**1. Introduction**

Tissue parasites such as *Leishmania* are transmitted from host to host through a vector species, and transmission can be from human to vector to animal or vice versa (zoonotic transmission), which occurs in rural and periurban environments or from human to vector to human (anthroponotic transmission), which occurs in urban environments. *Lutzomyia* and *Phleboto‐ mus* species have long been known as the primary transmitters of leishmaniasis. However, in recent decades, evidence has been building for the existence of alternative transmission pathways. These pathways involve direct contact with infected tissues, such as may be encountered during surgical/therapeutic procedures, biological/reproductive activities, certain work-related practices and by unsafe drug use, all of which are reviewed below.
