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The leishmaniasis comprise a group of clinical syndromes that include ulcerative skin lesions, destructive mucosal inflammation, and disseminated visceral infection caused by protozoan Leishmania species parasites, which are transmitted through the bite of female sand flies.The infection occurs in nature in a wide range of vertebrate hosts but is particularly common in canids; rodents; and primates, including humans.

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Leishmaniasis is caused by an obligatory intracellular protozoan parasite that is of the Leishmania genus and belongs to the order Kinetoplastida and family Trypanosomtidae.4 To date, over 20 different species of Leishmania have reportedly infected humans. These have been grouped in different complexes, according to biochemical and genetic characteristics. Leishmania species traditionally have been classified according to biological, clinical, and epidemiological features as belonging to three major clinical disease groups (Table 351-1).4 Most populations affected by leishmaniasis, either alone or in association with human immunodeficiency virus (HIV) infection, live in developing countries where there is poor access to appropriate medical intervention; this defines leishmaniasis as a neglected disease.

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Table 351-1. Leishmania Species Associated with Different Disease Patterns4,10
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Epidemiology

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Worldwide, there are 12 million people infected with Leishmania, and 2 million new infections are reported every year; 1 to 1.5 million with the cutaneous form and 0.5 million with visceral disease. The disease is endemic in over 88 countries of tropical and subtropical regions around the world, including southern Europe, North Africa, the Middle East, the American continent, and the Indian subcontinent.1

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The disease is associated with 2.4 million disability-adjusted life years and close to 70,000 deaths per year. Over 90% of the cutaneous form of leishmaniasis occurs in Afghanistan, Pakistan, Syria, Saudi Arabia, Algeria, Iran, Brazil, and Peru; 90% of visceral leishmaniasis occurs in India, Bangladesh, Nepal, Sudan, and Brazil.1 In the last two decades, the coinfection of leishmaniasis and HIV has been identified in 35 countries, mainly Mediterranean nations, the North African region, India, and Brazil. The adult group is the most affected, as this coinfection mainly strikes intravenous drug users (IVDU); however, there is evidence of mother-to-child transmission.5,6 Recently, leishmaniasis has gained importance within the United States due to infection ...

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