{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:03:24Z","timestamp":1791266604902,"version":"4.1.0"},"reference-count":16,"publisher":"American Society for Microbiology","issue":"3","license":[{"start":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T00:00:00Z","timestamp":1711411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T00:00:00Z","timestamp":1711411200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/100000060","name":"HHS | NIH | National Institute of Allergy and Infectious Diseases","doi-asserted-by":"crossref","award":["R01-146349"],"award-info":[{"award-number":["R01-146349"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000928","name":"Welch Foundation","doi-asserted-by":"crossref","award":["I-2086"],"award-info":[{"award-number":["I-2086"]}],"id":[{"id":"10.13039\/100000928","id-type":"DOI","asserted-by":"crossref"}]},{"name":"UH | Harrington Discovery Institute, University Hospitals","award":["Scholar-Innovator Award"],"award-info":[{"award-number":["Scholar-Innovator Award"]}]},{"name":"Children's Clinical Research Advisory Council","award":["Early Investigator Award"],"award-info":[{"award-number":["Early Investigator Award"]}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"crossref","award":["Postdoctoral Fellowship 916875"],"award-info":[{"award-number":["Postdoctoral Fellowship 916875"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["mSphere"],"published-print":{"date-parts":[[2024,3,26]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Over a 6-month span, three patients under 5 years old with cutaneous leishmaniasis presented to the Pediatric Infectious Diseases Clinic at the University of Texas Southwestern Medical Center\/Children\u2019s Health Dallas. None had traveled outside of northern Texas\/southern Oklahoma; all had\n                      <jats:italic>Leishmania mexicana<\/jats:italic>\n                      infections confirmed by PCR. We provide case descriptions and images to increase the awareness of this disease among United States (US) physicians and scientists. Two patients responded to fluconazole, but the youngest required topical paromomycin. Combining these cases with guidelines and our literature review, we suggest that (i) higher doses (10\u201312 mg\/kg\/day) of fluconazole should be considered in young children to maximize likelihood and rapidity of response and (ii) patients should transition to alternate agents if they do not respond to high-dose fluconazole within 6 weeks. Furthermore, and of particular interest to the broad microbiology community, we used samples from these cases as a proof of concept to propose a mechanism to strain-type US-endemic\n                      <jats:italic>L. mexicana<\/jats:italic>\n                      . For our analysis, we sequenced three housekeeping genes and the internal transcribed sequence 2 of the ribosomal RNA gene. We identified genetic changes that not only allow us to distinguish US-based\n                      <jats:italic>L. mexicana<\/jats:italic>\n                      strains from strains found in other areas of the Americas but also establish polymorphisms that differ between US isolates. These techniques will allow documentation of genetic changes in this parasite as its range expands. Hence, our cases of cutaneous leishmaniasis provide significant evolutionary, treatment, and public health implications as climate change increases exposure to formerly tropical diseases in previously non-endemic areas.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>\n                      Leishmaniasis is a parasitic disease that typically affects tropical regions worldwide. However, the vector that carries\n                      <jats:italic>Leishmania<\/jats:italic>\n                      is spreading northward into the United States (US). Within a 6-month period, three young cutaneous leishmaniasis patients were seen at the Pediatric Infectious Diseases Clinic at the University of Texas Southwestern Medical Center\/Children's Health Dallas. None had traveled outside of northern Texas and southern Oklahoma. We document their presentations, treatments, and outcomes and compare their management to clinical practice guidelines for leishmaniasis. We also analyzed the sequences of three critical genes in\n                      <jats:italic>Leishmania mexicana<\/jats:italic>\n                      isolated from these patients. We found changes that not only distinguish US-based strains from strains found elsewhere but also differ between US isolates. Monitoring these sequences will allow tracking of genetic changes in parasites over time. Our findings have significant US public health implications as people are increasingly likely to be exposed to what were once tropical diseases.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/msphere.00814-23","type":"journal-article","created":{"date-parts":[[2024,2,29]],"date-time":"2024-02-29T09:01:23Z","timestamp":1709197283000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":20,"title":["Cutaneous\n                    <i>Leishmania mexicana<\/i>\n                    infections in the United States: defining strains through endemic human pediatric cases in northern Texas"],"prefix":"10.1128","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3844-3491","authenticated-orcid":false,"given":"Binita","family":"Nepal","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA"},{"name":"Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8198-1143","authenticated-orcid":true,"given":"Clare","family":"McCormick-Baw","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karisma","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Firmani","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3990-7043","authenticated-orcid":false,"given":"Dawn M.","family":"Wetzel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA"},{"name":"Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_6_2_2","first-page":"1309","volume-title":"Goodman and Gilman\u2019s the pharmacological basis of Therapeutics","author":"Wetzel DM","year":"2023","unstructured":"Wetzel DM, Phillips MA. 2023. Chapter 67: Chemotherapy of protozoal infections: Amebiasis, giardiasis, trichomoniasis, trypanosomiasis, leishmaniasis, and other protozoal infections, p 1309\u20131324. In Brunton L (ed), Goodman and Gilman\u2019s the pharmacological basis of Therapeutics, 14th ed. McGraw-Hill Medical, New York, NY.","edition":"14"},{"key":"e_1_3_6_3_2","unstructured":"2023. Centers for Disease Control and Prevention. Available from: https:\/\/www.cdc.gov\/dpdx\/leishmaniasis\/index.html"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0000585"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.tcam.2009.06.006"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2007.11.008"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2018.2133"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.16-84256"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01177-11"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw662"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011882"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0190-9622(99)70393-2"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2230.1993.tb00987.x"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.15761\/CMI.1000213"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2011.01.014"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e31819f1f50"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1101\/2024.01.11.23300611"}],"container-title":["mSphere"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/msphere.00814-23","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/msphere.00814-23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,4]],"date-time":"2024-04-04T21:32:47Z","timestamp":1712266367000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/msphere.00814-23"}},"subtitle":[],"editor":[{"given":"Ira J.","family":"Blader","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,3,26]]},"references-count":16,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3,26]]}},"alternative-id":["10.1128\/msphere.00814-23"],"URL":"https:\/\/doi.org\/10.1128\/msphere.00814-23","relation":{},"ISSN":["2379-5042"],"issn-type":[{"value":"2379-5042","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,26]]},"assertion":[{"value":"2024-01-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e00814-23"}}