Leishmaniasis is a parasitic disease caused by the protozoan flagellates of Leishmania genus that are transmitted to humans through the bite of the phlebotomine sandfly The annual incidence is 1.5 to million The disease is found worldwide in tropical zones, with most cases in South Asia and the Horn of Africa There are three major clinical manifestations including cutaneous, mucosal, and visceral forms Immunosuppression is a risk factor for the visceral form More than 90% of visceral leishmaniasis cases occur in the Middle East, where as 90% of mucosal leishmaniasis cases occur in Peru, Brazil, and Bolivia Cutaneous leishmaniasis is more widely distributed and occurs in Central America, northern South America, northern Africa, the Middle East, and scattered portions of southern Europe Cutaneous infection presents as painless skin lesions localized to exposed parts of the body that are accessible to sandflies (e.g., extremities, face) The incubation period is approximately month The skin lesions initially present as erythematous papules, which evolve into nodules and then to shallow volcano-like ulcerative lesions that are locally destructive and have associated localized lymphadenopathy Mucosal infection may occur simultaneously or months to years after a cutaneous lesion heals Parasites may extend into the nasopharyngeal mucosa and cause nasal congestion The infection may continue to spread to the buccal mucosa and laryngeal membrane Advanced stages of the disease can involve severe tissue necrosis and disfigurement The incubation period for visceral leishmaniasis is to months and the onset of symptoms may be acute or chronic In sudden-onset cases, patients develop a persistent high fever, anorexia, a protuberant abdomen, and wasting of the limbs Painless splenomegaly is an early finding; while hepatomegaly is less common, icterus is a marker of poor prognosis