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2 Key Points Î The clinical manifestations of infection caused by protozoa of the genus Leishmania are variable and reflect a complex interplay between the human host's cell-mediated immune responses and the virulence and tropism of the infecting Leishmania species. Î Each leishmaniasis-endemic region has particular combinations of parasite species/strains, sand fly species, mammalian reservoir hosts (in zoonotic transmission cycles), and human hosts with different genetic backgrounds. Î Although Leishmania infection can be subclinical, the three main clinical syndromes are cutaneous leishmaniasis (CL), mucosal leishmaniasis (ML), and visceral leishmaniasis (VL). Less common presentations include diffuse cutaneous leishmaniasis, disseminated cutaneous leishmaniasis, leishmaniasis recidivans, bubonic leishmaniasis, uveitis, and post kala-azar dermal leishmaniasis (PKDL). Î VL, and less commonly CL or ML, may be opportunistic infections in persons who are immunocompromised because of HIV/AIDS or other reasons. Î The only FDA-approved medications for leishmaniasis are intravenous liposomal amphotericin B (L-AmB) for VL, and oral miltefosine for CL, ML, and VL caused by particular species. Î For prevention of leishmaniasis, no prophylactic medications or vaccines are currently available. Î Travelers should use personal protective measures (PPM) that minimize vector exposure whenever they are in leishmaniasis-endemic areas. These measures include protective clothing, insect repellents such as DEET applied to exposed skin, permethrin applied to clothing, window coverings, and insecticide-impregnated bed nets. Î Persons with a history of leishmaniasis (particularly, but not only, VL) should refrain from donating blood. Figure 1. Sand Flies that Transmit the Leishmania Parasites Image courtesy of CDC. Available at:

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