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Comment & Response
January 9, 2019

Endemic Human Cutaneous Leishmaniasis Incidence in the United States—Reply

Author Affiliations
  • 1Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
JAMA Dermatol. Published online January 9, 2019. doi:10.1001/jamadermatol.2018.4376

In Reply We appreciate the comments of Mr Kipp and Dr Hergert and thank them for their observations regarding our study.1 Specifically, when discussing endemic human cutaneous leishmaniasis in the United States, we concur with the importance of making a distinction between anthropophagic and non-anthropophagic sand flies.

As correctly indicated, the presence of anthropophagic Lutzomyia shannoni has been documented across the eastern, southern, and central United States in numerous areas where endemic human leishmaniasis has occurred and where sufficient reservoir populations are known to exist.2-4 However, the article referenced by Kipp and Hergert describes the infection of Lutzomyia shannoni with an Old World leishmanial parasite, Leishmania major, which has not been shown to be transmitted endemically in North America.5 And, to our knowledge, infection of North American L shannoni with Leishmania mexicana—the leishmanial species causing endemic human disease in the United States—has not yet been demonstrated. This stands in contrast to other Lutzomyia species highlighted in our article, such as Lutzomyia anthophora, which (1) exists in North American habitats that overlap with those of known disease reservoirs, (2) has exhibited wild infection with L mexicana, and (3) has been captured in areas where cases of endemic human cutaneous leishmaniasis occur.1,3

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