In Reply: A Perspective on Human Leishmaniasis and Novel Therapeutic Methods for Diagnosis, Prevention and Treatment

To the Editors: We read with great interest the recent review by Abbasi,1 “A perspective on human leishmaniasis and novel therapeutic methods for diagnosis, prevention and treatment,” published in the October 2025 issue of the Journal. The article thoughtfully synthesizes important advances in diagnostics, therapeutics and emerging molecular targets for leishmaniasis. However, we believe that an important dimension may benefit from further discussion: the disproportionate burden of leishmaniasis on vulnerable pediatric populations in low-resource, conflict-affected regions, particularly in Pakistan. In Pakistan, children represent a substantial proportion of reported cases of leishmaniasis, particularly cutaneous leishmaniasis (CL).2 Recent data from Khyber Pakhtunkhwa documented over 1559 pediatric CL cases from 2020 to 2022, with the highest frequency in children 5–9 years old.2 Conflict-affected districts such as Bajaur report prevalence exceeding 60%, reflecting a complex interplay between displacement, environmental exposure and disrupted healthcare access.3 The innovative diagnostic techniques highlighted by Abbasi, including polymerase chain reaction and loop-mediated isothermal amplification , offer meaningful promise. However, many high-burden areas continue to rely mainly on clinical diagnosis or smear microscopy. This gap is particularly relevant given the increasing recognition of atypical pediatric CL presentations, which may be more challenging to confirm without supportive laboratory tools.4 Improving access to feasible and affordable diagnostics may therefore strengthen local case detection and timely treatment. Similarly, while the review presents a concise summary of current and emerging therapies, practical barriers to availability persist in many low-resource pediatric settings. Pentavalent antimonials remain the predominant option despite logistical challenges, and children with suspected visceral leishmaniasis may experience delayed diagnosis. A study from Abbottabad found 13.2% positivity among children with pancytopenia tested for visceral leishmaniasis, accentuating the importance of maintaining clinical vigilance.5 Looking ahead, future reviews may also find value in exploring the psychosocial impact of pediatric CL. Children with visible or facial lesions frequently face stigma, reduced social participation and disruptions in schooling. Reports of elevated Children’s Dermatology Life Quality Index scores show how these experiences can affect long-term well-being. Integrating such quality-of-life perspectives could complement ongoing biomedical advances and help refine child-centered public health strategies. Future research could also focus on region-specific epidemiology, improving access to affordable diagnostics and treatment in remote or conflict-affected areas and evaluating the effectiveness of integrated interventions that combine clinical care, psychosocial support and community-based prevention. Such multidimensional approaches may provide actionable guidance for policymakers and healthcare providers seeking to reduce both the biomedical and social burdens of leishmaniasis in vulnerable pediatric populations.