The Texas data from 2007 to 2023 highlight a continual increasing trend in leishmaniasis incidence, which aligns with broader concerns regarding the emergence of this parasitic infection in the United States. The increase in reported cases—particularly seen from 2013 to 2018—may suggest improved awareness and reporting among health care providers. The fluctuations in recent years could be explained by the underreporting of cases (ie, only an estimated 20% of cases were reported to the Texas DSHS), which poses a significant epidemiologic issue.

The observed peaks in incidence, particularly in 2018, underscore the need for continued vigilance among health care providers in recognizing and diagnosing leishmaniasis. The drastic drop in incidence observed in 2020 is likely attributable to the COVID-19 pandemic, which altered exposure and travel patterns, reducing opportunities for leishmaniasis transmission. Additionally, disruptions to health care services and public health reporting during the pandemic may have contributed to the underreporting of cases. As the pandemic’s effects continue to influence public behavior, travel, and health care practices, it is probable that these factors are still impacting leishmaniasis incidence. The decrease in reported cases after 2018, along with the continued lower incidence observed in 2023, may reflect these ongoing effects and possible changes in environmental factors affecting the sandfly population.

This further emphasizes the necessity of nationwide reporting standards and greater education efforts among health care providers for ensuring early leishmaniasis detection and treatment. Diagnosis should include clinical assessment, travel history assessment, and laboratory tests such as skin biopsies and polymerase chain reaction assays. Early treatment is crucial for preventing complications, including topical antiparasitic medications for localized cases and systemic therapies for more severe involvement.

This study’s findings should encourage public health officials and clinicians to have a high level of suspicion for leishmaniasis and prioritize surveillance and reporting, particularly in endemic regions like Texas. Mitigating continued spread can be addressed by patient education on preventative measures, such as covering exposed skin, wearing Environmental Protection Agency–registered insect repellent, and avoiding the outdoors after dusk. Medical personnel must be aware of important symptomatology to recognize leishmaniasis, including slowly ulcerating skin sores, swallowing difficulty, and nosebleeds. As numerous influences continue to increase leishmaniasis incidence, the United States must necessitate ongoing research and public health preparedness.