NPR: Climate change has brought the 'tropical disease' leishmaniasis to U.S

A 'tropical disease' carried by sand flies is confirmed in a new country: the U.S.

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Back in 2014, dermatologist Bridget McIlwee saw a 3-year-old patient in central Texas with unusual bumps on his ear.

"They looked a little bit like almost kind of a benign mole that you would see in a child, except that you wouldn't expect something like that to come up quickly and then multiply," she says.

McIlwee sent off a sample for laboratory testing, and the results came back pointing to a surprising culprit: The boy had tested positive for cutaneous leishmaniasis, a neglected tropical disease. The World Health Organization says between 600,000 and 1 million new infections happen worldwide every year, mostly in tropical regions of the Americas, the Mediterranean basin, the Middle East and Central Asia — not in Texas. These illnesses can be disfiguring, even if they are rarely fatal.

"I was shocked, because in medical school, we're taught that this is a tropical disease, something that you see in immigrants, military returning from deployment, people who went on vacation to South America or Asia or Africa," McIlwee says.

But this boy hadn't traveled anywhere, meaning he must have picked up the cutaneous leishmaniasis parasite at home in the United States. That led McIlwee and her colleagues to investigate whether the parasite could be living and spreading in North America. They published their results in 2018, arguing that cutaneous leishmaniasis is, in fact, endemic to the United States.

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They boy never traveled anywhere but lives in Texas. Gee...what does Texas have a lot of that you said carry the disease?

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something that you see in immigrants, military returning from deployment, people who went on vacation to South America or Asia or Africa," McIlwee says.

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Oh...then I have an idea where it came from but let's see what the experts say

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Climate change brings "tropical disease" stateside

The CDC has not yet published the new results, but the team released its preliminary findings to get the word out sooner, particularly to clinicians.

But raising awareness about leishmaniasis means challenging some long-held beliefs about this disease. "Every medical textbook, whether it's Dermatology or Principles and Practice of Infectious Disease, teaches that this is a tropical disease," McIlwee says. "So there's a huge disconnect between the clinical reality and what's being taught in medical schools."

One thing that McIlwee believes needs to change is how leishmaniasis infections are tracked. Providers in states besides Texas aren't required to report cases to health agencies.

Medical providers will need to get familiar with leishmaniasis, say experts, as climate change puts more parts of the world at risk for the disease.

"Research projections suggest that the sand fly vector, which is prevalent throughout the southern U.S., over the next number of decades is likely to be able to move further north with climate change," Melby says.

Climate models estimate that there are some 12 million people in the U.S. who could be locally exposed to leishmaniasis — a number projected to more than double over the next 60 years. These Americans join the approximately 1 billion people worldwide who live in areas with endemic leishmaniasis, causing a million infections a year.

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So it has nothing to do with the millions crossing the border unchecked. Thank goodness!