies reporting high proportions of treatment failure [47][48][49].…”

A Clinicoepidemiological Study of Pediatric Cutaneous Leishmaniasis in Sinjar Province, Iraq

“…[8][9][10]12 However, even these studies consisted of small sample sizes. 6 In a study conducted in India recruiting 151 children who were treated with radiofrequency heat therapy or intralesional sodium stibogluconate, complete cure was observed in 91.8% and 84.4% of patients, respectively. 13 In a case-control study recruiting 127 patients using sodium stibogluconate investigating different risk factors for treatment failure, the treatment failure rate at the end of the study was 24.4%, and multivariate analysis identified younger age as a risk factor for treatment failure.…”

“…In endemic countries, the prevalence of CL increases with age until the age of 15 years, after which the prevalence declines probably because of the development of immunity. 6 In addition, previous studies including observational and clinical trials, recruiting pediatric age group patients, showed high treatment failure rates. 6 Therefore, clinicoepidemiological projects recruiting children are warranted for a better understanding of the clinical presentation, diagnosis, and proper management of CL in this age group.…”

“…6 In addition, previous studies including observational and clinical trials, recruiting pediatric age group patients, showed high treatment failure rates. 6 Therefore, clinicoepidemiological projects recruiting children are warranted for a better understanding of the clinical presentation, diagnosis, and proper management of CL in this age group. This study was conducted to treat the pediatric age group patients diagnosed with CL with sodium stibogluconate and evaluate the treatment outcomes and factors influencing the outcome.…”

Características clínicas-epidemiológicas y conocimiento sobre la leishmaniosis tegumentaria americana en una población de Carabobo. Venezuela

“…La leishmaniosis representa un conjunto de enfermedades producidas por más de 20 diferentes especies de un protozoo parásito del género Leishmania spp., la cual por sus características clínicas se dividen en leishmaniosis superficial y profunda. La primera afecta principalmente piel y mucosas, mientras que, la segunda daña órganos internos (hígado, bazo y médula ósea), ésta última si no es tratada a tiempo puede causar la muerte [1][2][3].…”