Epidemiology of Leishmaniasis: Risk factors for its pathology and infection.

Leishmaniasis is a neglected tropical disease caused by protozoan parasites of the genus Leishmania. About 20 species of Leishmania are pathogenic to humans, with the specific infecting species playing a crucial role in determining clinical outcomes. There are three main forms of disease: cutaneous, mucocutaneous and visceral leishmaniasis. In addition to the infecting species, it has recently been suggested that parasite strains and genetic factors affect disease manifestation and response to treatment. This suggests that infecting parasites are a crucial risk factor for the pathology of leishmaniasis. These parasites are transmitted by sand flies, of which more than 1000 species have been recorded. However, only approximately 10 % of these species are responsible for transmitting Leishmania, with each sand fly species typically transmitting specific species of Leishmania. Most Leishmania species are zoonotically transmitted by sand flies, with reservoir animals playing a crucial role in disease transmission and endemicity. This aspect of the disease ecology highlights the importance of considering both vectors and reservoir animals in endemic areas as risk factors for leishmaniasis. Our epidemiological studies on leishmaniasis focus mainly on South American countries. This review describes the epidemiological aspects of leishmaniasis in Ecuador and Peru, with a focus on pathological and infectious risks.