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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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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 ...