Surreal image of a traveler in the Negev Desert, Israel, surrounded by sandflies, symbolizing the risk of contracting Leishmaniasis.

Unmasking Leishmaniasis: A Traveler's Guide to Staying Safe in Unexpected Hotspots

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Elliot Brynn in Health & Wellness November 2026 • 4 min read.

"Three Dutch travelers contract Leishmaniasis in Israel, highlighting the disease's shifting geography and the importance of travel health awareness."


Cutaneous leishmaniasis (CL), a protozoan infection spread through sandfly bites, typically manifests as skin ulcers. While often mild, it can lead to disfigurement. Leishmaniasis affects an estimated 0.7 to 1.2 million people each year, mostly in tropical and subtropical zones. Afghanistan, Algeria, and other countries account for 75% of cases.

Traditionally, CL is associated with well-known endemic regions. However, a recent cluster of cases among travelers returning from Israel is challenging these assumptions. This situation underscores the need for travelers to be vigilant and aware of the risks, even in destinations not typically considered high-risk.

This article delves into the recent outbreak of Leishmaniasis among three Dutch travelers who visited Israel. By examining this specific incident, we aim to raise awareness about the changing epidemiology of the disease, highlight the importance of pre-travel health consultations, and empower travelers with the knowledge to protect themselves from vector-borne illnesses, regardless of their destination.

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What the CDC Source Reports

The CDC Travelers’ Health disease directory includes leishmaniasis as a traveler-health topic and identifies the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). The supplied source excerpt gives no case counts, prevalence, mortality figures, or other quantitative impact measures. Therefore, it does not support a numerical statement about current statistics.

Unexpected Transmission: How Did Travelers Contract Leishmaniasis in Israel?

Surreal image of a traveler in the Negev Desert, Israel, surrounded by sandflies, symbolizing the risk of contracting Leishmaniasis.

In the fall of 2015, three individuals from the Netherlands, who were travel companions participating in a study course in Israel, were diagnosed with cutaneous leishmaniasis upon their return. They had visited multiple sites in the Negev Desert, a region in southern Israel. Subsequent testing confirmed that the Leishmania major species was responsible for their infections.

The cases presented with varied symptoms. The first patient, a 55-year-old man, developed multiple ulcerating lesions on his head and shoulders. The second, a 52-year-old woman, experienced ulcers on both legs, initially misdiagnosed as a bacterial skin infection. The third, also 52, had a single plaque-like lesion on her arm. All were confirmed as L. major through skin biopsy and PCR testing.

  • Case 1: A 55-year-old man developed multiple, ulcerating lesions on his head and shoulders. He was successfully treated with miltefosine.
  • Case 2: A 52-year-old woman presented with ulcers on both legs, initially misdiagnosed. She also responded well to miltefosine treatment after the correct diagnosis.
  • Case 3: A 52-year-old woman had a single plaque-like lesion on her arm and chose to monitor the condition without immediate treatment.
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Limits of the Evidence and Testing

A 2014 literature review reports that Ehehalt et al. used the EuroTravNet network for a retrospective analysis of travelers who acquired leishmaniasis within Europe and were diagnosed between 2000 and 2012. The CDC Yellow Book says serologic testing is generally not useful for cutaneous leishmaniasis (CL), because the assays are insensitive and cannot distinguish active from past infection. Together, these sources describe a defined retrospective evidence base and a specific diagnostic limitation.

Regional Patterns and Imported Cases

One review lists endemic regions including Africa, the Middle East, south Asia, southern Europe, northern South America, and Central America, and reports increasing imported leishmaniasis in developed, non-endemic countries alongside increasing global travel. A 2022 source says CL in Asia, Northern Africa, and Sub-Saharan Africa is mainly caused by *Leishmania major* and *Leishmania tropica*. It also evaluates treatment outcomes for CL among travelers and migrants in Europe, placing those imported cases in a different setting from the listed endemic regions.

Traditionally, Israel is not considered a primary hotspot for Leishmaniasis compared to other regions in the Middle East or South America. However, this cluster of cases highlights a changing trend. Research indicates a significant increase in L. major cases within the local population of the Negev Desert. Factors such as urban expansion into previously unpopulated areas and alterations in land use are thought to be contributing to this rise. This cluster suggests that the risk is not limited to locals but extends to visitors as well.

Protecting Yourself: Practical Steps for Travelers

This outbreak serves as a reminder that infectious disease risks can shift and emerge in unexpected locations. Before traveling, especially to regions with known vector-borne diseases or undergoing environmental changes, consult with a healthcare provider specializing in travel medicine. Discuss necessary vaccinations, preventative medications, and personal protection measures. Prevention is key. Using insect repellent containing DEET, wearing long sleeves and pants, and staying in accommodations with screened windows or using bed nets can significantly reduce the risk of sandfly bites. Be vigilant for any unusual skin lesions developing after your trip and seek prompt medical attention, informing your doctor about your travel history.

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Travel-Associated Disease and Diagnostic Clues

A review describes cutaneous leishmaniasis (CL) as potentially emerging among international travelers and migrants, while noting that data on mucocutaneous leishmaniasis (MCL) in travelers are limited. A 2021 report notes that visceral leishmaniasis can be a differential diagnosis for leukemia-like syndromes in infants living or traveling in endemic countries. The same report says travel history can help differentiate CL in patients returning from Latin America from cases in those returning from Africa and the Middle East.

Surveillance and Shifting Priorities

A 2025 review reports that control of visceral leishmaniasis in India, Nepal, and Bangladesh is being heralded, while East Africa has become the region with the most cases. It also says cutaneous leishmaniasis rates continue to rise, with relocation and conflict among the factors noted. WHO’s 2024 global surveillance update makes six indicators publicly available through the Global Health Observatory and provides country profiles with up to 30 indicators, based on detailed data from 45 Member States.

Poverty, Displacement, and Preparedness

A 2024 source describes leishmaniasis as a disease of poverty and says it imposes a devastating medical, social, and economic burden on over 1 billion people nationwide. It also says that, at the time of publication, no in-depth study had analyzed the major global challenges and needs. The source further cautions that cutaneous or mucosal leishmaniasis need not require prolonged travel to an unusual destination, and highlights the need to plan for imported cases amid refugee migration from conflict and political instability.

Travelers and Evidence Gaps

A 2025 review describes cutaneous leishmaniasis (CL) as an emerging global health concern associated with increasing migration, travel, and climate change. A review focused on travelers says CL may be emerging among international travelers. It also notes that few data exist on mucocutaneous or mucosal leishmaniasis in travelers, and that more than half of published traveler cases in recent literature were reported in the past 15 years.

What surveillance and species testing add

Israel appears among the reported source countries for travel-associated CL in specialized-clinic surveillance. That places Israel within the surveillance picture, but the excerpt does not rank its contribution against the other listed locations.[1]

Because Leishmania species can affect management, identifying the species gives clinical meaning to a case beyond recognizing the infection; the excerpt does not quantify how often identification changes management.[1]

How the travel evidence and diagnostic methods differ

GeoSentinel reports laboratory-confirmed CL among patients seen at specialized travel or tropical medicine clinics, whereas the EuroTravNet analysis retrospectively examined travelers who acquired leishmaniasis within Europe. These are different surveillance and study populations, not a direct comparison of rates.[1] [2]

Questions beyond the skin presentation

  • How do clinicians weigh serology’s limits against parasite or DNA detection methods when interpreting suspected infection?[1]

Sources

  1. Leishmaniasis | CDC Yellow Book™ (cdc.gov)
  2. Leishmaniasis in travelers: A literature review - ScienceDirect (sciencedirect.com)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

1

What is Leishmaniasis, and why is it relevant to the context?

Leishmaniasis is a parasitic disease transmitted by sand flies. It is a protozoan infection that can manifest in different forms, with Cutaneous Leishmaniasis (CL) causing skin ulcers. The disease's significance in this context is highlighted by a cluster of cases among travelers in Israel, a region not traditionally associated with high Leishmaniasis risk. This underscores the evolving nature of the disease and the need for increased vigilance and awareness.

2

What are the symptoms of Cutaneous Leishmaniasis, and what was the range of symptoms experienced by the Dutch travelers?

Cutaneous Leishmaniasis (CL) typically manifests as skin ulcers. These lesions can cause disfigurement, though they are often mild. In the cases of the Dutch travelers, the symptoms varied: the first patient had multiple ulcerating lesions, the second had ulcers on her legs, and the third had a single plaque-like lesion. The varied presentations emphasize the importance of considering Leishmaniasis in the differential diagnosis for skin lesions, particularly in travelers with relevant travel history.

3

Where did the Dutch travelers contract Leishmaniasis, and why is this significant?

The three Dutch travelers contracted Leishmaniasis in the Negev Desert region of Israel. They were infected with the Leishmania major species. This incident is significant because Israel is not typically considered a high-risk area for Leishmaniasis. Their infections highlight how disease geography can shift and that travelers need to be aware of risks even in unexpected locations. The cases also reveal the importance of considering this disease in travelers returning from areas where sand flies might be present.

4

What is the importance of pre-travel health consultations?

Pre-travel health consultations are vital. Before visiting regions with vector-borne diseases, travelers should consult a healthcare provider specializing in travel medicine. Discussing necessary vaccinations, preventative medications, and personal protection measures is crucial. In the context of the Leishmaniasis outbreak, this includes advice on preventing sandfly bites through the use of insect repellent containing DEET, wearing protective clothing, and staying in accommodations with adequate screening. This proactive approach is essential because Leishmaniasis risk is not always predictable.

5

What are some practical steps travelers can take to protect themselves?

Practical steps include using insect repellent with DEET, wearing long sleeves and pants, and staying in accommodations with screened windows or using bed nets. After traveling, if any skin lesions develop, prompt medical attention is essential. The Dutch travelers' cases illustrate the importance of these precautions, as early diagnosis and treatment are critical. Informing your doctor about your travel history is also very important for accurate diagnosis and treatment of potential infectious diseases like Leishmaniasis.

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