partly due to bad sanitation and waste left uncollected in streets, allowing parasite-spreading sand flies an environment they find favorable. in kabul, the number of people infected was estimated to be at least 200,000, and in three other towns (herat, kandahar, and mazar-i-sharif) about 70,000 more occurred, according to who figures from 2002. kabul is estimated as the largest center of cutaneous leishmaniasis in the world, with around 67,500 cases as of 2004. africa, in particular the east and north, is also home to cases of leishmaniasis. leishmaniasis is considered endemic also in some parts of southern parts of western europe and spreading towards north in recent years. for example, an outbreak of cutaneous and visceral leishmaniasis was reported from madrid, spain, between 2010 and 2012. leishmaniasis is mostly a disease of the developing world, and is rarely known in the developed world outside a small number of cases, mostly in instances where troops are stationed away from their home countries. leishmaniasis has been reported by u.s. troops stationed in saudi arabia and iraq since the gulf war of 1990, including visceral leishmaniasis. in september 2005, the disease was contracted by at least four dutch marines who were stationed in mazar-i-sharif, afghanistan, and subsequently repatriated for treatment. history a 1917 case of cutaneous leishmaniasis in the middle east, known then locally as "jericho buttons" for the frequency of cases near the ancient city of jericho descriptions of conspicuous lesions similar to cutaneous leishmaniasis appear on tablets from king ashurbanipal from the seventh century bce, some of which may have derived from even earlier texts from 1500 to 2500 bce. persian physicians, including avicenna in the 10th century ce, gave detailed descriptions of what was called balkh sore. in 1756, alexander russell, after examining a turkish patient, gave one of the most detailed clinical descriptions of the disease. physicians in the indian subcontinent would describe it as kala-azar (pronounced kālā āzār, the urdu, hindi, and hindustani phrase for "black fever", kālā meaning black and āzār meaning fever or disease). in the americas, evidence of the cutaneous form of the disease in ecuador and peru appears in pre-inca pottery depicting skin lesions and deformed faces dating back to the first century ce. some 15th- and 16th-century texts from the inca period and from spanish colonials mention "valley sickness", "andean sickness", or "white leprosy", which are likely to be the cutaneous form. it remains unclear who first discovered the organism. david douglas cunningham, surgeon major of the british indian army, may have seen it in 1885 without being able to relate it to the disease. peter borovsky, a russian military surgeon working in tashkent, conducted research into the etiology of "oriental sore", locally known as sart sore, and in 1898 published the first accurate description of the causative agent, correctly described the parasite's relation to host tissues and correctly referred it to the protozoa. however, because his results were published in russian in a journal with low circulation, his results were not internationally acknowledged during his lifetime. in 1901, william boog leishman identified certain organisms in smears taken from the spleen of a patient who had died from "dum-dum fever" (dum dum is an area close to calcutta) and proposed them to be trypanosomes, found for the first time in india. a few months later, captain charles donovan (1863–1951) confirmed the finding of what became known as leishman-donovan bodies in smears taken from people in madras in southern india. but it was ronald ross who proposed that leishman-donovan bodies were the intracellular stages of a new parasite, which he named leishmania donovani. the link with the disease kala-azar was first suggested by charles donovan, and was conclusively demonstrated by charles bentley's discovery of l. donovani in patients with kala-azar. transmission by the sandfly was hypothesized by lionel napier and ernest struthers at the school of tropical medicine at calcutta and later proven by his colleagues. the disease became a major problem for allied troops fighting in sicily during the second world war; research by leonard goodwin then showed pentostam was an effective treatment. society and culture the institute for oneworld health has reintroduced the drug paromomycin for treatment of leishmaniasis, results with which led to its approval as an orphan drug. the drugs for neglected diseases initiative is also actively facilitating the search for novel therapeutics. a treatment with paromomycin will cost about us$10. the drug had originally been identified in the 1960s, but had been abandoned because it would not be profitable, as the disease mostly affects poor people. the indian government approved paromomycin for sale in august 2006. by 2012 the world health organization had successfully negotiated with the manufacturers to achieve a reduced cost for liposomal amphotericin b, to us$18 a vial, but a number of vials are needed for treatment and it must be kept at a stable, cool temperature. research main article: leishmaniasis vaccine a parasitologist working on l. major in a biocontainment hood as of 2017, no leishmaniasis vaccine for humans was available. research to produce a human vaccine is ongoing. currently some effective leishmaniasis vaccines for dogs exist. there is also consideration that public health practices can control or eliminate leishmaniasis without a vaccine.