What’s Eating You? Sand Flies



Phlebotomine sand flies are the only member of the Psychodidae family that are capable of taking blood.1 The mouthparts of the sand fly are toothed distally, and the maxilla and mandible are utilized in a sawtooth fashion to take a bloodmeal.2 The flies are very small (ie, only 1.5–3.5 mm in length), which makes their identification difficult.1 Sand flies can be distinguished by the appearance of their wings, which often are covered in hair and extend across the back in a V shape.3 The adult sand fly is hairy with a 6- to 8-segmented abdomen, and the color can range from gray to yellow to brown.2 Phlebotomine sand flies can be further identified by their long antennae, dark eyes, and small heads (Figure).2

Sand fly anatomy.

As is the case with all Diptera, the sand fly goes through 4 complete life stages from egg to larva to pupa to adult.3 Female sand flies will lay their eggs following a blood meal and have been found to take multiple blood meals in a single cycle.2 On average, the eggs will hatch in 6 to 17 days but are temperature dependent.3 The subsequent larvae and pupa stages last 20 to 30 days and 6 to 13 days, respectively.1 The larvae are white in color with short antennae and dark heads.4 Sand flies prefer to lay their eggs in areas where adequate resting places are available and where their larvae will thrive.4,5 The larvae require warm moist environments to succeed and thus are commonly found in animal burrows.3 Once fully developed, the adult sand fly can live up to 6 weeks.2

Sand Fly Vector

Although it is more common in rural forested areas, the sand fly also can be found in urban areas, including heavily populated cities in Brazil.6 Sand flies are most active during hot humid seasons but depending on the local climate may remain active year-round.1,7 For example, in tropical regions of Asia, the number of sand flies increases substantially during the monsoon season compared to the dry season.2 Phlebotomine sand flies are most active at dusk and during the night5 but may become agitated during the daytime if their environment is disturbed.1

Host selection usually is broad and includes a wide variety of vertebrates.2 In the United States, host species are thought to include small rodents, foxes, armadillos, and opossums.8 One study found that visceral leishmaniasis in foxhounds is able to develop fully in sand flies, thus posing an emerging risk to the American population.9


The Phlebotominae family contains approximately 700 different species of sand flies but only 21 are known vectors of disease.10 The great majority belong to 1 of 3 genuses: Phlebotomus, Sergentomyia, and Lutzomyia.11 The vectors are commonly divided into Old World species, dominated by the Phlebotomus genus, and New World species, which exclusively refers to the Lutzomyia genus.3 The Old World and New World distinction helps to classify the various vectors and subsequently the diseases they transmit. Old World refers to those vectors found in Southwest and Central Asia, the Indian subcontinent, the Middle East, and East Africa, as well as Southern Europe.6 New World refers to vectors found predominantly in Brazil and other parts of Latin America but also Mexico and the United States.6 Sand flies are found to be endemic in 90 countries and on each continent, except Australia.5 Although the vector can be found in a variety of environments, sand flies prefer moist environments that typify tropical and subtropical climates, thus it is not surprising that the highest diversity of Phlebotominae in the world can be found in the Amazon basin.12


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Author and Disclosure Information

Dr. Willenbrink is from the Transitional Year Program, Spartanburg Regional Medical Center, South Carolina. Dr. Elston is from the Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston.

The authors report no conflict of interest.

The image is in the public domain.

Correspondence: Tyler J. Willenbrink, MD, Transitional Year Program, 101 E Wood St, Spartanburg, SC 29303 (T.J.Willenbrink@gmail.com).


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What’s Eating You? Sand Flies