Encompassing a complex group of disorders, leishmaniasis is caused by unicellular eukaryotic obligatory intracellular protozoa of the genus Leishmania and primarily affects the host's reticuloendothelial system. Leishmania species produce widely varying clinical syndromes ranging from self-healing cutaneous ulcers to fatal visceral disease. These syndromes fall into three broad categories: visceral leishmaniasis (VL), cutaneous leishmaniasis (CL), and mucosal leishmaniasis (ML).
Leishmaniasis is caused by ∼20 species of the genus Leishmania in the order Kinetoplastida and the family Trypanosomatidae (Table 212-1). Several clinically important species are of the subspecies Viannia. The organisms are transmitted by phlebotomine sandflies of the genus Phlebotomus in the “Old World” (Asia, Africa, and Europe) and the genus Lutzomyia in the “New World” (the Americas). Transmission may be anthroponotic (i.e., the vector transmits the infection from infected humans to healthy humans) or zoonotic (i.e., the vector transmits the infection from an animal reservoir to humans). Human-to-human transmission via shared infected needles has been documented in IV drug users in the Mediterranean region. In utero transmission to the fetus occurs rarely.
Table 212-1 Geographic Distribution and Characteristic Epidemiology of Leishmaniases |Favorite Table|Download (.pdf)
Table 212-1 Geographic Distribution and Characteristic Epidemiology of Leishmaniases
|Organism, Endemic Region||Clinical Syndrome||Species||Vector||Reservoir||Transmission||Setting|
|L. donovani Complex|
|South Asia||VL, PKDL||L. donovani||Phlebotomus argentipes||Humans||Anthroponotic||Rural, domestic|
|Sudan, Somalia, Ethiopia, Kenya, Uganda||VL, PKDL||L. donovani||P. orientalis, P. martini||Humans, rodents in Sudan, canines||Anthroponotic, occasionally zoonotic||Majority peridomestic, occasionally sylvatic|
|Mediterranean basin, Middle East, Central Asia, China||VL, CL||L. infantum||P. perniciosus, P. ariasi||Dogs, foxes, jackals||Zoonotic||Domestic, peridomestic|
|Middle East, Saudi Arabia, Yemen||VL||L. donovani||P. perniciosus, P. ariasi||Dogs, foxes, jackals||Zoonotic||Domestic, peridomestic|
|Central and South America||VL, CL||L. infantum||Lutzomyia longipalpis||Foxes, dogs, opossums||Zoonotic||Domestic, peridomestic, periurban|
|Azerbaijan, Armenia, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan||VL||L. infantum||P. turanicus||Humans, dogs, foxes||Anthroponotic, zoonotic||Domestic|
|Western India to Turkey, parts of North and East Africa||CL, leishmaniasis recidivans||L. tropica||P. sergenti||Humans||Anthroponotic||Urban domestic, peridomestic|
|Western and Central Asia, North and sub-Saharan Africa||CL||L. major||P. papatasi, P. duboscqi||Nile rats, rodents||Zoonotic||Sylvatic, peridomestic|
|Kazakhstan, Turkmenistan, and Uzbekistan||CL||L. major||P. papatasi, P. duboscqi||Gerbils||Zoonotic||Rural|
|Ethiopia, Uganda, Kenya||CL, DCL||L. aethiopica||P. longipes, P. pedifer||Hyraxes||Zoonotic||Sylvatic, peridomestic|
|Peru, Ecuador||CL, ML||L. (V.) peruviana||Lutzomyia verrucarum, L. peruensis||Wild rodents||Zoonotic||Andean Valleys|
|Guyana, Surinam, French Guyana, Ecuador, Brazil, Colombia, Bolivia||CL, ML||L. (V.) guyanensis||L. umbratilis||Sloths, arboreal anteaters, opossums||Zoonotic||Tropical forests|
|Central America, Ecuador, Colombia||CL, ML||L. (V.) panamensis||L. trapidoi||Sloths||Zoonotic||Tropical forest and deforested areas|
|South and Central America||CL, ML||L. (V.) braziliensis||Lutzomyia spp., L. umbratilis, ...|
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