La leishmaniose cutanée de l’enfant au Maroc : particularités cliniques et épidémiologiques

Abstract

Cutaneous leishmaniasis (CL) is a parasitic disease caused by a flagellate protozoa of the genus Leishmania and is a public health problem throughout the world. In Morocco, CL may be sporadic or endemic depending on the species of Leishmania and the region involved. Casablanca is a non-endemic city but many children with CL come from elsewhere in the country. The aim of our study is to describe the clinical and epidemiological particularities of CL diagnosed in children at the Casablanca University Hospital. A cross-sectional study was conducted between 2010 and 2016. All patients with one or more skin lesions suggestive of CL underwent parasitological and molecular investigation. Epidemiological and clinical data from patients with positive genotyping were collected and analyzed. A comparative study was made of epidemiological and clinical variables between children and adults and between different species found in children. One hundred and six cases of CL were diagnosed, of which 40 in children (37.7%): 29 due to L.tropica (72.5%), 7 due to L.major (17.5%), and 4 due to L.infantum (10%). CL caused by L.tropica was significantly associated with children (P=0.009) and was distinguished by the predominance of the nodular form (P=0.04) and a facial location (P=0.007). Compared to adults, childhood CL lesions were characterized by their small size (P=0.001) and facial location (P=0.003). Children were treated mainly with pentavalent antimonials, with good safety and clinical response. In our series, CL due to L.tropica was predominant in children, reflecting the epidemic nature and wide geographical distribution of this species in Morocco. CL due to L.tropica was significantly associated with facial location and nodular form in children.