**4. Conclusion: Two American cutaneous leishmaniasis vectors as drivers of its geographical expansion in Brazil**

Both *Lutzomyia (N.) whitmani* and *L. (N.) flaviscutellata* are widely spread in Brazilian territory. Each one with its particular epidemiological importance, their geographical distributions overlap areas of ACL occurrence in Brazil (Figure 7).

Since it has a wide geographical distribution and it is associated with two ACL parasites (*Leishmania (V.) braziliensis* and *Leishmania (V.) shawi*), currently, *Lutzomyia (N.) whitmani* is considered the most important ACL vector in Brazil. Its importance is due mainly to its role in transmission cycles related with ACL epidemiological pattern 2 (sylvatic/occupational and impacted areas). This sand fly species was found in several localities associated with areas of environmental changes of different origins, such as deforestation, road constructions, human settements and agricultural activities. This epidemiological pattern is frequently observed in Brazil, and constitutes the main evidence of the disease's geographical spreading.

*Lutzomyia (N.) flaviscutellata*, with evidences of dispersion to peridomestic areas especially in the Cerrado biome, confirms the ruralization process of the previously considered strictly sylvatic cycle of *Leishmania (L.) amazonensis*. The possibility of this enzootic cycle to be main‐ tained in secondary forests and even become peridomestic was previously discussed [69]. This could be happening, in part, because of the adaptation process of the vector to man-modified environments. At first, it would be logical to think that a strictly sylvatic cycle would disappear with deforestation of primary forests [92], but the *Leishmania (L.) amazonensis* cycle shows evidences of occurrence in secondary forests and peridomestic areas, where the vector could be dispersing to domestic animal shelters [22].

Considering the great challenge that is controlling ACL, a disease with complex epidemiology directly associated with environmental changes, studies that aim to characterize and monitor its spatial and temporal trends can support the Epidemiological and Entomological Surveil‐ lance actions of Health Departments. These studies can help to identify receptive areas for new ACL outbreaks and population groups at higher risk of infection, so that control actions can be better planned and more effective.

**Figure 6.** Brazilian municipalities with *Lutzomyia (Nyssomyia) flaviscutellata* occurrence and biomes

14 Leishmaniasis - Trends in Epidemiology, Diagnosis and Treatment

**Figure 7.** Brazilian municipalities with *Lutzomyia (Nyssomyia) whitmani* and *Lutzomyia (Nyssomyia) flaviscutellata* oc‐ currence and American Cutaneous Leishaniasis human cases recorded by state in the past ten years (2003-2012)
