Epidemiology and control of cutaneous leishmaniasis
- Naomi Aronson, MD
Naomi Aronson, MD
- Professor of Medicine
- Uniformed Services University
Leishmaniasis consists of a complex of vector-borne diseases caused by a heterogeneous group of protozoa belonging to the genus Leishmania; it is transmitted by sand fly vectors. Clinical manifestations range from cutaneous ulcers to systemic multiorgan disease. The epidemiology and control of cutaneous leishmaniasis are reviewed here. The clinical manifestations, diagnosis, and treatment are discussed separately. (See "Clinical manifestations and diagnosis of cutaneous leishmaniasis" and "Treatment of cutaneous leishmaniasis".)
Leishmania infection is endemic in scattered foci in more than 98 countries on five continents . Globally, the annual incidence of cutaneous leishmaniasis (CL) is estimated to be 0.7 to 1.2 million new cases per year. Approximately 75 percent of CL is reported from 10 countries: Afghanistan, Algeria, Brazil, Colombia, Costa Rica, Ethiopia, Islamic Republic of Iran, North Sudan, Peru, and the Syrian Arab Republic (figure 1 and figure 2 and figure 3) . Detailed global distribution maps (1960 to 2012) have been published [3,4].
At least 23 species of Leishmania have been associated with human infection . In general, leishmaniasis is transmitted by the bite of an infected female sand fly to mammalian reservoirs (typically rodents, sloths, marsupials, or wild or domestic canines) (figure 4). Humans are infected incidentally when they enter endemic areas. Anthroponotic (human–sand fly–human) transmission of Leishmania tropica in urban areas (Kabul, Afghanistan) has been described .
Emerging issues — The number of CL cases imported into nonendemic developed countries increased during the 1990s and 2000s. The GeoSentinel surveillance database demonstrated that, between 1996 and 2004, CL was among the 10 most common dermatologic disorders among returning travelers from Central and South America [7,8]. Approximately 160 cases of CL were reported; these were largely related to exposures in Bolivia (Madidi National Park), Costa Rica, and Peru .
Similarly, the Hospital for Tropical Diseases in London identified 223 patients with CL between 1998 and 2009 . Old World CL was observed in 90 patients; it mostly occurred among travelers to the Mediterranean region and was caused by L.L. infantum chagasi. New World CL was observed in 133 patients; 73 percent was caused by Leishmania Viannia species and it mostly occurred among backpackers or soldiers in jungle training. There were also 11 cases of mucosal leishmaniasis (ML); other reports have also described recognition of ML among young, healthy adventure travelers to Central and South America [9,10].
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