Cutaneous Leishmaniasis and Human Conflict

Cutaneous leishmaniasis (CL) is a parasitic infection cau sed by a number of different Leishmania species affecting some 0.7–1.3 million people annually worldwide. There are different clinical manifestations of the condition, including skin lesions associated with the deep form or visceral leishmaniasis, kala-azar. Skin lesions typically occur on exposed body parts and can result in permanent scarring and, depending on the site of the lesion, disfigu rement. Ninety-five percent of these cases occur in the Americas, Mediterranean basin, Middle East and Central Asia (1). Old World CL is most frequently caused by Leishmania species such as L. major, L. infantum and L. tropica, and these vary in terms of clinical presentation, regional and seasonal distribution (2). Whilst the preva lence of CL is variable, in many such areas it remains at a relatively stable level of endemicity, depending on a number of factors including the organisms, host preva lence and vector. Transmission may be zoonotic (mainly L. major) where the reservoir hosts are other mammals such as rodents and canines; this type is more prevalent rurally. With some species such as L. tropica transmission may be anthroponotic, where the main reservoir host is the human and infection is transmitted by sandflies such as Phlebotomus sergenti. Rarely direct human-to-human transmission via blood products without an intermediate host has been reported.