LAUSR

Epidemiology and Risk Factors Leishmaniasis is a protozoan disease transmitted through the bite of infected female sandflies of the genera Phlebotomus (Old World) and Lutzomyia (New World). Infection with Leishmania species (Figure 1) may cause cutaneous, mucocutaneous, or visceral leishmaniasis (VL). Cutaneous leishmaniasis (CL) is characterized by single or multiple skin ulcers, satellite lesions, or nodular lymphangitis and is associated with multiple species (Figure 2). Mucocutaneous leishmaniasis (MCL) is often caused by L. braziliensis and L. panamensis, and leads to metastasis of the disease to the mucosal tissues of the mouth and upper respiratory tract via lymphatic or hematogenous dissemination (Figure 3). VL in the New World is caused by L. infantum (= L. chagasi). In this form, the parasite can infect internal organs, such as the liver, spleen, and bone marrow, causing life-threatening diseases. However, in immunocompromised hosts, such as organ transplant recipients, the clinical presentation of this disease and the response to treatment can be greatly altered. Annually, there are 1.3 million new cases of leishmaniasis worldwide, predominantly in tropical andMediterranean regions, where the disease is endemic. Over 1000000 new cases of CL and 200000 to 400000 new cases of VL are reported annually. Brazil has a high burden of both VL and CL. In 2014, 3453 cases of VL were reported (0.41