Phlebotomine sand flies (Diptera: Psychodidae) are the natural vectors of Leishmania (Leishmania) spp. (Kinetoplastida: Trypanosomatidae) and phleboviruses (Bunyavirales: Phenuiviridae) in Mediterranean countries. Leishmania infantum and phleboviruses are widespread in the region, whereas Leishmania major and Leishmania tropica are restricted to North Africa, the Middle East and Asia Minor. Leishmania infantum causes zoonotic visceral and cutaneous leishmaniasis (VL and CL) and L. major and L. tropica zoonotic and anthroponotic CL, respectively. Phleboviruses are negative-sense RNA viruses, and most are associated with human disease causing a short, mild febrile illness known as 'three-day fever'. One exception is Toscana virus (TOSV) which can cause a severe, and occasionally fatal, neuro-invasive disease. Although the public health impact of sand fly-borne infections is greatest in countries on the southern and eastern shores of the Mediterranean, they are an emerging problem in Europe in connection with global warming and societal behaviour that affects vector distribution and abundance.
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