A 35 year old captain in the army has been plagued by a painful, erosive lesion near his ear lobe since his return from operation dese storm several years ago. Punch biopsy of the leading edge of the erosion reveals macrophages distended with oval amastigotes. How was this infection acquired?

This is the history of cutaneous leishmaniasis caused by the L. tropica or L. major. The vector is sandfly (Phlebotomus sergenti or P.papatasii). This disease is also called as Delhi boil, Baghdad boil and oriental sore. Most cases of cutaneous leishmaniasis are seen in Afghanistan, Brazil, Iran, Iraq, Peru, and Saudi Arabia.