Volume 88, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Autochthonous human cases of leishmaniasis in the United States are uncommon. We report three new cases of cutaneous leishmaniasis and details of a previously reported case, all outside the known endemic range in Texas. Surveys for enzootic rodent reservoirs and sand fly vectors were conducted around the residences of three of the case-patients during the summer of 2006; female sand flies were collected at a north Texas and southeast Oklahoma residence of a case-patient, indicating proximity of a suitable vector. Urban sprawl, climatologic variability, or natural expansion of are possible explanations for the apparent spread to the north and east. Enhanced awareness among healthcare providers in the south central region of the United States is important to ensure clinical suspicion of leishmaniasis, diagnosis, and appropriate patient management.


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  1. Magill AJ, Mandell GL, Bennett JE, Dolin R, , 2010. Leishmania species: visceral (kala-azar), cutaneous and mucosal leishmaniasis. , eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Seventh edition. Philadelphia, PA: Churchill Livingstone, 34633480.[Crossref]
  2. McHugh CP, Melby PC, LaFon SG, , 1996. Leishmaniasis in Texas: epidemiology and clinical aspects of human cases. Am J Trop Med Hyg 55: 547555.
  3. Maloney DM, Maloney JE, Dotson D, Popov VL, Sanchez RL, , 2002. Cutaneous leishmaniasis: Texas case diagnosed by electron microscopy. J Am Acad Dermatol 47: 614616.[Crossref]
  4. Wright NA, Davis LE, Aftergut KS, Parrish CA, Cockrell CJ, , 2008. Cutaneous leishmaniasis in Texas: a northern spread of endemic areas. J Am Acad Dermatol 58: 650652.[Crossref]
  5. McHugh CP, Grogl M, Kerr SF, , 1990. Isolation of Leishmania mexicana from Neotoma micropus collected in Texas. J Parasitol 76: 741742.[Crossref]
  6. Merkelz RM, Kerr SF, , 2002. Demographics, den use, movements, and absence of Leishmania mexicana in southern plains woodrats (Neotoma micropus). Southwest Nat 47: 7077.[Crossref]
  7. Raymond RW, McHugh CP, Witt LR, Kerr SF, , 2003. Temporal and spatial distribution of Leishmania mexicana infections in a population of Neotoma micropus . Mem Inst Oswaldo Cruz 98: 171180.[Crossref]
  8. Kerr SF, McHugh CP, Merkelz R, , 1999. Short report: a focus of Leishmania mexicana near Tucson, Arizona. Am J Trop Med Hyg 61: 378379.
  9. McHugh CP, Thies ML, Melby PC, Yantis LD, Jr Raymond RW, Villegas MD, Kerr SF, , 2003. Short report: a disseminated infection of Leishmania mexicana in an eastern woodrat, Neotoma floridana, collected in Texas. Am J Trop Med Hyg 69: 470472.
  10. Endris RG, Young DG, Perkins PV, , 1987. Experimental transmission of Leishmania mexicana by a North American sand fly, Lutzomyia anthophora (Diptera: Psychodidae). J Med Entomol 24: 243247.[Crossref]
  11. McHugh CP, Grogl M, Kreutzer RD, , 1993. Isolation of Leishmania mexicana (Kinetoplastida: Trypanosomatidae) from Lutzomyia anthophora (Diptera: Psychodidae) collected in Texas. J Med Entomol 30: 631633.[Crossref]
  12. McHugh CP, Ostrander BF, Raymond RW, Kerr SF, , 2001. Population dynamics of sand flies (Diptera: Psychodidae) at two foci of leishmaniasis in Texas. J Med Entomol 38: 268277.[Crossref]
  13. Rodgers MR, Popper SJ, Wirth DF, , 1990. Amplification of kinetoplast DNA as a tool in the detection and diagnosis of Leishmania . Exp Parasitol 71: 267275.[Crossref]
  14. Young DG, Perkins PV, , 1984. Phlebotomine sand flies of North America (Diptera: Psychodidae). Mosq News 44: 263304.
  15. Simpson MH, Mullins JF, Stone OJ, , 1968. Disseminated anergic cutaneous leishmaniasis. An autochthonous case in Texas and the Mexican states of Tamaulipas and Nuevo Leon. Arch Dermatol 97: 301303.[Crossref]
  16. Stewart CD, Pilcher JF, , 1945. American leishmaniasis: report of an autochthonous case. Arch Derm Syphilol 51: 124128.[Crossref]
  17. Furner EB, , 1990. Cutaneous leishmaniasis in Texas: report of a case and review of the literature. J Am Acad Dermatol 23: 368371.[Crossref]
  18. Galino A, Duncan JM, Zeluff B, De Priest J, McAllister HA, Radovancevic B, Frazier OH, , 1992. Leishmaniasis in a heart transplant patient. J Heart Lung Transplant 11: 820823.
  19. Gustafson TL, Reed CM, McGreevy PB, Pappas MG, Fox JC, Lawyer PG, , 1985. Human cutaneous leishmaniasis acquired in Texas. Am J Trop Med Hyg 34: 5863.
  20. Nelson DA, Gustafson TL, Spielvogel RL, , 1985. Clinical aspects of cutaneous leishmaniasis acquired in Texas. J Am Acad Dermatol 12: 985992.[Crossref]
  21. Reed CM, , 1986. Autochthonous human cutaneous leishmaniasis in Texas. Border Epidemiol Bull 13: 15.
  22. Shaw PK, Quigg LT, Allain DS, Juranek DD, Healy GR, , 1976. Autochthonous dermal leishmaniasis in Texas. Am J Trop Med Hyg 25: 788796.
  23. Velasco O, Savarino SJ, Walton BC, Gam AA, Neva FA, , 1989. Diffuse cutaneous leishmaniasis in Mexico. Am J Trop Med Hyg 41: 280288.
  24. Pavlovsky EN, , 1966. Natural Nidality of Transmissible Diseases. Urbana, IL: University of Illinois Press.
  25. Shaw J, , 2007. The leishmaniases – survival and expansion in a changing world. A mini-review. Mem Inst Oswaldo Cruz 102: 541547.[Crossref]
  26. Cardenas R, Sandoval CM, Rodriguez-Morales AJ, Franco-Paredes C, , 2006. Impact of climate variability in the occurrence of leishmaniasis in northeastern Colombia. Am J Trop Med Hyg 75: 273277.
  27. Costa CH, Pereira HF, Araujo MV, , 1990. Visceral leishmaniasis epidemic in the State of Piaui, Brazil, 1980–1986 [in Spanish]. Rev Saude Publica 24: 361372.[Crossref]
  28. Thompson RA, Wellington de Oliveira LJ, Maguire JH, Braud DH, Scholl DT, , 2002. Climatic and demographic determinants of American visceral leishmaniasis in northeastern Brazil using remote sensing technology for environmental categorization of rain and region influences on leishmaniasis. Am J Trop Med Hyg 67: 648655.
  29. Bradley RD, Hanson JD, Amman BR, Baxter BD, Carroll DS, Durish ND, Haynie ML, KageYama M, Longhofer LK, Mendez-Harclerode FM, Reeder SA, Suchecki JR, Ruthven DC, Cajimat MN, Milazzo C, Milazzo ML, Fulhorst CF, , 2006. Rapid recovery of rodent populations following severe drought. Southwest Nat 51: 8793.[Crossref]
  30. Gonzalez C, Wang O, Strutz SE, Gonzalez-Salazar C, Sanchez-Cordero V, Sarkar S, , 2010. Climate change and risk of leishmaniasis in North America: predictions from ecological niche models of vector and reservoir species. PLoS Negl Trop Dis 4: e585.[Crossref]
  31. Ali A, Nayar JK, , 1997. Invasion, spread, and vector potential of Aedes albopictus in the USA and its control possibilities. Med Entomol Zool 48: 19.[Crossref]
  32. McHugh CP, , 1991. Distributional records for some North American sand flies, Lutzomyia (Diptera: Psychodidae). Entomol News 102: 192194.
  33. Mead DG, Cupp EW, , 1995. Occurrence of Lutzomyia anthophora (Diptera: Psychodidae) in Arizona. J Med Entomol 32: 747748.[Crossref]
  34. Centers for Disease Control and Prevention, 2011. Practical Guide for Laboratory Diagnosis of Leishmaniasis. Available at: http://www.cdc.gov/parasites/leishmaniasis/resources/pdf/cdc_diagnosis_guide_leishmaniasis.pdf. Accessed September 12, 2011.
  35. Centers for Disease Control and Prevention, 2012. Resources for Health Professionals. Available at: http://www.cdc.gov/parasites/leishmaniasis/health_professionals/index.html. Accessed October 25, 2012.
  36. World Health Organization, 2010. Control of the Leishmaniasis: Report of a Meeting of the WHO Expert Committee on the Control of Leishmaniases. Geneva, March 22–26, 2010. Geneva: World Health Organization.

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  • Received : 17 Nov 2011
  • Accepted : 31 Oct 2012

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