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Case Report: Simple Nodular Cutaneous Leishmaniasis Caused by Autochthonous Leishmania (Mundinia) orientalis in an 18-Month-Old Girl: The First Pediatric Case in Thailand and Literature Review

Suvaporn AnugulruengkittDivision of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;
Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand;

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Wipaporn Natalie SongtaweesinDivision of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;
Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand;

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Nattawan ThepnarongVachira Phuket Hospital, Phuket, Thailand;

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Amatanun TangthanapalakulDivision of Dermatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

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Manassaya SitthisanDivision of Dermatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

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Susheera ChatproedpraiDivision of Dermatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

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Jade WititsuwannakulDivision of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

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Sasithorn LikitnukulDivision of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;
Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand;

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Narissara JariyapanCenter of Excellence in Vector Biology and Vector-Borne Disease, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

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Gareth D. WeedallSchool of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, United Kingdom

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Padet SiriyasatienCenter of Excellence in Vector Biology and Vector-Borne Disease, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

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Kanok PreativatanyouCenter of Excellence in Vector Biology and Vector-Borne Disease, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

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ABSTRACT.

We report an autochthonous case of simple, localized cutaneous leishmaniasis in a healthy 18-month-old girl from southern Thailand. The patient presented with a solitary chronic cutaneous nodular lesion on her left cheek for approximately 1 year. Histopathological dissection of the cheek skin biopsy demonstrated remarkably nodular and interstitial infiltrates of lymphocytes and histiocytes full of intracellular oval-shaped amastigotes, consistent with cutaneous leishmaniasis. The Leishmania promastigotes were also cultured successfully from the lesion biopsy and were designated with the WHO code MHOM/TH/2021/CULE5. Using internal transcribed spacer 1-specific polymerase chain reaction, the parasite DNA was demonstrated in both saliva and lesion biopsy. Based on the BLASTn and phylogenetic analysis, the parasite was identified as Leishmania orientalis, clustered in the Mundinia subgenus. The patient responded well to a 6-week course of oral itraconazole, without recurrence. To our knowledge, this is the fourth case of autochthonous leishmaniasis resulting from L. orientalis and the youngest patient of leishmaniasis ever reported in Thailand. More importantly, we also demonstrate the clinical course of the lesion according to the timeline before and after treatment, which can help physicians better understand and provide an accurate diagnosis with appropriate treatment of this emerging parasitic disease.

Author Notes

Address correspondence to Kanok Preativatanyou, Center of Excellence in Vector Biology and Vector-Borne Disease, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand. E-mail: kanok.pr@chula.ac.th

Financial support: This study was funded by the Ratchadapiseksompote Fund (Grant No. RA65/028, 2022), the Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Authors’ addresses: Suvaporn Anugulruengkitt, Wipaporn Natalie Songtaweesin, and Sasithorn Likitnukul, Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, and Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand, E-mails: suvaporn.a@chula.ac.th, wipaporn.n@chula.ac.th, and slikitnukul@gmail.com. Nattawan Thepnarong, Vachira Phuket Hospital, Phuket, Thailand, E-mail: j_nattawan@hotmail.com. Amatanun Tangthanapalakul, Manassaya Sitthisan, and Susheera Chatproedprai, Division of Dermatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, E-mails: amatanun.t@gmail.com, manas_pack@hotmail.com, and susheera.c@chula.ac.th. Jade Wititsuwannakul, Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, E-mail: jademdcu@gmail.com. Narissara Jariyapan, Padet Siriyasatien, and Kanok Preativatanyou, Center of Excellence in Vector Biology and Vector-Borne Disease, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, E-mails: narissara.j@chula.ac.th, padet.s@chula.ac.th, and kanok.pr@chula.ac.th. Gareth D. Weedall, School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, UK, E-mail: g.d.weedall@ljmu.ac.uk.

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