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Leishmaniasis, also known as Kala-azar, is caused by neither a bacterium nor virus, but rather, like malaria, by a protozoan which is transmitted through the bite of a flying insect. In Leishmaniasis, this is the sand fly. There are two forms: cutaneous, which causes ulcerations of the skin, and visceral, which causes progressive weakness and bleeding from gums and mucous membranes. If left untreated, the visceral form of the disease can be fatal. Leishmaniasis infects canids (wild and domestic) and humans. In 2000 an outbreak in the United States among hounds of a New York state hunt club raised questions about how and when the disease had been introduced into the country. Subsequent investigation showed that the disease had been confirmed in dogs in 21 states, leading to speculation that it had been quietly smoldering over a period of 20 years or more before becoming an epidemic. In other countries, a decrease in human cases has been directly proportional to the elimination of infected dogs and fly control measures.
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