Phlebotomine sandflies of the Phlebotomus and Lutzomyia genera are vectors for the spread of Leishmania parasites. Leishmaniasis is a parasitic infection most common in the Middle East and Central and South America. Few cases have been reported in the United States, with most patients presenting after returning from travel to other countries; however, the parasite has been locally acquired in Texas and Oklahoma. Clinical presentation varies depending on the species of Leishmania. There are 4 general clinical classifications of leishmaniasis: cutaneous, diffuse cutaneous, mucocutaneous, and visceral.