Diagnostics and treatment of cutaneous and mucocutaneous Leishmania infections: expert recommendations

Cutaneous and mucosal/mucocutaneous Leishmania infections may present with very different clinical signs depending on the involved species, the site of infection and the immune status of the host. Leishmania species are intracellular protozoan pathogens transmitted by phlebotomine sand flies, of which over 20 species infecting humans have been described. Leishmania infections are rather common, with an estimated number of one million new cases per year worldwide. The countries with the highest incidence of cutaneous leishmaniasis cases are Afghanistan, Algeria, Brazil, Colombia, Iraq, Libya, Pakistan, Peru, Syria, and Tunisia, while most mucocutaneous cases occur in Bolivia, Brazil, Ethiopia, and Peru. The disease is also endemic in all Southern European countries, with approximately 700 autochthonous human cases reported each year and many more asymptomatic infections. Central Europe is considered non-endemic for the disease; however, epidemiological patterns are affected by travel habits, migration, globalization, and climate change. This review focuses on the diagnostic procedures and treatment options for cutaneous and mucocutaneous Leishmania infections.