Experts fear skin-disfiguring parasite ‘endemic’ as infections spread across US

A sharp rise in skin-disfiguring parasite infections is leaving experts concerned as cases continue to rise in the US – with many fearing an “endemic.”

According to the Centres for Disease Control and Prevention, there were 1,222 positive cases in the US of Leishmania, a parasite transmitted through the bites of infected female sandflies. These can cause leishmaniasis, which can develop into skin sores within just a few weeks or months after a bite.

The cases, identified from 2005 to 2019, are typically found in people who travel outside the US to tropical or subtropical climates such as central Asia, northern Africa, Latin America, and the Middle East. However, the CDC found 86 of the Leishmania samples were from people who had not recently travelled outside the US. The World Health Organisation says the disease is now endemic in the US.

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In addition, researchers discovered an unusual strain of Leishman that appeared to be genetically distant from travel-related cases, which suggest it is spreading locally across the US. “We cannot say that it is exclusive to Texas, but from the samples that were submitted to CDC, the majority were from Texas,” said Vitaliano Cama, a senior adviser with CDC’s Division of Parasitic Diseases and Malaria, who conducted the research.

The CDC delivered the data this week at the Annual Meeting of the American Society of Tropical Medicine and Hygiene in Chicago. Dr. Mary Kamb, a CDC epidemiologist also involved in the research, said the findings are mostly relevant to healthcare providers. “We need to increase the awareness among clinicians, dermatologists, infectious disease doctors, or general practitioners,” she said.

The CDC said leishmaniasis is a disease that can come as a “silent infection, without any symptoms or signs.” The medical experts added: ” People who develop clinical evidence of infection have one or more sores on their skin… The sores can change in size and appearance over time. “The sores may start out as papules (bumps) or nodules (lumps) and may end up as ulcers (like a volcano, with a raised edge and central crater); skin ulcers may be covered by scab or crust.”

Despite the number of cases in Texas, the CDC has received additional reports of leishmaniasis in Florida – however cases have not been confirmed yet. More cases, though, have been detected in Arizona and Oklahoma. “Our understanding of leishmaniasis acquired in the U.S. is still really evolving,” said Joshua Lieberman, assistant director of the molecular microbiology clinical laboratory at UW Medicine, who was not involved in the research. “It’s not clear to me whether the true rate of new infections is increasing or we’re just getting better at detecting it, or both.” Leishmania remains uncommon in the U.S., he added.