In the Old World (Eastern Hemisphere), CL is found in parts of the Middle East, Asia (particularly southwest and central Asia), Africa (particularly the tropical region and North Africa), and southern Europe. In the New World (Western Hemisphere), CL is found in parts of Mexico, Central America, and South America. Occasional cases have been reported in Texas and Oklahoma. CL is not found in Chile, Uruguay, or Canada. Overall, CL is found in focal areas of about 90 countries. Most (>90%) of the world’s cases of CL occur in 10 countries: Afghanistan, Algeria, Iran, Iraq, Saudi Arabia, and Syria in the Old World; and Bolivia, Brazil, Colombia, and Peru in the New World.

The geographic distribution of cases of CL evaluated in countries such as the United States reflects travel and immigration patterns. More than 75% of the cases diagnosed in US civilians have been acquired in Latin America, including popular tourist destinations such as Costa Rica. Cases in US service personnel reflect military activities (in Iraq, for example). CL is usually more common in rural than urban areas, but it is found in some periurban and urban areas (such as in Baghdad, Iraq, and Kabul, Afghanistan). The ecologic settings range from rainforests to arid regions.

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