Parasitologia

The species composition and host–parasite associations of Gyrodactylus parasitising freshwater fishes in Bulgaria were re-examined based on the revision of museum specimens. Revised data are provided for 28 species. There are 22 species confirmed as occurring in Bulgaria based on morphological examination (G. aphyae, G. cyprini, G. fossilis, G. gobii, G. gracilihamatus, G. katharineri, G. laevis, G. latus, G. leucisci, G. luciopercae, G. macrocornis, G. macronychus, G. malmbergi, G. markakulensis, G. medius, G. prostae, G. rhodei, G. shulmani, G. sprostonae, G. stankovici, G. truttae and G. vimbi). New records for the country are reported for G. cobitis, G. dykovae, G. gobiensis and G. papernai. The data about the occurrence of nine species could not be verified. The most species-rich region is the Danube Drainage (21 species), followed by the East-Aegean Sea Drainage (12 species). The smaller drainages (Black Sea Drainage—nine species; West-Aegean Sea Drainage—four species) are less studied. G. prostae (four host species from eight localities) and G. sprostonae (four host species, four localities) are revealed as the most frequent species; these euryxenous parasites infect a broad range of host species, often fishes of economic importance. Fish species of less commercial value are less studied. Full article

The tick Rhipicephalus sanguineus is the most prevalent ectoparasite in dogs, causing discomfort to the animals and acting as a vector for several pathogens, including the bacterium Ehrlichia canis and the protozoa Babesia canis, Babesia gibsoni, and Hepatozoon canis. Control of this parasite is traditionally carried out with synthetic chemical acaricides. However, due to the increasing number of cases of resistance, phytotherapy has been increasingly investigated as a promising alternative. In this study, the larvicidal activity of the crude ethanolic extract and essential oil obtained from the inflorescences of Achyrocline satureioides was evaluated, whose constituents were identified through phytochemical analyses and gas chromatography. The analyses revealed that the extract is rich in flavonoids, tannins, and saponins, while the essential oil is composed mainly of terpenes. In contact tests with impregnated paper, the extract at 100 mg/mL showed a mortality rate of 32.2% in R. sanguineus larvae with LC₅₀ calculated at 249.62 mg/m., while the essential oil, at the same concentration, resulted in 56.55% mortality, and the LC₅₀ and LC₉₀ were 119.73 mg/mL and 185.53 mg/mL, respectively. These results indicate that the essential oil of A. satureioides has significant larvicidal activity and has potential for use as an alternative, alone or in combination with other extracts or synthetic acaricides. Full article

Our study reports the first molecular detection of the protozoan pathogen Histomonas meleagridis, the causative agent of histomonosis, in the poultry red mite Dermanyssus gallinae. Mite samples were collected from a commercial poultry farm and a backyard flock in Hungary and analyzed using PCR assays that targeted the COX1 gene in mites and 18S rRNA gene in H. meleagridis. Phylogenetic analysis confirmed the identity of D. gallinae and revealed distinct genetic lineages between farm and backyard isolates. H. meleagridis DNA was detected in 10 of 17 mite samples, representing multiple variants within Genotype 1. No histomonosis was detected in the examined poultry, although one hen harbored Simplicimonas sp. The findings suggest that D. gallinae could serve as a carrier for H. meleagridis, potentially facilitating the persistence and transmission of the pathogen. This novel host–pathogen association highlights the need for further research into the epidemiological role of poultry ectoparasites in the spread of histomonosis. Full article

Helminth parasites infect mammalian hosts through complex life cycles, mostly triggering T helper type 2 (Th2) immune responses characterized by interleukin-4 (IL4), interleukin-5 (IL5), and interleukin-13 (IL13) production. Environmental chemical exposures may modulate these immune pathways, potentially affecting infection outcomes. Using The Comparative Toxicogenomics Database (CTD), we analyzed chemical–gene interactions affecting IL4, IL5, and IL13 genes to identify chemicals capable of modulating Th2 immunity and their associated expression profiles. Accordingly, a total of 818 chemicals can interact with IL4, IL5 and/or IL13, with 145 chemicals showing the potential of affecting all three genes. These 145 chemicals include air pollutants (8.3%), allergens (2.7%), bioactive molecules (8.3%), industry-related chemicals (14.5%), medicinal drugs (21.4%), metal and metal-containing chemicals (8.3%), pesticides (3.4%), plant compounds (12.4%), and others (20.7%). We observed a greater number of chemicals associated with increased (n = 95) gene expression compared to decreased (n = 14) gene expression, suggesting a Th2 pathway hyperactivation caused by chemicals capable of affecting IL4, IL5 and IL13. Eight classes of parasitic diseases were observed among chemical-associated conditions. Environmental chemicals extensively modulate Th2 immune responses through diverse molecular mechanisms. The trend concerning upregulation of Th2 pathways may enhance antiparasitic protection but, on the other hand, could predispose individuals to allergic diseases, among other Th2-related conditions. These exploratory findings suggest that chemical pollution may influence the susceptibility and pathogenesis of helminth infections and highlight the need for the incorporation of exposome-based approaches in parasitology research. Full article

Pediculosis produced by the presence of the human head louse (Pediculus humanus capitis DeGeer, 1767) and the body louse (Pediculus humanus humanus L., 1758) remains a neglected tropical disease in Nigeria, where permethrin-based pediculicides are widely used. However, the resistance status of lice populations has not been previously assessed. Knockdown resistance (kdr) to pyrethroids is primarily driven by two mutations—T917I and L920F—in the voltage-sensitive sodium channel (VSSC) gene. This study investigated the presence of these mutations in 85 head and body lice collected from school-age children in two settlements in Nigeria. The T917I mutation was detected in head lice at frequencies ranging from 21% to 76%, and in body lice from 10% to 95%, with significant variation between sites and louse types. Remarkably, all lice examined carried the L920F mutation, regardless of T917I genotype, a pattern not previously reported in body lice. These findings suggest that pyrethroid resistance is well established or under active selection in the study populations. This is the first report of kdr mutations in human lice from Nigeria and highlights the urgent need for resistance monitoring programs. Early genetic surveillance of these mutations can inform treatment strategies and help prevent widespread resistance in lice populations, preserving the efficacy of available pediculicides. Full article

The increasing global incidence of infections caused by free-living amoebae (FLA) and the lack of effective, safe, and approved treatments highlight the urgent need for novel amoebicidal compounds with pharmacological potential. Despite a growing body of literature on the anti-FLA properties of various compounds, comprehensive reviews summarizing this progress remain scarce. This study aimed to identify the most promising compounds tested in vitro and/or in vivo for anti-FLA activity. A systematic review was conducted, analyzing 108 studies published between 1986 and 2024, selected from an initial pool of 23,653 database results. A total of 537 compounds were evaluated for their in vitro anti-FLA activity. Compounds exhibiting ≥50% reduction in amoeba viability relative to untreated controls were classified as promising if they showed low toxicity in mammalian cell models, particularly when active at concentrations ≤ 10 µM, consistent with predicted favorable pharmacokinetic and pharmacodynamic profiles. The most promising compounds for drug and disinfectant development include ten trophocidal agents against B. mandrillaris, thirty-two trophocidal and four cysticidal agents against N. fowleri, and sixty-two trophocidal and nineteen cysticidal agents against Acanthamoeba spp. Compounds active at low concentrations (≤10 µM or <0.014 mg/mL) prioritized for in vivo drug development studies include: against Balamuthia mandrillaris, trophocidal 515, 531, 533; against Naegleria fowleri, trophocidal 421, 416, 518, 46, 254, 522, 111–120 and cysticidal 16; and against Acanthamoeba spp., trophocidal 498, 499, 500, 535, 107, 347, 348, and 340. Future studies should evaluate their efficacy, safety, pharmacokinetics, and pharmacodynamics toward developing effective drugs, antiseptics, and disinfectants. Full article

The main pathological, epidemiological, and clinical findings of haemonchosis in goats and sheep in a semi-arid region of Northeast Brazil are described. Necropsy records conducted between January 2012 and December 2021 at the Animal Pathology Laboratory (APL) of the UFCG, were reviewed. In 2022, a prospective study monitored the necropsies performed on these species. In total, necropsies were conducted on 410 goats and 319 sheep, haemonchosis was observed in 50 (12%) goats and 49 (15%) sheep. For goats, females (45/50, 90%; p ≤ 0.05), the age range of 13–35 months (25/50, 50%; p ≤ 0.05), and crossbred animals (38/50, 76%; p ≤ 0.05) were most affected. Both goat and sheep, respectively, raised in a semi-intensive system were more infected (41/50, 82%; 36/49, 76.5%; p ≤ 0.05). The animals came from the States of Paraíba, Pernambuco, Ceará, and Rio Grande do Norte. The proportion of goats (32/50, 64%) and sheep (30/49, 61.2%) with a normal body condition score was significantly different (p ≤ 0.05). The main pathological alterations (p ≤ 0.05) were the mucosal and carcass paleness, and the presence of H. contortus specimens in the abomasum. Haemonchosis remains a significant parasitic disease affecting small ruminants in the semi-arid region of Northeast Brazil, leading to mortality and decreased production rates, posing substantial economic challenges that adversely impact goat and sheep farming. Full article

Excretory/secretory products from parasites (ESPs) can act as pathogen-associated molecular patterns (PAMPs) to activate innate immunity. Parasites may achieve immune evasion by modulating the interaction between PAMPs and the nucleotide-binding oligomerization domain-like receptor family, pyrin domain-containing three (NLRP3) inflammasome. Previous studies have suggested that some components of ESPs from Clonorchis sinensis (CsESPs) can induce the host’s immune responses, but the components that balance immunopathology and maintain chronic infection in chronic Clonorchis sinensis (C. sinensis) remain unclear. We previously found that the iNOS-interacting protein from C. sinensis (CsNOSIP), a component of CsESP, stimulates macrophages to produce reactive oxygen species (ROS) and nitric oxide (NO), both of which inhibit NLRP3 inflammasome activation. Therefore, this study investigated the effects of CsESP and CsNOSIP on inflammasome activation using RT-PCR, Western blot, and ELISA. This study showed that CsESPs promoted NLRP3 inflammasome activation in RAW264.7 cells, while CsNOSIP inhibited LPS-induced IL-1β secretion through an NLRP3-caspase-1-dependent pathway and reversed the CsESPs-induced activation through the iNOS/NO–NF-κB pathway. These results reveal the antagonistic effects of CsESPs and CsNOSIP in inflammasome regulation, suggesting that this balance contributes to the regulation of the host’s immunity and the promotion of chronic infection of C. sinensis, providing potential targets for prevention and treatment. Full article

African trypanosomiasis is a protozoan disease that affects both humans and animals. Human African Trypanosomiasis (HAT) is a Neglected Tropical Disease targeted for elimination in 2030. Although WHO has not reported HAT from Nigeria in the last decade, there are published studies reporting seroprevalence, parasite detection/isolation, and animal reservoirs potentially involved in HAT transmission in Nigeria. Interestingly, the burden of Animal African Trypanosomiasis (AAT) continues to increase. In this study, we synthesized published reports on the prevalence of HAT and AAT in Nigeria from 1993–2021, the trypanosome species involved, the spread of animal reservoirs, and the variability in diagnostic methodologies employed. A scoping review was performed following the methodological framework outlined in PRISMA-ScR checklist. Sixteen eligible studies published between 1993 and 2021 were reviewed: 13 for AAT and 3 for HAT. Varying prevalence rates were recorded depending on the diagnostic methods employed. The average prevalence reported from these studies was 3.3% (HAT), and 27.3% (AAT). Diagnostic methods employed include microscopy, PCR and Card Agglutination Test for Trypanosomiasis (CATT). Cattle, pigs, and dogs were identified as carriers of human-infective trypanosomes. This study highlights the scarcity of HAT epidemiological studies/data from Nigeria, the high prevalence, complex epidemiology, limited attention and surveillance of African Trypanosomiasis in Nigeria. Remarkably, WHO records do not reflect the published data showing evidence of HAT prevalence/cases in Nigeria. Unfortunately, diagnostics challenges and unrealistic disease reporting protocols seem to limit HAT reporting from Nigeria. Therefore, adequately coordinated epidemiological surveys and targeted intervention policies are imperative to ascertain the true epidemiological status of HAT in Nigeria and prevent disease re-emergence towards achieving WHO’s elimination targets. The presence of animal carriers of human-infective trypanosomes underscores the importance of a one-health approach to combat African trypanosomiasis effectively. Full article

Stomoxys calcitrans (Linnaeus, 1758) is a hematophagous fly species of veterinary importance, known for its negative effects on animal health and productivity. The stress caused by their painful bites results in losses in milk and meat production. Despite its impact, data on its ecology and activity in Algeria are lacking. Such knowledge is needed to evaluate its potential effects on livestock production and rural health, and to support surveillance, outbreak prediction, and control strategies. This study aimed to investigate the monthly and daily dynamics of S. calcitrans in livestock farms in the Batna region and evaluate the influence of climatic factors on its abundance. From July 2022 to July 2023, Vavoua traps were placed monthly from 7 a.m. to 6 p.m. on four farms in the Batna region, representing different livestock types. Captured flies were identified, sexed, and counted every two hours. Climatic data were collected both in situ and from NASA POWER datasets. Fly abundance was analyzed using non-parametric statistics, Spearman’s correlation, and multiple regression analysis. A total of 1244 S. calcitrans were captured, mainly from cattle farms. Activity occurred from August to December, with a peak in September. Males were more abundant and exhibited a bimodal activity in September. Fly abundance was positively correlated with temperature and precipitation and negatively correlated with wind speed and humidity. This study presents the first ecological data on S. calcitrans in northeastern Algeria, highlighting its seasonal dynamics and the climatic drivers that influence it. The results highlight the species’ preference for cattle and indicate that temperature and rainfall are key factors influencing its abundance. These findings lay the groundwork for targeted control strategies against this neglected pest in Algeria. Full article

Human subcutaneous dirofilariasis caused by Dirofilaria repens is an emerging zoonotic parasitic infection increasingly observed in southern Europe. We report a case of a woman from western Sicily, who likely acquired the infection locally through a mosquito bite. The high prevalence of D. repens in the local canine population (up to 20.4%) suggests a role of dogs as a probable reservoir for transmission to humans in the local population. With ultrasound analysis being inconclusive, only after surgical removal was the presence of an adult worm evident, and only after molecular analysis through DNA sequencing of the cytochrome oxidase subunit I gene (COI) could a definitive D. repens infection diagnosis be obtained. This case highlights the need for enhanced vector control, animal health surveillance and public awareness to limit the transmission to humans of D. repens. A correct parasitological diagnosis would be imperative for the recognition of human cases. Full article

In this study, a diverse collection of images of myxozoans from the genera Henneguya and Myxobolus was created, providing a practical dataset for application in computer vision. Four versions of the YOLOv5 network were tested, achieving an average precision of 97.9%, a recall of 96.7%, and an F1 score of 97%, demonstrating the effectiveness of MLens in the automatic detection of these parasites. These results indicated that machine learning has the potential to make microparasite detection more efficient and less reliant on manual work in parasitology. The beta version of the MLens showed strong performance, and future improvements may include fine-tuning the WebApp hyperparameters, expanding to other myxosporean genera, and refining the model to handle more complex optical microscopy scenarios. This work presented a significant advancement, opening new possibilities for the application of machine learning in parasitology and substantially accelerating parasite detection. Full article

The pressing global challenges of parasitic diseases, particularly prevalent in tropical and subtropical regions, underscore the critical urgent need for innovative therapeutic strategies in identifying and developing new treatments. The immense chemical diversity inherent in nature has rendered natural product (NP) chemistry a promising avenue for the discovery of novel antiparasitic chemotypes. Despite challenges such as sourcing, synthetic complexity, and drug resistance, NPs continue to offer invaluable contributions to antiparasitic therapy. This review focuses on recent advancements in NP chemistry and their application in the development of antiparasitic therapeutics. Key highlights include the identification of new molecular targets such as enzymes, membrane proteins, and metabolic pathways in parasites, as well as the role of metabolomics, genomics, and high-throughput screening in accelerating drug development. Additionally, the exploration of microorganisms (including soil bacteria and fungi) and marine organisms as a latent reserve of bioactive compounds with potent antiparasitic activity is discussed. The review further examines emerging strategies such as chemoinformatics and combination and polypharmacology therapies, aimed at addressing the challenges of antiparasitic chemotherapeutic treatment and advancing the development of new and effective treatments. Ultimately, NP chemistry represents a frontier for the design of novel antiparasitic drugs, offering the potential for more effective and sustainable therapies for combating parasitic diseases. Full article

Due to their zoonotic potential and close interaction with humans, feline parasitic infections are an important public health concern. This study investigated 2758 domiciled and feral cats sampled across Mexico to assess the occurrence of parasites, coinfections, and associated risk factors. Twelve genera of parasites were identified, with Ancylostoma and Ctenocephalides being the most frequent. Coinfections were common, often involving both intestinal and ectoparasites. Multivariable logistic regression revealed that feral lifestyle, absence of recent antiparasitic treatment, female sex, and climatic conditions were significant predictors of infection. Cats with unrestricted outdoor access and direct contact with other cats, where hunting behavior and the ingestion of prey cannot be ruled out (ESCCAP risk group B), were more than five times as likely to be infected as those cats that live indoors (ESCCAP risk group A). Although antiparasitic use was reported in some cats, inappropriate drug choice and long treatment intervals reduced effectiveness, while nearly seven out of ten cats had never received treatment. These findings highlight major gaps between current practices in Mexico and international guidelines. Strengthening surveillance, promoting owner education, and implementing risk-based strategies are critical to reducing feline parasitism and associated zoonotic risks within a One Health framework. Full article

Chagas disease, caused by Trypanosoma cruzi, presents a variety of clinical outcomes ranging from mild symptoms to Chagas cardiomyopathy, the most severe and life-threatening manifestation of the disease. The degree of virulence is influenced by both parasite and host factors. In this study, we characterized a murine infection model using the T. cruzi Dm28c strain in BALB/c mice to assess disease progression. Infected mice showed a peak of parasitemia at 14 dpi, followed by a progressive decrease. Spleen weight increased up to sixfold compared to uninfected controls at 14 and 21 dpi, correlating with parasitemia levels. Histological analysis revealed focal inflammatory infiltrates in the heart starting at 7 dpi, with maximal intensity at 14 and 21 dpi. The expression of inflammatory cytokines (IFN-γ, IL-1β, TNF-α) and anti-inflammatory cytokines (IL-10, TGF-β) in the spleen showed a dynamic profile, with an early increase during the acute phase. Dm28c infection of BALB/c mice can be considered as a non-lethal Chagas disease experimental model, with detectable parasitemia during the acute phase and a controlled inflammatory response. Full article

Trypanosoma cruzi is a hemoflagellate protozoan and the causative agent of Chagas disease, also known as American trypanosomiasis. Transmission occurs through the feces of triatomine insects, its biological vector. It is estimated that around 7 million people are infected across Mexico, Central America, and South America. This study aimed to identify and characterize T. cruzi isolates obtained from wild triatomine vectors collected in Aguascalientes, Mexico. Molecular identification was performed at different developmental stages—epimastigotes in culture media, metacyclic trypomastigotes in triatomine feces, and amastigotes in mouse cardiac tissue—using endpoint PCR targeting satDNA and mtCytB regions. In addition, next-generation sequencing was employed to analyze variable regions of kinetoplast DNA minicircles. The pathogenicity of the isolated and identified T. cruzi strain was assessed in a murine model, where trypomastigote stages were detected in peripheral blood and amastigote stages in muscle tissue. Molecular analyses confirmed the presence of T. cruzi across different developmental stages from wild vectors, demonstrating that the isolated wild strain possesses pathogenic potential when completing its life cycle in an experimental mammalian host, specifically BALB/c mice. Full article

Vector-borne diseases (VBDs) continue to pose a persistent global health challenge, disproportionately impacting low- and middle-income countries where surveillance and healthcare infrastructure are constrained. Within these countries, residents of remote island communities are particularly vulnerable to emerging VBD threats; however, they remain critically understudied. We conducted a community-based cross-sectional survey of 300 residents from Shahpori Island, Bangladesh, and Gaya Island, Malaysia, to assess knowledge, attitudes, and practices (KAP) related to VBDs. Using a structured questionnaire and mixed-effects Poisson regression modeling, we identified socio-demographic predictors of VBD-related knowledge and compared KAP outcomes across the two islands. Significant disparities were observed between the two settings: the Gaya Island residents demonstrated a higher level of awareness regarding VBDs and preventive practices compared to the Shahpori residents. Education was a strong predictor of VBD knowledge, with individuals possessing secondary education or above exhibiting significantly better knowledge (β = 0.2024, p = 0.0003). Marital status was also a significant factor, with unmarried respondents showing lower levels of knowledge (β = –0.1657, p = 0.0372). Age was positively correlated with VBD knowledge (β = 0.0051, p = 0.0119), indicating a gradual increase with age, while income, gender, occupation, and household size were not significantly associated. Despite basic awareness of VBD symptoms and transmission, detailed understanding of mosquito ecology, disease symptoms, and breeding prevention strategies was remarkably poor, especially among the Shahpori residents. Our findings highlight critical gaps in VBD-related knowledge and prevention behaviors shaped by socio-economic and educational disparities. Community-focused public health strategies including educational campaigns, establishment of health infrastructure, access to trained healthcare providers, and integrated vector control interventions are urgently needed to enhance resilience against emerging VBD threats such as drug-resistant malaria in remote island populations. Full article

Aim: In sub-Saharan Africa, approximately 40 million pregnant women are exposed to parasitic diseases such as malaria caused by Plasmodium falciparum, Schistosome parasites, and soil-transmitted helminths (STHs). When parasitic diseases share the same habitat and overlap in distribution, then high co-infection rates occur. The co-infection can lead to consequences for the child, such as intrauterine growth retardation, low birth weight, pre-term delivery, and neonatal mortality. Methods: The objective of the study was to determine the nature and extent of coinfection from 100 samples collected from the Battor (50) and Adidome (50) towns of Ghana in collaboration with the Noguchi Memorial Institute for Medical Research, University of Ghana. Results: Out of 50 for the Adidome towns determined for P. falciparum by Rapid Diagnostic Test (RDT), Malaria Pan-specific Antigen (PAN), and Malaria Pf kit, 39 were true positive (TP), 8 were true negative (TN), and 30 were false negative (FN). For Battor, 19 were TP, 12 TN, and 20 FN. For S. mansoni in Adidome via polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP), 21 tested positive, and 29 were negative, with 52.5% sensitivity and 100% specificity. For S. haematobium, 28 were positive and 22 negative using PCR with 70% sensitivity and 100% specificity. In LAMP, 28 were positive, and 22 negatives, with 70% sensitivity and 100% specificity. In Battor PCR for S. mansoni, 28 positives and 22 negatives with 68.3% sensitivity and 100% specificity. In LAMP, 32 were positive, and 18 were negative, with 80% sensitivity and 100% specificity. For S. haematobium, PCR showed 30 positive and 20 negative, with 73.2% sensitivity and 100% specificity. With LAMP, 21 were positive, and 29 negatives, with 51% sensitivity and 100% specificity. In both towns, 20–30 years had the highest infection prevalence for P. falciparum, S. mansoni, S. haematobium, and Strongyloides stercoralis. Conclusion: The results will be utilized as a part of the continuous surveillance for future research aiming at gathering nationally representative data in Ghana on the prevalence of coinfection and proposing interventions based on that for the vulnerable pregnant women population. Full article

Background: First-line treatments for cutaneous leishmaniasis (CL), including topical agents, are often limited in cases of complicated disease involving multiple, facial, or treatment-resistant lesions. Data on intravenous liposomal amphotericin B (L-AmB) are scarce, especially in children. We report our experience using L-AmB to treat pediatric CL, focusing on treatment rationale, safety, and clinical effectiveness. Methods: A retrospective case series. Diagnosis was confirmed by PCR. Data on demographics, clinical presentation, treatment rationale, adverse events, lab findings, and outcomes, during treatment and follow-up, were collected. Results: Twenty-seven children were included, most (96%) with Leishmania major. The mean number of lesions per child was 5.71 ± 6.19. All had facial involvement; 41% nasal and 15% eyelid. Most lesions were ulcerated (78%). Prior treatment failure was common (78%), with the use of topical antimicrobials, liposomal amphotericin gel, and paromomycin-containing ointments (59%, 38%, 19%, respectively). Twenty-four children (89%) completed treatment successfully. Adverse events occurred in 41% of cases but were mostly mild and reversible: flushing, rash, shortness of breath, and vomiting (11%, each). One case of transient renal impairment and one case with neutropenia were recorded. Early improvement was noted by day 10, with 50% (n = 12) of cases exhibiting crust falling/reduced ulceration and a 50% lesion size reduction. By day 30–90, 92% achieved substantial healing without the need for further therapy. Nevertheless, scarring was noted in 79% of cases. Conclusions: L-AmB treatment appears to be safe and effective for pediatric CL, particularly in cases with facial lesions or prior treatment failure. Clinical improvement was notable, although scarring was common. Full article