Sand Fly

Subfamily Phlebotominae of family Psychodidae — the sand flies — contains about 800 species worldwide and includes the sole vectors of human leishmaniasis. Phlebotomus papatasi is the dominant Old World vector (Mediterranean, Middle East, North Africa, parts of South Asia), while Lutzomyia species are the dominant New World vectors. Sand flies are tiny (2-3 mm), hairy, brownish, and characterized by a hopping flight pattern between short bursts of hovering. The mouthparts are similar to mosquitoes (a piercing-sucking proboscis), but the body is much smaller — sand flies routinely pass through the mesh of standard mosquito nets, and special fine-mesh netting is required for sand fly protection. Females blood-feed on vertebrate hosts (mammals, reptiles, birds depending on the species), and certain species transmit Leishmania protozoan parasites. The clinical syndrome depends on the Leishmania species: cutaneous leishmaniasis (most common globally) causes localized skin ulcers; mucocutaneous leishmaniasis causes progressive destruction of mouth, nose, and pharynx tissues (especially in South America); visceral leishmaniasis (kala-azar, Sudan and South Asia) causes fever, hepatomegaly, splenomegaly, and is fatal in 95% of untreated cases. WHO estimates 12 million current global infections and 700,000-1 million new cases per year. Leishmaniasis is one of the major neglected tropical diseases targeted by current WHO elimination campaigns. The disease was a significant military medical concern in both World Wars (Mediterranean theater), the Iraq and Afghanistan campaigns of the 2000s, and continues to affect deployed military personnel in endemic regions.