Medical Parasitology

‫ﻋﻠم دراﺳﺔ اﻟطﻔﯾﻠﯾﺎت ذات اﻷھﻣﯾﺔ اﻟطﺑﯾﺔ‬

What is a parasite? And What is a host?
A parasite is a living organism that lives in(endoparasite) or on (ectoparasite) another organism
termed its host and cause harm( daises or infection) to such host

What are Parasites of Medical Importance?

Parasites of Medical Importance (Medical Parasitology) Scientific Classification of Parasites

Helminths
(worms)
‫اﻟدﯾدان‬
Helminthology

Protozoa
(unicellular parasites)
‫اﻟطﻔﯾﻠﯾﺎت وﺣﯾدة اﻟﺧﻠﯾﺔ‬
Protozoology

Arthropods
(invertebrate animals with exo-skeleton and jointed legs) ‫اﻟﻣﻔﺻﻠﯾﺎت‬
Entomology

what are the different types of parasites?

Classification of parasites based on their living habits
Ectoparasites
live on the body surface of their hosts. e.g. Lice Ectoparasites cause infestations of their hosts.
ECTO=out side
Endoparasites
live inside the body of their hosts. e.g. Ascaris worms living in the small intestine of man.
Endoparasites cause infection to their hosts.
ENDO= INSIDE
An obligatory parasite
lives Completely dependent on its host and can’t exist without it. e.g. Ancylostoma
(hookworms).
OBLIGATORY= HOST IS A MUST
A facultative parasite
can change its life style between free-living and parasitic according to the surrounding
conditions. e.g. Strongyloides stercoralis.
FACULTATIVE= WITH OR WITHOUT A HOST ACC. TO THE CONDITIONS= PARASITIC +FREE LIVING
A permanent parasite
is the one that lives in or on its host without leaving it. e.g. lice.
PERMANENT= LEAVES THE HOST ONLY WHEN THE HOST DIES OR BODY TEMPERATURE
CHANGES
A temporary parasite
is that one which visits its host only to get its meal and then leave it. e.g. bed bug visiting man
for a blood meal.
TEMPORARY= HOST VISITOR FOR FOOD (blood)

An opportunistic parasite
is that one which is capable of producing a disease in immuno-compromised host (immuno-
deficient host like AIDS and cancer patients).
In the immuno-competent host, it is either found in a latent form or cause a self limiting
disease. e.g. Toxoplasma gondii.
OPPORTUNISTIC= USE THE CHANCE OF DECREASED IMMUNITY

What are the different types of hosts?

Definitive host
(D.H.) is the host that harbors the adult or sexually mature stage of the parasite (or where
sexual reproduction occurs).
Intermediate host
(I.H.) is the host that harbors larval or sexually immature
Stages of the parasite (or where asexual reproduction occurs). Sometimes, a parasite needs
more than one I.H. then, they will be termed 1st and 2nd I.H.
e.g. H.heterophyes
Reservoir host
(R.H) is the animal host that harbours the same species and same stages of a parasite as man.
It maintains the life cycle of the parasite in nature and is therefore, a reservoir source of
infection for man.
Vector
usually an arthropod that transmits parasites from one host to another.
A vector may be mechanical or biological transmitter of a parasitic infection

The parasitic diseases that are originally of animal source and

transmitted to man are called zoonitic diasese and man is usually an accidental host.
e.g. hydatid disease

habitat:Where the parasite lives in or on the host?

Each parasite has a special organ or tissue where it lives inside its host, termed its habitat.
e.g. in the muscles, skin, intestine, in the liver….etc

Parasites can be classified according to their habitat.

Example:
Integumentary system: Scabies mite
Haemopoietic system : blood parasites e.g. Malaria parasite
what is the life cycle of a parasite?
To study the life cycle of a parasite means to follow the pathway of its development, starting by
one stage and ending to it where the cycle repeats

What is the importance of the life cycle of a parasite?

Following the life cycle of a parasite means to track the clinical picture of the parasite based on
its pathway (prepatent infection) till arriving its habitat (patent infection), to request
investigations for diagnosis, diagnostic stage and to prevent and control infection by measures
to cut the parasite life cycle. It also shows mode of infection and infective stage.

caseation of parasites
Based on their taxonomy (scientific classification) Purpose: for their laboratory identification
and diagnosis
Metazoa: Helminths= Worms
Flat worms (Platyhelminthes): Trematoda, Cestoda
Round worms (Nemathelminthes): Nematoda
Protozoa= Unicellular parasites
Amoebae (Rhrizopodes), Flagellates, Ciliates, Sporozoa
Metazoa: Arthropoda:
Insecta, Arachnida, Crustacea
Based on their habitat (where they live in human host) Purpose: for clinical diagnosis

medical Helminthology

Phylum:Platyhelminthes
(Flat worms)
No body cavity
Class: trematoda (the flukes) (‫اﻟدﯾدان اﻟﻣﻔﻠطﺣﺔ )اﻟورﻗﯾﺔ‬
Flat leaf like un segmented
Class: Cestoidea
Subclass: Cestoda (The Tapeworms) ‫اﻟدﯾدان اﻟﺷرﯾطﯾﺔ‬
Flat and segmented

Phylum: Nemathelminthes
(Round worms) Nematodes ‫اﻟدﯾدان اﻷﺳطواﻧﯾﺔ‬
With a body cavity
Protozoa: Protozoa are single-celled microscopic eukaryotes that are capable of performing all
physiological functions of life.

basic classification of protozoa:

It is set according to:
- The morphological identification characters,
- Reproduction and locomotion.
- Their habitat in the human body.

Subkingdom: Protozoa

Phylum: Sarcomastigophora

Class:Rhizopoda( Amoebae)
Intestinal:- Entamoeba spp.

Class: Zoomastigophora (Flagellates)

Intestinal :Giardia lamblia

Phylum: Ciliophora (move by cilia, sexual and asexual reproductio)

Class: Ciliata (Ciliates)
Intestinal: Balantidium coli

Phylum: Apicomplexa
(have apical complex, no special organs of locomotion, sluggish gliding, sexual and asexual
reproduction)
Class: Sporozoa
Intestinal Coccidia: Cryptosporidium

Classification of arthropods of medical importance:

Arthropods
Insects: 3 pairs of legs/ Head Thorax abdomen
Arachnids Acarina
4 pairs of legs/Body not well differentiated
Crustaceans
cephalothorax Segmented abdomen

venomous arthropods (stings ‫ﻟدﻏﮫ‬

‫ اﻟﺿﺑور‬Wasps and bees ‫اﻟﻧﺣﻠﮫ‬
‫ اﻟﻌﻧﻛﺑوت‬Spiders
44 ‫ ام‬Centipedes
‫ اﻟﻌﻘرب‬Scorpions
Biological transmission by vectors:
TYPES
YOU HAVE TO COMMENT ON change in morphology AND/OR in number of the transmitted
organism:

• PROPAGATIVE: only increase in number of the organism inside the vector. E.g. Plague in fleas
• CYCLO-PROPAGATIVE: increase in number and change in morphology of the organism. E.g.
malaria parasites inside female Anopheles
• CYCLO-DEVELOPMENTAL: only change in morphology of the organism. E.g. Wuchereria
bancrofti inside female Culex
• Trans-ovarian (vertical transmission): organism passes to the off springs. E.g. Zika virus inside
female Aedes especially in bad climate.

Class INSECTA
Medically important insects belong to 4 Orders:
• Order Diptera (2 wings) : Mosquitoes and flies.
• Order Siphonaptera: Fleas.
• Order Hemiptera (rudimentary wings): Bugs.
• Order Anoplura: Lice.

Mosquitoes: Adults measure 4-10 mm.

Mouth parts possess a long piercing proboscis adapted for piercing and
sucking blood in females, or sucking plant juice in males (nectar feeder,
vegetarian).

Resting position of adult mosquitoes

Culex and Aedes: parallel to the surface
Anopheles: makes 45 degrees angle with the surface

Life cycle of mosquitoes:

completed in stagnant water( complete metamorphosis)

Bionomics (Ecology) of mosquitoes

•Habits: female mosquitoes are temporary ectoparasites

•Life span 6-8 weeks increased in winter
•Flight range is 2 kilometers increased to 10 Km by wind.
•They are attracted by bright light and dark clothes.
•According to feeding habits they can be:
Anthropophilic (suck man blood)
Zoophilic (suck animal blood).
After a blood meal, female lays eggs because the blood meal stimulates the production of
special hormone necessary for ovulation.
•Mosquitoes breed in water collections and rice fields
•Aedes and some other mosquitoes can breed in very little collection of water inside flower
vase, water inside buckets and even in a bottle cover.

Medical Importance of Mosquitoes as injurious arthropods

• They have annoying, biting and blood sucking activities of females.
• The saliva of mosquito causes irritating rash due to hypersensitivity reaction.
Vector : female anopheles
Transmits: 1-Human Plasmodium species (Malaria)
Infective stage: Sporozoite
Type of transmission: Cyclo- Propagative (Male and female gametocytes from human blood
change to à Thousands of sporozoites in salivary glands of mosquitoes
Mode of infection: Inoculation
Disease :Febrile attacks with rupture of Plasmodium parasite infected RBCs causing haemolytic
anaemia (Pallor and fatigue) and jaundice (increase bilirubin with yellow sclera and skin).

CASESTUDY: A 24-year-old geologist went on a three-week work trip to South Africa. Though
recommended, he did not take malaria prophylaxis. Two days before his return to Egypt, he
developed a low-grade fever. The next day his fever was accompanied by chills and muscle
aches. After arriving home, he went to the hospital emergency room. A thin blood smear was
made and stained with Giemsa. The following images shows intra- erythrocytic ring and
amoeboid diagnostic stages in his blood smears (films).

1. What is the vector responsible for the disease transmission?

2. What is the type of transmission by the vector? Justify.

Biological Mechanical
Gametogenesis and Sporogony: Sexual multiplication inside female Anopheles (D.H.) of
Plasmodium (malaria) parasite

Malaria vectors:
Anopheles pharoensis: chief malaria vector GD: Nile valley
Season: summer and autumn
Biting habits: nocturnal and mainly zoophilic
Anopheles sergenti:
GD: Oasis, Faiyum, Sinai
Season: all year especially autumn
Biting habits: nocturnal and mainly zoophilic
Anopheles gambiae:
Not found in Egypt
Efficient Vector of malignant malaria (Plasmodium falciparum causing severest form of malaria)
Biting habits: nocturnal and mainly anthropophilic
Aedes species:
Female Aedes aegypti and A. albopictus (tiger mosquito)
Medical Importance of Mosquitoes

Vector:Female Aedes
Transmits:
1- Dengue fever Haemorrhagic fever
(red sea area in Egypt)
Infective stage: virus
Type of transmission: Propagative/ Transoverian??
Mode of infection: Inoculation. Once Aedes is infected it becomes infective for all life.
Disease: Fever, rash on face and thorax, muscle and joint pain and decreased platelet count
May be haemorrhage in severe form of disease started as bleeding gum and epistaxis (bleeding
from the nose) and internal haemorrhage and death

2-Yellow fever (not in Egypt)

Infective stage: virus
Type of transmission: Propagative/ Transoverian??
Mode of infection: Inoculation.
Disease: Acute febrile disease. The virus affects the liver causing jaundice and dark urine. May
end by liver and renal failure

3-Zika virus (in Egypt)

Infective stage: virus
Type of transmission: Propagative/ Transoverian??
Mode of infection: Inoculation.
Disease: Congenital microcephaly due to mother infected during pregnancy

4-Rift valley fever (in animals in Egypt)

Infective stage: virus
Type of transmission: Propagative/ Transoverian??
Mode of infection: Inoculation
Disease:Usually affects animals (commonly cattle and sheep) but can also involve humans. In
humans the disease ranges from a mild flu-like illness to severe haemorrhagic fever that can be
lethal.

Case :Epistaxis (bleeding from the nose) due to

dengue haemorrhagic fever
What is the vector?
What is the type of transmission?

Case:This traveller is coming back to his home country after a visit to South Sudan without
taking the proper vaccine nor taking the protective measures. When back he suffered from flue
like symptoms in addition to jaundice and dark urine. What is the vector for this infection?
Case: This baby was born to a mother from Brazil due to a vector transmitted viral infection
•What is the name of this condition?
•What is the causative virus?
•What is the vector responsible for the disease transmission?
•What is the type of transmission by the vector?
Justify. Biological Mechanical

Culex, the hairy non-spotted wings mosquito

Vector:Female Culex
Transimits :

1-Wuchereria bancrofti
Infective satge: Infective filariform larva
Type of transmission : Cyclo-developmental (Every microfilaria taken from human blood
Change to -> filariform larva (infective stage) in salivary glands of mosquitoes
Mood of infection: During the bite, the infective filariform larva (infective stage) , drops
on skin, pierces it by its own activity.
Disease: Fever, lymphangitis and lymphadenitis and if untreated is complicated by elephantiasis
of the lower limb and external genitalia.

2-West Nile Viral Encephalitis

Infective satge: virus
Type of transmission : propagative
Mood of infection: Inoculation during bite.
Disease: Fever, Headache, Body aches, Fatigue, Back pain Skin rash, Swollen lymph glands, Eye
pain, stiff neck, convulsions, may be paralysis

3-Rift valley fever also found in Saudi and Yamen

Infective satge: virus
Type of transmission : propagative
Mood of infection: Inoculation during bite.
Disease: Disease of sheep and cattle. In man, it causes fever, sweating, headache, muscle pain,
ends by complete recovery.

Case Study:
Random night blood specimens were collected from over 500 subjects in an area known to be
endemic for lymphatic filariasis in Sharkia governorate. The diagnostic stage (microfilaria) were
observed on Giemsa- stained thick blood films from several of symptomatic and asymptomatic
cases.

What is the vector responsible for the disease transmission? •What is the type of transmission
by the vector? Justify. Biological/ Mechanical

What is the infective stage by the vector?

Case :40-year-old Lady from Nile Delta suffered from the shown condition due to lymph vessels
obstruction by a vector transmitted parasite.

What is the name of this condition?

What is the vector responsible for the disease transmission? •What is the type of transmission
by the vector? Justify.Biological Mechanical

What is the infective stage by the vector?

Mosquito Control:
A-Control of aquatic stages
Physical (natural) control:
• Removal of breeding places or rendering them unsuitable by:
Swampy areas are filled with earth.
Drainage or pumping of water from small collections.

• Rendering water collections unsuitable for breeding by: Making water fast-running instead of
slow.

• Alternate flooding of rice fields for 5 days followed by drying for 2 days, since improper or
uncontrolled flooding produces numerous mosquitoes.

• Photolarvicidal method using laser rays are under trial

Biological control:
This can be done by promoting the breeding of natural enemies in permanent collections of
water e.g.:
• Fish of various species feed freely on aquatic stages. The most useful is the fish Gambusia
affinis which feeds on larvae and pupae.

• Ducks, dragon flies and frogs eat both aquatic and adult stages of mosquitoes.

• The bacteria Bacillus thurnigiensis forms spores which are highly toxic to mosquito larvae
especially against Aedes and Culex.

Chemical control:
• The chemicals used, even the safest of them, are poisonous with varying degree of toxicity to
man, domestic animals and plants. These include:

• Non-volatile oil as solar, diesel oil, waste engine oil or malariol which is a mixture of non-
volatile oils. When sprayed on water surface they form a continuous film and therefore act as
respiratory poisons which suffocate and poison aquatic forms (eggs, larvae, pupae) by
inhalation.
• Paris green (stomach poison): It is a green powder composed of copper acetate and copper
meta-arsenite. It has the advantage of being cheap and non-toxic to man, fish or birds. Being a
stomach poison, it is larvicidal especially to the surface-feeding anopheline larvae. Pupae do not
feed and therefore are not affected.

• Residual insecticides: These are stomach and cuticle poisons that kill larvae and pupae.
• Chlorinated hydrocarbons as D.D.T. (dichloro-phenyl-trichloro-ethane) is used at a low
concentration of 2-5% sprayed mixed with dust or oil. Its use as well as the use of other
organochlorine insecticides as Gammexane (gamma-hexachloro-cyclohexane: HCH) should be
avoided because of their persistence in the environment and accumulation in the animal and
plant tissues.
• Organophosphorus compounds as Malathion, or carbamates as Sevin are similarly used in the
presence of resistance to the above compounds. Both are anti-choline esterase that act by
interfering with neuro-transmission across synapses in nerve cords leading to paralysis and
should be used with care as they are toxic to man.

B-Control of adults
Screening windows and doors of houses by wire screens with meshes narrow enough (18
holes/square inch) to prevent mosquitoes.

Sleeping under mosquito nets in endemic area. Nets may be impregnated with insecticides.

Using repellents disliked by insects:

Several repellents applied to bare skin or on the clothes have been discovered, but the perfect
repellent has not been found, since various species of mosquitoes act differently against the
same chemical substance, e.g. Citronella oil or Eucalypteus oil whose action is of short duration
for up to 30 minutes. Synthetic repellents as Indalone used alone or mixed with others give
protection for several hours.

Anti-mosquito tablets impregnated with an insecticides as Indalone and put in a special electric
heater is used as an indoor repellent e.g. Ezalo. Also Pyrethrum-impregnated coils when burnt
outdoors produce a strong smoke that repels mosquitoes from the surrounding area.

Using insecticides sprayed indoors or outdoors:

• Non-residual insecticides as Pyrethrum plant extract which is a cuticle (skin cover of the
insect) poison used as aerosol. It kills rapidly but loses its effect quickly (nock out effect).

• Residual insecticides that have a long lasting effect for months as:
e.g.
• Chlorinated hydrocarbons : Gammexane, D.D.T.
• Organo-phosphorous compounds e.g. Malathion, Dipterex.
• Carbamates e.g. Sevin, Baygo

• Using light traps usually give good results.

• Using animal barriers deviates mosquitoes from feeding on man. This is done by putting the
domestic animals between mosquitoes and human beings. Thus they get their blood meals
from these animals and spare man. It doesn’t work with anthropophilic mosquitoes

• Using updated genetic control measures by sterilizing male mosquitoes chemically or by

irradiation.

• Paratransgenesis: feeding the larval stage with symbiont bacteria that capable of preventing
adult mosquitoes from being infected by viruses and parasites and consequently no disease
transmission

Phlebotomus sp. Lutzomyia sp. (Sand fly)

Geographical distribution:
Sand flies are distributed in Tropical and Subtropical countries as well as temperate areas of the
Old World (Phlebotomus species)
and the New World (Lutzomyia species). Phlebotomus papatasii is prevalent in Egypt.

Habits/ bionomics:
• Sand fly distribution is limited to areas that have temperatures above 15.6oC
• Old world Phlebotomus are savanna and desert species ( low rainfall) and Population
increases after rainy seasons
• New world Lutzomyia are mainly inhabitants of forests ( high rain fall)

Adults feed on mammals and as a rule the females are the blood sucking being nocturnal
feeders(bite at dusk with sunset)
• In the daytime, adults hide in burrows of rodents, cracks and crevices of buildings.
• They are more exophillic (outdoors) than endophillic (indoors)
• They are weak fliers with tendency of hopping that is why their disease
transmission is of limited spread
• However, with human made genetic interference, span of flight ‫ﻣدى اﻟطﯾران‬is increased
experimentally.

Development:Complete metamorphosis (30 days)

Breeding sites: adults hide in burrows of rodents, in humid cracks and crevices‫ اﻟﺷﻘوق‬of buildings
(not in water like mosquitoes)

MEDICAL IMPORTANCE AS INJURIOUS ARTHROPOD

Sand fly bite reaction (Harrara):
• Sand flies are annoying pests. An allergic reaction to the bite is produced at the site of bite. A
painful and itchy red papule is formed, surrounded by an area of erythema of 1-2 cm. In
sensitive individuals, and malaise it is accompanied by fever
Medical importance:
Disease transmission:
A. Phlebotomus acts as an intermediate host of Leishmania species by cyclopropagative
transmission. Infective stage (promastigote) is passed in the saliva.

Transmission :Leishmaniasis is transmitted by the bite of infected female sand flies, which
become disease carriers after sucking the blood of an infected person or animal

infecting man: The Leishmania parasites, in a developmental stage called promastigotes

(infective stage), are deposited by a sand fly's proboscis into the skin when it bites a person or
animal
propelled by their flagellum, the promastigotes in the skin can enter the bloodstream. They
infect White blood Cells called macrophages (phagocytes), which ingest foreign invaders as
immune mechanism
Ingestion The promastigotes are ingested by the host macrophages (phagocytes). Once inside
the host cells, the promastigotes lose their flagellum and become amastigotes.

Evasion of immune system Normally macrophages (phagocytes) destroy parasites, but

Leishmania amastigotes have adapted to live and multiply in them.

3types of leishmaniasis:
1- Visceral in spleen and liver
2- Cutaneous in the skin
3- Mucocutaneous affecting skin and underlying mucous membrane and cartilage

Hepatosplenomegaly due to visceral leishmaniasis (Leishmania donovani)

Habitat of L. donovani inside human host: macrophages and monocytes in spleen, liver, bone
marrow, lymph nodes and blood

Diagnostic stage: Bone marrow aspiration reveals amastigotes inside macrophages under the
microscope
Geographic disturbing : Found in Mediterranean area, India and Pakistan

Cutaneous leishmaniasis“oriental sore” Leishmanial tropica

Habitat of L. tropica inside human host: macrophages of the skin

Clinical course of the cutaneous leishmaniasis. Oriental sore first begins as an erythematous
papule (a), then becomes a nodule within 6 months (b), then central ulceration with raised
border and crusting occurs (c), and then untreated lesion leaves an atrophic and depigmented
scar over months to years (d)
Daises: Ulcer with raised border and Undermined base (volcano like)
Diagnostic stage: Edge of the ulcer aspiration reveals amastigotes inside macrophages under
the microscope
- Sand fly fever (3-days fever, pappataci fever): This is an acute infectious disease characterized
by fever, muscular pain, severe headache and orbital pain. The causative organism is a virus and
is transmitted by the bite of the sand fly (propagative transmission). It is self-limiting. Some
severe types of the virus associated with hepatitis or neurologic manifestations as in Italy,
Turkey and Cyprus. Sometimes it is accompanied by sandfly bite rash.

3 days sandfly pappataci fever case study

A 45-year-old woman presented at the center for tropical diseases‫ ﻣرﻛز اﻷﻣراض اﻟﻣﺗوطﻧﺔ‬with
fever 40 C, diarrhea, headache, myalgia, malaise, and an itchy papular rash. She had been on
holiday with her family in a mountain village in Algeria. The place was infested with a lot of
small, stinging insects. She and her family became sick after they returned home. The physical
examination was normal apart from the rash on the inside of the extremities. Elevated liver
enzymes level were found in the blood examination. Blood picture showed decrease WBCs
count. Antibodies to the sandfly fever virus were detected. Thus “pappataci fever” was
diagnosed. (Differential diagnosis in travellers or refugees suffering from severe febrile hepatitis
and rash after their stay in the Mediterranean area).

Oroya fever (Bartonellosis, Carrion’s disease):

This disease is present in South America and transmitted by the sand fly Lutzomyia. The
causative bacteria is Bartonella bacilliformis which is a small bacillus- bacteria that invades the
red blood cells causing their destruction and severe haemolytic anaemia. May be warty skin
rash. Type of transmission inside sandfly is propagative.

Oroya fever (Bartonellosis, Carrion’s disease):

• Symptoms, including pallor, fever, anorexia, malaise, myalgia, headache, jaundice,
tachycardia, hepatosplenomegaly; sometimes accompanied by warty skin rash in chronic cases.

Integrated vector control:

• Preventing fly from laying eggs by plastering cracks in walls and filling holes.
• Spraying with potent residual insecticides (DDT).
• Sleeping under mosquito nets with narrow meshes (40
meshes/square inch).
• Use of personal repellents on exposed parts.
• Recently Para transgenesis
Flies This family includes three flies of medical importance (Musca, Stomoxys, and Glossina).
MUSCA DOMESTICA: (House fly)
Distribution: world wide
1- Adult:
Size: 7-10 mm.
Colour: greyish.
Body: divided into head, thorax and abdomen
2- Egg:
- banana-shaped with 2 longitudinal ridges.
- creamy white.
- about 1 mm in length.
3- Larva:
- worm-like tapering anteriorly and blunt posteriorly.
- dirty white in colour.
- about 1 cm in length.
- composed of head, thorax (3 segments) and
abdomen (8 segments).
4- Pupa:
- barrel-shaped.
- Brownish.
- enclosed in the last larval skin (coarctate).
5- Posterior respiratory spiracles: posteriorly in the last abdominal segment of the larva there
are 2 posterior respiratory spiracles
(D-shaped peritreme enclosing 3 sinuous spiracular slits and a button).
Musca domestica and human disease:
A- Musca domestica as a parasite:
Invasion of human tissues: (Accidental myiasis).
Larvae of Musca domestica may accidentally get in the
tissues.
B- Musca domestica serve as a vector or intermediate host:
Indirect mechanical transmission of microorganism (as typhoid, poliomyelitis and bacillary
dysentery), eggs of helminthes and cysts of protozoa.
FAMILY CALLIPHORIDAE
Subfamilies: CALLIPHORINAE (Metallic flies)
Members:
1-Calliphora 2- Lucilia
Adult
Size: Slightly bigger than musca Slightly bigger than musca
Color: blue green
Arista: As Musca but longer with more hairs. As Musca but longer with more hairs
Probosis : Sucking sucking
Thorax: -- --
Wings Abdomen: as musca as muscs
Medical importance: Semi-specific myiasis Semi-specific myiasis
Subfamilies: SARCOPHAGINAE (Flesh flies)
Members: 1-Sarcophaga 2- Wohlfahrtia
Adult
Size: bigger than musca bigger than musca
Color: grey(red eye) grey
Arista: distal third bare bare
Probosis : Sucking sucking
Thorax :3 longitudinal stripes 3 longitudinal stripes
Wings : as musca as muscs
Abdomen: Chess-board Dark spots pattern dark
Medical importance: Semi-specific myiasis Semi-specific myiasis

MYIASIS
Definition: The invasion of tissues of animals or man by dipterous fly larvae.
1- According to the Habit of the fly:

(a) Specific Myiasis: Examples:

i- Members of family Oestridae:
- Oestrus. - Hypoderma.
- Dermatobia.
ii- Gasterophilus.
iii- Cordylobia.
iv- Some species of Chrysomyia or Wohlfahrtia.

(b) Semi-specific Myiasis:

e.g. members of family Calliphoridae.

(c) Accidental Myiasis:

e.g. Musca, Stomoxys and Fannia.

2- According to Habitat (type of tissue invaded):

(a) Intestinal: e.g. Musca, Calliphora, Lucilia and Sarcophaga.
(b) Gastric: e.g. Eristalis.
(c) Urogenital: e.g. Fannia (lay eggs on urethral opening).
(d) Cutaneous:
- Traumatic (wound) myiasis invade wounds or ulcers e.g. members of Calliphoridae.
- Creeping eruption e.g. Gasterophilus & Hypoderma.
- Nodular e.g. Dermatobia and Cordylobia. (e) Ocular: e.g. Oestrus, Wohlfahrtia and
Sarcophaga.
(f) Aural: e.g. Wolfahrtia and Sarcophaga.
(g) Nasopharyngeal: e.g. Wohlfahrtia and Sarcophaga.
(a) Specific Myiasis:
These are obligatory tissue parasites; larvae develop only in living tissues (obligatory
sarcobiots), so the flies oviposit or larviposit in or near living tissues.
Examples:
i- Members of family Oestridae:
- Oestrus , Cordylobia (tumbo fly limited to tropical Africa), Dermatobia and certain species of
Chrysomia and Wohlfahrtia.
- Hypoderma.
- Dermatobia (lay eggs on some insect, which when visits man and bites him the eggs hatch and
larvae penetrate the skin).
ii- Gasterophilus.
iii- Cordylobia (lay eggs on ground or clothing, larvae penetrate unbroken skin).
iv- Some species of Chrysomyia or Wohlfahrtia (larvae do not penetrate unbroken skin, but
wounded or diseased tissues).

(b) Semi-specific Myiasis:

These are obligatory necrobiots (laying eggs or larvae on decaying matter) but may attack
tissues (facultative sarcobiots), attracted by odour emanating from discharges of diseased
tissues or wounds, e.g. members of family Calliphoridae.

Lucilia, Chrysomyia and Sarcophaga on dead bodies (Necrobiots) Forensic parasitology Post
mortem interval (PMI) determination is useful in cases of homicide, suicide and accidental or
unattended death because of natural causes. An important aspect of calculating the PMI is the
accurate and quick identification of the dipteran fly collected from a crime scene.

(c) Accidental Myiasis: larvae may accidentally get in the tissues, e.g. Musca, Stomoxys and
Fannia.

Cutaneous myiasis: - Creeping eruption: Larvae of Hypoderma parasitize some animals. causing
certain papules and pustules. - Furuncular or nodular myiasis by dermatobia (human botfly) and
cordylobia –
Traumatic dermal myiasis, where wounds or ulcers are invaded by larvae, causes serious
damage. e.g. Wohlfahrtia, Calliphora, Sarcophaga and Chrysomia.
Case study: 65-year-old man presented with skin lesions on his chest and left arm and shoulder
six weeks after returning from a vacation in Belize at the beach and in the rain forest. The
lesions occasionally stung, drained a dark exudate, and enlarged despite two weeks of
treatment with cephalexin. The patient had no constitutional symptoms. Physical examination
revealed five nodules of varying sizes with surrounding erythema and a central pore through
which a single, moving larva was observed. The pores were occluded with petrolatum for two
hours. After lidocaine was injected around the nodules, five Dermatobia hominis larvae at
various developmental stages were extracted with the use of manual pressure and tweezers.
Case study for exam:
The patient lived in a rural area and had been admitted to the same hospital with a diagnosis of
Alzheimer’s disease 5 years earlier. Clinical examination revealed edema of the upper lip with a
small opening (required for the larvae to breathe). The patient reported the sensation of things
moving inside the swollen area. Two 6 mg ivermectin tablets were prescribed.
Dermatobia A 46-year-old woman returned from a trip to Nigeria with multiple boils on her
lower back and extremities. Under the care of her primary physician, several fly larvae, one
from each boil, were extracted. Cordylobia .

MCQ :
53-year-old man presented with mainly nausea, vomiting and abdominal discomfort or pain
with diarrhea. Living or dead larvae may be found in stools or vomitus and can be diagnosed by
their posterior respiratory spiracles
1- Dermatobia 2- Oestrus 3-eristalis 4-Musca 5-Cordylobia

Aural myisis is caused by

Fannia Sarcophagi gastrophilus Codylobia

Accidental myisis is due to

Dermatobia Codylobia Lucillia Stomoxys Hypoderma

Nodular cutaneous myiasis is caused by

Musca Glossina stomoxys sarcophagi Cordylobia

Occular myiasi is due to

Musca Fannia oestrus codylobia stmoxys

22- years female reported the sensation of things moving inside the swollen area of the skin
over her abdomen . She has nausea, colicky pain in her tummy. She start vomiting the larva
causing certain papules and pustules. This is called creeping eruption or larva migrans.

Codylobia dermatobia lucilia stomoxys hypoderma semispecific myiasis none of the

above

In female patients 19 years -old , the larvae go to the vagina. There were symptoms of
obstruction to urine with pain or inflammation with pus, mucus and blood in urine. Some larvae
may pass with urine.

Musca fannia oestrus codylobia stmoxys Specific myiasis semispecific myiasis

all of the above
Medical importance of lice:
As biological vectors IH by propagative transmission in case of:
( by Pediculus humans corporis only)
Epidemictyphus. (intracellular)
Trench 5 days fever (intracellular)
Epidemic relapsing fever (body flueds)

As a cause of disease (injurious agents):

Pediculosis capitis, corporis (vagabond) and phthyriasis (MSK102-2)

PEDICULUS HUMANUS
Size: 2-5 mm, mouth parts for piercing and sucking, strong tarsal claws and tibial thumb,
permanent ectoparasite

Habits and bionomics of Body louse

Lice are obligate, permanent ectoparasites
• Lice are obligate, permanent ectoparasites of man (Pediculus humanus). Both sexes feed on
sucking blood and are therefore vectors of diseases.
• Body lice are most common in crowded and unhygienic living conditions, such as refugee
camps and shelters for the homeless.
• Body lice bites can spread certain types of diseases and can even cause epidemics. They can
also spread from contact with an infected person's clothes.
• The seams of clothing are the most common places for body lice to lay their eggs (nits).

Pediculus humanus corporis, “The vector”

Size: 2-5 mm, mouth parts for piercing and sucking, stick more to areas where clothes are tight
on the skin, permanent ectoparasite.
Homeless are more susceptible

Order Anoplura -Pediculus humanus corporis (Body louse) vector

1-Disease transmitted :Epidemic typhus fever
Causative organisms:Rickettsia prowazekii
(Rickettsia is a gram- negative, obligate non motile intracellular microorganisms)
Mode of infection
1- Contamination of wound by faeces or by crushing it on broken skin.
2- Contamination of conjunctiva or mucous membrane by fingers
3- Inhalation of dried faeces(multiplication happens in endothelial lining of gut)
Type of transimission: PROPAGATIVE TRANSMISSION
2-Disease transmitted: Trench fever (5days fever)
Causative organisms: Rickettsia quintana
Mode of infection Inhalation of contaminated dust by dried louse Faeces
Type of transimission: PROPAGATIVE TRANSMISSION

3-Disease transmitted: Epidemic relapsing fever

Causative organisms: Borrelia recurrentis
(Spirochaetes)
Mode of infection By crushing the louse on the skin or mucous membrane
(Borrelia multiply in body fluids)
Type of transimission: PROPAGATIVE TRANSMISSION

Epidemic typhus: severest form of typhus

Presented as: Pyrexia, Rash that begins on the chest or back and spreads to the rest of the body
(except the palms of the hands and soles of the feet)
Severe headache
Severe muscle and joint pain
Stupor and eye sensitivity to light
low blood pressure
Diagnosis: Special staining can identify the bacteria within infected tissue (skin tissue,
usually).PCR testing of a skin biopsy from skin rash or lesions, or blood samples.

Brill Zinsser syndrome: recurrent epidemic typhus after full recovery due to presence of
Rickettsia which will be activated if immunity is lowered. It is a sporadic uncommon form of the
disease.

Louse borne epidemic relapsing fever

• LBRF cases declined significantly worldwide with the exception of East African countries
(Ethiopia, Sudan, in particular Ethiopia, where LBRF remains a common cause of hospital
admission and death.
• Manifested as recurrent fever corresponding to spirochaetemia (increased Borrelia
spirochaetes in blood). 3-6 days febrile period followed by 5-10 days afebrile period. Relapse is
milder than first episode. A single relapse characterizes louse-borne relapsing fever
• Constitutional symptoms (headache, boneache, ........)
• Macular and petechial rash
• Later in the several weeks’ course of the disease, jaundice, hepatomegaly, splenomegaly,
myocarditis, and heart failure may occur, especially in louse-borne disease.
• Microscopy of blood films has a low sensitivity and cannot differentiate between Borrelia
species
• PCR is good in the diagnosis.

Borrelia in blood film in a case of relapsing fever

• Spirocheates were detected in blood film
Control of body lice
• Delousing: proper bathing, boiling of clothes, shaving hairs
• Machine wash and dry infested clothing and bedding using the hot water above 60 oC
• Dry cleaning or tumble drying affected items at >60oC for 15 minutes is another method of
effectively killing lice and eggs.
• Do not share clothing, beds, bedding, and towels used by an infested person.
• Storage of clothes in a plastic bag should see all lice and eggs dead after a month.
• Application of insecticides in form of dust, spray or fumes to the clothes (last options)
Packing for 2-4 weeks to kill the adults and eggs

Oral treatment for body lice

• Oral ivermectin 12 mg given as 3 doses 7 days apart has also been shown to be effective to
treat body lice.
• Topical pediculicide is usually not needed. Boiling of clothes and linens is very important.

Fleas with angular head

Tunga penetrans (Jigger flea or sand flea)
Habits and Ecology
• Fleas are obligate, temporary, ectoparasites of man and animals.
• Both sexes feed on sucking blood and are therefore vectors of diseases.
• They can withstand desiccation and starvation, for up to 6 months in the absence of suitable
hosts.
• They move by jumping (up to 20cm vertically and 30cm horizontally)

Life cycle:
• This is by complete metamorphosis.
• Total life cycle takes about 2-3 weeks and up to many months under unfavorable conditions.

Dipylidium caninum a double pored cestode found in infected human small intestine
(Dipylidiasis). There is a history of accidental ingestion of dog flea due to dog contact
Vector: dog flea Ctenocephalus (double comb)

Hymenolepis nana (dwarf tapeworm) commonest cestode affecting small intestine of children
(hymenolepiasis)

Plague (black death)

Caused by Yersinia (Pasteurella) pestis.
• The disease is primarily of wild animals especially rodents, and not
of humans (zoonotic).
• It starts among rats and is transmitted among them by rat flea (Xenopsylla) which is the most
efficient vector, leading to their high mortality.
• When rats die the flea turn to man for feeding, thus transmitting the disease to man.
Among humans the disease is then transmitted by the human flea (Pulex).
• Transmission of plague is propagative where organisms taken with blood pass to the
proventriculus (stomach) where they multiply and are regurgitated with the next feed into a
new host. The organisms multiply until the rat flea (Xenopsylla) becomes blocked.
• The blocked rat flea bites many times as it is hungry and therefore disseminates more
infection with each bite.
• The organisms pass in the flea faeces and contaminate bite wound or skin abrasions, but the
commonest mode of spread is by the blocked flea.
• Once established in the human population the disease may also be transmitted to man by
droplet infection from cases of pneumonic plague.

Types of fleas transmitted plague (black death)

• Bubonic plague: bacilli in the inguinal lymph nodes and lymphatics
• Septicemic plague: bacilli in the blood’
•A third type is pneumonic plague transmitted by droplet infection
Endemic or Murine (zoonotic from rodents) typhus
• Murine typhus occurs in tropical and subtropical climates around the world where rats and
their fleas live. It is cosmopolitan
• This is essentially a disease of rodents, particularly rats infected by Rickettsia typhi (mooseri)
and spread among the rats by Xenopsylla species which transmits the infection to man.
• The rickettsial organism is ingested by the flea with its blood meal to multiply within its gut.
Unlike plague bacilli they do not cause blockage of the proventriculus.
• The mode of infection is by infected flea faeces being rubbed into abrasions or coming in
contact with mucous membranes, and by release of the organisms from crushed fleas.
• The fleas remain infective as long as they live.
• It has a clinical picture like epidemic typhus but milder and self limiting.

Control of fleas:
• Before an anti-rat campaign is started their
• environment is sprayed to kill the flea
population which will look for other hosts.
• Fleas cocoons (pupa) are not susceptible to insecticides and hence spraying treatments
should be repeated every 2 weeks for about 6 months.

• In infected areas the adult and larval fleas are killed by dusting of insecticidal powders or
spraying emulsions (Gammexane), Malathion and DDT.
• In case of development of resistance, Carbaryl (Sevin) is effective.
• Insecticidal fogs are used to fumigate houses.
• Collars impregnated with various flea-killing
agents are used for pet dogs and cats.
• Insecticidal repellents may afford personal protection against fleas.
Triatoma= Winged bug= cone nosed bug= kissing bug
Geographical distribution:
Central and South America It coincides with distribution of Trypanosoma cruzi (Chagas disease)
which is zoonotic from wild animals
Reduviid or triatomine bugs (Triatoma or kissing bugs): HABITS
Active at night when they feed on human blood. They usually bite an exposed area of skin such
as the face, and the bug defecates close to the bite

Releases metacyclic trypomastigotes in its feces near the site of the bite

Parasites enter host through the wound

Kissing bug habitat Undeveloped Housing

Note: Triatomine bugs typically live in the cracks of poorly- constructed homes in rural or
suburban areas = rural poverty!

Development of Triatoma
INCOMPLETE METAMORPHOSIS

Medical importance:
Disease transmission:
Triatoma acts as an intermediate host of Trypanosoma cruzi (monomorphic trypanosomes) by
cyclopropagative transmission. Infective stage (short metacyclic trypomastigote) is passed in
the faeces of bugs and contaminate the scratched bite wound (CONTAMINATIVE
TRANSMISSION, stercorarian, posterior station development).

Monomorphic trypanosomes inbetween red blood cells (Diagnostic stage)

(CYCLOPROPAGATIVE )Monomorphic trypanosomes inbetween red blood cells (Diagnostic
stage)Monomorphic trypomastigote change into thousands of metacyclic trypomastigote inside
hindgut of Triatoma àShort metacyclic trypanosomes in faeces of triatoma= contaminative
stercorarian cyclopropagative transmission

Disease transmission: Chagas disease

American Trypanosomes/ Trypanosoma cruzi
(pathognomonic)
unilateral edema of the eyelid and conjunctivitis, a syndrome known as Romana’s sign
Diagnostic stage of American trypanosomiasis in blood film
MONOMORPHIC trypomastigote with short undulating membrane and thick kinetoplast
Control
• Repair of cracks
• Insecticides, however not easy for control of Triatoma which lives in forests and resist
insecticides.
• Use of entomopathogenic fungi biological control as topical application to kill adult and
nymph of Triatoma are under trial
• Indoor residual spraying and deltamethrin (non residual spray with knock out effect) around
homes however, resistant triatomines evolved.
• Nets for kissing bugs
insecticidal paints
Recent advances paint technology microencapsulated insecticides, or active ingredients are
embedded in the paint and gradually released on the surface of the dried paint.
used for of vector-borne diseases including malaria ,Chagas, leishmaniasis, lymphatic filariasis,
dengue

QUIZ
• Pediculus humanus transmits:
a) Epidemic typhus
b) Endemic typhus Xenopsylla
c) Scrub typhus Trombicula
d) Murine typhus

• The most efficient vector of plague is:

1- Tunga penetrans
2- Pulex irritans
3- Xenopsylla cheopis
4- Ctenocephalus canis

• The arthropod which is not easily killed by insecticides is:

a) Bed bug
b) Cone nosed bug
c) Bodylouse
d) Crab louse
 Arthropod vectors for disease transmission ,types of transmission.
Glossina: African sleeping sickness

GLOSSINA Tsetse fly

1- GLOSSINA PALPALIS (West Africa). 2- GLOSSINA MORSITANS (East Africa)

1- Adult:
Size: 10-15 mm.
Colour: Black (Glossina palpalis), brown (Glossina morsitans).
Body: divided into head, thorax and abdomen.

Proboscis is the food channel adapting for : Biting (piercing and sucking blood).

Vector of trypanosomes –
Sleeping sickness in man:
Trypanosoma rhodesiense
Trypanosoma gambiense

Glossina Tsetse fly

The Biological vector for human African trypanosomaisis is the tsetse fly .

Bites during daytime hours (Daytime feeder)

Both males and females are capable of carrying and transmitting the disease.

• Glossina sp. = Tsetse fly

• Feedsonblood
• Savannahandriverineflies
• Tsetsefliesfollowmovingobjects
• They are attracted by the odors like acetone and phenol
• Tsetse flies are attracted to bright or dark colors and bite through thin clothing

TRYPANOSOMA
Two different forms of genus Trypanosoma occur in humans: The Trypanosoma brucei complex
includes:
Trypanosoma brucei gambiense associated with West African sleeping sickness and

Trypanosoma brucei rhodesiense associated with East Africa sleeping sickness.

Habitat: Blood, lymphatic system and C.N.S.
Main host: Man.
Morphology: in the blood trpanosoma is polymorphic occurring in 3 forms:
1- Long slender form: 30 μ in length, with a free flagellum and actively motile.
2- Short stumpy form: 15 μ in length, without a free flagellum and sluggish.
3- Intermediate form: 22 μ in length, with a short free flagellum
Transmission: life cycle takes about 3 weeks.
1- The tsetse fly takes blood of the patient (or reservoir host)
containing polymorphic trypanosomes.
2- Trypanosomes multiply in the midgut by longitudinal binary
fission.
3- They undergo change in morphology in the foregut of Glossina (tse tse fly) and become
Metacyclic trypomastigote (the infective stage) in the salivary glands of the vector.
4- The bite of the tsetse fly is now infective (Anterior station development or inoculative
salivarian transmission).
5-Transmission of the parasites in the vector is of the
cyclopropagative type’’

Infective stage: Metacyclic trypomastigote.

1- From the site of bite (primary lesion: trypanosomal chancre),
It is seen in a week after the bite , large, red and rubbery.

2- Haemo-lymphatic stage: trypanosomes reach the blood and lymphatics

Irregular fever, lymph nodes are enlarged specially those of the posterior triangle of the neck
(Winterbottom’s sign). Also, hepatospleenomegaly.

WINTERBOTTOM SIGN DUE TO TRYPANOSOMA BRUCEI GAMBIENSE INFECTION (enlarged

lymph nodes in posterior triangle of the neck)
HAEMOLYMPHATIC STAGE OF AFRICAN SLEEPING SICKNESS

3- Meningoencephalitis stage :Later on invasion of the C.N.S. occurs. It is a chronic late stage .
Brain damage and meningitis occur resulting in disturbed mentality, and meningoencephalitis.

Laboratory diagnosis: Direct methods, depend on finding trypanosomes in a in lymph nodes

aspirate, blood film or in C.S.F.
DIAGNOSTIC STAGE: POLYMORHIC TRYPOMASTIGOTE

1. Vector control
Eliminate breeding places
Use insecticides (DDT)
Fly traps
Release of sterile males
Paratransgenesis
insecticidal paints
Release of sterile males: and irradiated Males are reared in captivity with gamma rays before
release in the wild
insecticidal paints :Recent advances paint technology microencapsulated insecticides, or
active ingredients are embedded in the paint and gradually
released on the surface of the dried paint.
used for of vector-borne diseases including malaria ,Chagas, leishmaniasis, lymphatic filariasis,
dengue

Prevention
2. Public awareness
Avoid tsetse fly bites:
Travelers should wear clothing of wrist and ankle length made of medium-weight fabric in
neutral colors

Permethrin-impregnated clothing and use of DEET repellent may minimally reduce the number
of fly bites

CYCLOPS (Water flea)

Morphology:
Size: 1-3 mm.
Shape: pear shaped, broad anteriorly.
Body: divided into cephalothorax and abdomen.
Cephalothorax: 5-segmented and carries:
(a) a single median eye.
(b) 2 pairs of antennae (17 and 4 segmented).
(c) 4 pairs of legs ending biramously.
Abdomen:
(a) 4-segmented in female.
(b) 5-segmented in male.
(c) It ends biramously, each has 2 bristles.
The female carries two egg sacs on the sides of the abdomen.
Medical importance:
Cyclops serve as vector or intermediate host for:
1- Diphyllobothrium latum.
2- Diphyllobothrium mansoni.
3- Dracunculus medinensis.
 ticks
Arthropoda
2 families of ticks that are vectors for human disease

• Hard ticks (Ixodidae)

• soft ticks (Argasidae)

Distribution
Cosmopolitan
more common in tropical areas
parasites of both human and animal

type of transsimition
Incomplete metamorphosis

Bionomics and Ecology

Hosts: According to species a variety of animals are infested e.g. dogs, cats, rodents, birds,
cattle, horses and wild animals. Humans are accidentally parasitized.
Copulation occurs on the host
Eggs laid on the floor
Larva hatch, search for the host, feed on
blood then drop to the ground.
Larvae moult into nymphs
Nymphs feed on blood then drop to the
ground & moult to give adults.

TICKS Ecology
Wooded areas
Tall brush/grass
Under plants/leaves to prevent dehydration
Under ground cover (plants) in yard
Around stone walls and woodpiles where mice & other small mammals live

Connecting to a Host
1- Questing:
by perching in low vegetation and waiting for a mammal to walk by

2- Ticks use chemical stimuli such as CO2, NH3,, airborne vibrations, and body temperatures to
locate mammals
Mechanism of ticks as a disease vectors
Hypostoma attaches to the host’s skin using hooks

it inserts a mouth piece into the skin called the hypostoma. The hyopstoma has hooks that,
once inserted into the skin, serve to anchor it in place.
Ticks as Disease Vectors
Substances secreted into skin
• Cementingsubstance:Gluesthehypostomain place
• Immunosuppressive,Anti-inflammatory chemicals: Helps the tick go unnoticed by the host
• Anticoagulant: Allows blood to go where it needs to go in the body
TICK BORNE DISEASES, (TBD)

Infection:

I- Rickettsial infections

1- Rocky mountain spotted fever Typhus-like fever Rash (Haemorrhagic)

Geographical distribution: Rocky mountain area in America & Mexico Endemic in USA

Reservoir Hosts: Dogs, rabbits & rodents

Tick :Hard tick (Dermacentor “American dog tick”, Rhipicephalus) (transovarian transmission)

Causative organism: Rickettsia rickettsii

Mode of infection: Bite of Ticks ( with blood meal)

2- Q-fever Bronchopneumonia Hepatomegaly

Classified by CDC under bioterrorism (a biological attack with intentional release of germs that
can sicken or kill people, livestock animals or crops)

Human vaccine is available in Australia

Geographical distribution: Worldwide

Reservoir Hosts: Cattle, sheep & goats

Tick :Hard & soft ticks (transovarian transmission) Development in tick is not mandatory for
transmission

Causative organism: R.(Coxiella ) Burnetii

Mode of infection: During bite and also contamination by tick faeces +Other non vector modes
of infection

3- Boutonneuse fever /Mediterranean spotted fever/ Kenya tick typhus/Indian tick typhus,
African tick typhus

Button-like ulcer (eschar) at site of bite/ Regional lymphadenopathy /Rash allover the body /May
be multiorgan failure in severe cases

Europe, North Africa, Palastine

Geographical distribution First recorded in Tunisia and Algeria

Reservoir Hosts: dogs

Tick : Hard Tick (Rhipicephalus = brown Dog tick)

Causative organism: R. Conori complex

Mode of infection: -Bite of ticks /- Faeces of ticks /- Coxal gland secretion after crushing of ticks
removed from dogs.

II- Spirochaetal infections

1- Endemic relapsing fever Febrile episodes last 3days separated by afebrile episodes of 7 days.
It repeats several time.

Geographical distribution: N. Africa, Palestine, & America

Reservoir Hosts: Rodents

Tick : Soft tick (Ornithodoros) transovarian transmission Ticks lives in rodent burrows and
attack human living in rodent infested cabin by mountains. It bites at night

Causative organism: Borrelia duttoni

Mode of infection: Saliva & coxal fluid contaminate the wound at site of bite.

2- Lyme disease -Erythema Chronicum Migrans- Arthritis of large joints- Facial paralysis (palsy)
- Myalgia- Cardiac complications

Geographical distribution: USA, Europe & Canada Some cases reported worldwide including
Egypt

Reservoir Hosts: Deer

Tick : Hard tick (Ixodes)

Causative organism: Borrelia burgdorferi

Mode of infection: Bite of Ticks

III-Protozoal infections :Babesiosis :Babesia is an intraerythrocytic parasite like malaria

parasites. Severe haemolytic anaemia and black urine especially in splenoctomized patients

Geographical distribution: Worldwide

Reservoir Hosts: Rodents, Cattle

Tick : Hard Tick (Ixodes) Transovarian transmision

Causative organism: Babesia sp. Infective stage: sporozoites

Mode of infection: Bite of ticks

IV- Bacterial infections Tularaemia (rabbit fever): Fever - Inflammatory ulceration of skin

- Enlargement of adjacent lymph nodes

Geographical distribution: Worldwide especially rural areas

Reservoir Hosts: Rabbits

Tick : Hard Ticks Transovarian transmision

Causative organism: Pasteurella (Francisella tularensis) Classified by CDC under bioterrorism

NB Pasteurella pestis causing plague also classified under bioterrorism

Mode of infection: - Bite – Faeces

Tick dermatosis:

Tick dermatosis: at the site of bites leads to

Local inflammation

Oedema

Bleeding

Secondary infection and ulceration if capitulum is torn off by forcible traction

Patient must be followed up for fear of developing fever due to a transmitted disease.

Tick paralysis caused by bite of hard ticks especially

female with injection of toxins found in its saliva at the back of neck of man or near base of brain
or spinal cord mostly in young children.

• toxins lead to failure in liberation of acetyl cholin at the neuromuscular junction

• It occurs worldwide
• Clinically there is fever, toxaemia, acute ascending motor flaccid paralysis, difficult respiration
and death. Though a rapidly fatal disease in man and animals, it is easily cured by removal of
ticks.

• Ticks in the genera Dermacentor and Ixodes have been implicated in tick paralysis

Treatment of tick paralysis:

• TREATMENT: This is treated by addition of few drops of chloroform or ether on head of tick
which will cause it to relax its hold and will allow it to be removed easily by traction.

INTEGRATED VECTORMANAGEMENT

• MINIMIZE EXPOSURE TO TICKS

• SANITATION

• BIOLOGICAL CONTROL

• CHEMICAL CONTROL

MINIMIZE EXPOSURE TO TICKS

• Use of repellents as DEET

• Use of permethrin on clothes: clothes treated with permethrin are left to dry for 2 hours before
use

• In tick infested areas tuck pants inside your boots

• Wear white coloured clothes so ticks will be seen and get rid of them

SANITATION

• Close cracks where rodents live

• Move firewood away from houses and also bird feeders

• Keep grass mowed

CHEMICAL CONTROL

• Tick control on domestic animals as sheep, cattle and dogs with residual insecticides as 0.5%
malathion.
• Hard ticks being permanent parasites are best controlled by dipping infected domestic hosts in
emulsions of chlorinated hydrocarbons or spraying.

• Malathion and proxupar (Baygon) are effective sprays for inside homes, on floors and walls to
a height of a foot or two.

• Soft ticks being intermittent feeders are best controlled by attacking them in their hiding places
inside homes

BIOLOGICAL CONTROL

Successful trials have been conducted on Metarhizium fungus to control ticks.

When the spores of these fungi come in contact with the ticks or insects they stick to their
cuticle.

Ixodiphagus wasps are very efficient against ticks