Which countries have the highest incidence of leishmaniasis?

Updated: Feb 18, 2020
  • Author: Craig G Stark, MD, FACP, FFTM, RCPS(Glasg), FISTM; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Geographic distribution of leishmaniasis is generally restricted to tropical and temperate regions (natural habitats of the sandfly), and it is limited by the sandfly’s susceptibility to cold climates, its tendency to take blood from humans or animals only, and its capacity to support the internal development of specific species of Leishmania. With the increase in international travel, immigration, overseas military exercises, and coinfection with human immunodeficiency virus (HIV), leishmaniasis is becoming more prevalent throughout the world.

The World Health Organization (WHO) reports endemic leishmaniasis in 98 countries and 3 territories on 5 continents (Africa, Asia, Europe, North America, South America), with an official estimated annual incidence of 0.7-1.3 million cases of cutaneous disease and 0.2-0.4 million cases of visceral disease. [11]

Approximately 95% of cases of cutaneous disease occur in the Americas, the Mediterranean Basin, the Middle East, and Central Asia. More than two-thirds of these cases are reported in six countries, including Afghanistan, Algeria, Brazil, Colombia, Iran, and Syria. Over 90% of new cases of visceral leishmaniasis occur in 6 countries: Bangladesh, Brazil, Ethiopia, India, South Sudan, and Sudan. [11] India has the largest burden of visceral leishmaniasis, with 13,869 new cases reported in 2013. [12]

The visceral leishmaniasis control program has achieved significant gains in Southeast Asia, with the incidence declining to 10,209 cases in 2014, which is approximately 75% lower than in 2005, when the Kala-Azar control program was launched. In this region, the disease is on the verge of being removed from the Public Health Problem list. [13]

Almost 90% of mucocutaneous leishmaniasis cases occur in Bolivia, Brazil, and Peru. [11]

In Colombia, the military fighting the Fuerzas Armadas Revolucionarias de Colombia (FARC) saw more than 30,000 cases of leishmaniasis over 3-year period.

Countries and/or regions not considered to have endemic leishmaniasis despite being surrounded by regions that do include Australia and the South Pacific, Chile, Uruguay, and Canada.

Visceral and cutaneous leishmaniasis in patients with AIDS have been increasingly appreciated as a potential opportunistic infection. Coinfection with HIV has been reported in more than 35 countries throughout southern Europe, the Mediterranean Basin, Central and South America, and India. [14] Disease occurs in conjunction with severe immunosuppression. The incidence of coinfection has decreased in developed countries because of the widespread use of antiretroviral therapy.

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