Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Dermatol Ther. 2022 Jan;35(1):e15185. doi: 10.1111/dth.15185. Epub 2021 Nov 30.
Leishmania tropica (L. tropica) cutaneous leishmaniasis (CL) is associated with high morbidity and low response rate to therapy, especially in pediatric patients. Intravenous (IV) liposomal amphotericin B (LAmB) has been used off-label as a treatment for L. tropica CL for many years. However, data regarding its efficacy and safety in children is lacking. In order to evaluate the efficacy and safety of IV LAmB for treating pediatric patients with L. tropica, we retrospectively reviewed electronic medical records of 24 children who were diagnosed with L. tropica CL and treated with IV LAmB during 2014-2020, at a tertiary medical center in Israel. Fourteen (58%) completed the treatment protocol and 10 (42%) experienced an infusion-related adverse event (IRAE) leading to treatment termination. Complete response was noted in 6/14 (43%) patients, while 8/14 (57%) failed to respond. Lower response rate was noted in lesions involving the mid-facial area. The relatively low response rate is speculated to result from a low dose of LAmB, short follow-up period, and difficult to treat anatomic locations. The observation of a lower response rate for mid-facial lesions should be validated in larger cohorts. The highrisk of IRAE should be considered in physician decisions regarding this treatment.
热带利什曼原虫（L. tropica）皮肤利什曼病（CL）发病率高，对治疗的反应率低，尤其是儿科患者。多年来，静脉注射（IV）两性霉素 B 脂质体（LAmB）已被超适应证用于治疗热带利什曼原虫 CL。然而，关于其在儿童中的疗效和安全性的数据尚缺乏。为了评估 IV LAmB 治疗热带利什曼原虫 CL 儿科患者的疗效和安全性，我们回顾性分析了 2014 年至 2020 年期间，以色列一家三级医疗中心使用 IV LAmB 治疗的 24 例热带利什曼原虫 CL 患儿的电子病历。14 例（58%）完成了治疗方案，10 例（42%）发生与输注相关的不良事件（IRAE）而导致治疗终止。14 例患者中，6 例（43%）完全缓解，8 例（57%）无反应。累及中面部的病变反应率较低。反应率较低推测是由于 LAmB 剂量低、随访时间短以及难以治疗的解剖部位所致。中面部病变反应率较低的观察结果应在更大的队列中得到验证。在医生决定使用这种治疗方法时，应考虑 IRAE 的高风险。
