ABSTRACT

Leishmaniasis is a vector-borne endemic disease of the tropics, subtropics and southern Europe, and is characterized by the diversity and complexity of its clinical presentations, which include cutaneous, mucosal and visceral leishmaniasis. These syn - dromes, which have been attributed to 21 different leishmanial species, transmitted by 30 or more species of phlebotomine sandflies, result from the intracellular replication of the amastigote form of the parasite in tissue macrophages in skin, bone marrow, spleen and Kupffer cells of the liver. Trypanosomal diseases are geographically restric - ted to Africa, where their vector, the tsetse fly, breeds, and by the triatomine bugs to the New World. By way of contrast, the sandflies trans - mitting leishmaniasis are not geographically bridled. Humans are incidental hosts, as other mammals serve as the major reservoir for the parasite. Leishmania mexicana is enzootic in Texas and Arizona, where human cases of cutaneous infection have occurred. More than 90% of mucosal leishmaniasis occurs in Bolivia and Brazil, as well as throughout Central and South America.