Leishmaniasis Endemicity by Geographic Location
I cannot provide a definitive answer about endemicity without knowing the specific location you're asking about, but I can guide you through the global endemic regions and help you determine risk based on geography.
Global Endemic Regions for Leishmaniasis
Leishmaniasis is endemic in specific geographic regions worldwide, with distinct patterns for visceral and cutaneous forms. 1
Visceral Leishmaniasis (VL) Endemic Areas:
- Indian subcontinent (India, Bangladesh, Nepal) - predominantly L. donovani 1, 2
- East Africa (Sudan, South Sudan, Ethiopia, Kenya) 1, 2
- Mediterranean basin (Southern Europe, North Africa, Middle East) - predominantly L. infantum 1, 2, 3
- Latin America (Brazil, Venezuela, Colombia) - L. infantum-chagasi 1, 2
Cutaneous Leishmaniasis (CL) Endemic Areas:
- Old World CL: Mediterranean basin, Middle East, Central Asia, North Africa, East Africa 1
- New World CL: Central America (south of Nicaragua), South America (particularly the "mucosal belt") 1
- United States: Endemic transmission documented, particularly in Texas and surrounding regions with L. mexicana 4
Mucosal Leishmaniasis (ML) Endemic Areas:
- South America (Bolivia, Peru, Brazil) - associated with L. braziliensis 1
- Central America (Costa Rica southward) 1
Critical Geographic Considerations
The specific Leishmania species varies by region, which directly impacts clinical presentation and treatment response. 5, 6
Species-Specific Geographic Distribution:
- L. donovani: India, Bangladesh, East Africa (anthroponotic transmission) 1, 7
- L. infantum: Mediterranean, Latin America (zoonotic transmission with dogs as reservoir) 1, 3, 7
- L. braziliensis: Central/South America (highest risk for mucosal involvement) 1, 5
- L. guyanensis: Northern South America (Guyana, Brazil) 5
- L. panamensis: Central America (Panama, Colombia) 5
- L. mexicana: Mexico, Central America, southern United States 4
- L. tropica: Middle East, Mediterranean, Central Asia 1
- L. major: Middle East, North Africa, Central Asia 1
Emerging Endemic Patterns
Climate change and urbanization are expanding endemic zones, with leishmaniasis now documented in previously non-endemic areas. 1, 4
- Madrid, Spain outbreak (2009-2012): 446 cases in a previously low-transmission area, demonstrating urban transmission potential 1
- United States endemicity: 41 of 69 cases (59%) were acquired domestically without travel history, predominantly in Texas 4
- Climate projections: Models predict doubling of exposed populations in North America by 2080 4
Clinical Implications for Travel History Assessment
When evaluating a patient for leishmaniasis, obtain detailed geographic exposure history including:
- Specific countries and regions visited (not just continent-level information) 1, 2
- Duration of stay (even brief exposures can result in infection) 1
- Activities and accommodations (rural vs urban, outdoor exposure) 1
- Timeframe of exposure (VL can reactivate decades after initial infection, particularly with immunosuppression) 2, 3
High-Risk Exposure Settings:
- Rural or peri-urban areas in endemic regions 7, 6
- Military deployments to endemic zones 1
- Adventure travel or ecotourism in tropical regions 1
- Residence in endemic areas (even childhood exposure decades prior) 2
Common Pitfalls in Geographic Risk Assessment
Do not dismiss leishmaniasis based on:
- Remote travel history: Latent infection can reactivate years to decades after exposure when immunosuppression develops 2, 3
- Lack of recalled sandfly bites: Most patients do not recall being bitten or cannot distinguish sandflies from other insects 1
- Urban-only travel: Urban transmission occurs, particularly in outbreak settings 1
- Domestic US travel only: Endemic transmission is documented in the southern United States 4
Geographic variation in treatment response exists even for the same species, so knowing the specific region of acquisition is critical for treatment planning 5, 6