TUGAS PARASITOLOGI

RANGKUMAN

oleh:
Anindhita Dyah Sekartaji

NIM 132010101086

FAKULTAS KEDOKTERAN
UNIVERSITAS JEMBER
JEMBER
2015

BAB 110
ZOONOSES
Trenton K. Ruebush II
Zoonoses are infections ihat are transmitted in nature between vertebrate animals and humans.
They include those infections that man acquires from lower animals as well as infections that can
be transmitted from man to lower animals. Also usuallv included are infestations with
ectoparasites, such as scabies and myiasis, in which the arthropod burrows into or penetrates the
body of the vertebrale host.

To understand the epidemiology of zoonotic diseases, it is first necessary to have a

comprehensive understanding of the cycle of transmission of the organism in natuie. as wiih any
infectious disease, four factors must be considered in the transmission of zoonotic diseases: the
infective agent, the host, the route of transmission, and the enviionmenr. However, as a group of

diseases, the zoonoses tend to demonstrate much more complexity and variability in their
epidemiology than do most infectious diseases. This is primarily due to the fact that a minimum
of two hosts, the natural reservoir host and man, are involved in the transmission of all zoonotic
diseasei. As a result, a greater variety of host-infectious agent interaction may be established, and
the epidemiology of the disease may vary with each host-agent combinalion.
Infective Agent and Reservoir Host.
More than 150 different zoonotic diseases have been recorded. The natural or reservoir host of a
zoonotic disease may be a wild animal, a domestic animal, or both. Human beings are not
necessary for the transmission of zoonotic diseases in nature. They become infected when
they accidentally come into contact with some part of the narural transmission cycle between the
organisms animai reservoir host. Arthropods may also act as a reservoir for certain infections
agents. The rickettsiae of Rocky Mountain spotted fever can be maintained for several years in
the tick vector by-transstadial and transovarial passage in the absence of infected vertebrate
hosts. Tiansoiarial transmission of some virus species also occurs in mosquitoes. Babesia microti
apparently overwinters in the tick vector and then is transmitted io susceptible rodent hosts
during the following spring.
Transmission.

The

transmission

of

an

infectious

agent

from the reservoir host to man may take place by an of the four basic routes of diseaie
tranimission contact or by the airborne, vector-borne, or common vehicle route. However, the
route of transmission of ar: organism among the natural animal hosts and betrveen the reservoir
host and man is not necessarily identical. With tularemia, for example, tick transmisiion is the
major _route of spread among wild animals, but man generally acquires infection by direct
contact with the tissues of infected animals.
Environment. Environmental factors play an important role in the epidemiology of all zoonotic
diseases but particularly for those who contact with wild animal reservoirs. The general term
"landscape epidemioiogy'" has been used to emphasize the epidemiologic importance of the
environment in which a disease occurs and to indicate that the physical characteristics of a
locality may suggest the likelihood of a given disease being present or not.
Control. Zoonotic diseases present special problems in the planning of control and eradication
programs. Control measures may be directed against any of the links in the chain of
transmission-the infective agent, the natural host, or the route of transmission. Because of the

variety of host animals involved in many zoonotic diseases, however, control of the infectious
agent in one or two animal species alone is often not sufficient to eradicate the disease. This is
particularly true in the case of zoonotic diseases that have a wild animal reservoir, such as
sylvatic plague, leishmaniasis, or yellow fever. Efforts directed against the reservoir of an
infective agent offer a greater chance of success lvhen the major reservoir host is a domestic
animal. Control programs for bovine tuberculosis, anthrax, and brucellosis have been particularly
successful. Even with these diseases, however, it is often not economically feasible to eliminate
all infected reservoirs. As a result, the infection may persist at lorv levels in one or more
reservoir hosts, and unless controI measures are continued, further outbreaks will occur. Public
health education and protection of food supplies are generally effective in controlling zoonotic
diseases such as trichinosis, brucellosis, and salmonellosis, in which infection is acquired by
ingestion of the causative agent. In the case of occupational diseases, measures ciirected toward
reducing liuman exposure to the infectious agent through healtn education, improvement of
working conditions, and vaccination of highrisk individuals may be the most satisfactory
approach to disease control.

BAB 111
MOLLUSKS INVOLVED IN DISEASE TRANSMISSION
William A Sodeman, Jr.
Some mollusks transmit infection when eaten because of bacteria or viruses concentrated by
filter feeding, such as the bivalves, ovsters, mussels, and clams. Many parasites utilize the snail
as a first and/or second intermediate host for their larval stages. Transmission to humans can
occur with ingestion of raw or poorly cooked snails, but most often the parasite leaves the snail
and penetrates the skin of the host or encysts on another food item that is eaten raw. Snail
identification primarily depends upon morphology, including distinctive shells, radula (tooth)
patterns, and soft-part anatomy, principally the anatomic variations oI the genital apparatus. In a
few cases, biochemical. inrmunologic, or cytogenetic characteristics must be asccrtained to
distinguish betu,een morphologicalli, sirnilar. closely related species. Shell morphology is often
helpful in separating potential internrediate hosts from the manv unsuitable mollusks. There are
many areas where shell morphology alone can serve as an adequate guide to the prcsence or
absence of suitable intermediate-host snails, but in some circumstances, the definitive species
identification requires at least the study of soft-pan anatomy and radular structure. The class
Gastropoda is divided into two subclasses: Streptoneura readily identifiable by the presence of an
operculum and the Euthyneura, of which the freshwater pulmorrtes are the primary concern.
SUBCLASS STREPTONEURA. Snails within the subclass Streptoneura are operculate, with
the opercu1um, a trap door covering the aperture of the shell, fixed to the top of the foot behind
the aperture. The operculum can be calcified, but in most freshwater families it is made of an
organic noncalcified material. Soft-part anatomy shows a characteristic figure-eight twist to the,
visceral nerve and in the aquatic form, anterior gills. There are three orders, one of which, the
Mesogastopoda contains snails of medical importance.
Order Mesogastropoda. Snails of the order Mesogastropoda are responsible, as intermediate
hosts, for the transmission of an extraordinary collection of trematodes that can produce disease
in man. Eight families are of medical importance. These are the Ampullariidae (Pilidae),
Viviparidae, Pomatiopsidae, Bithyniidae, Thiaridae, Pieuroceridae, Potatimididae, and
Littorinidae.

Family Viviparidae. The families Ampullariidae and Viviparidae can be distinguished by the
appearance of the operculum, which grows with a concentric rather than a spiral pattern.
Viviparidae are large, globular snails (Fig. 111-1) that are ovoviviparous (bear live
young). They are widespread in lakes and rivers. A single species, Viviparus javanicus, serves as
a second intermediate host for Echinostortta ilocanum in Java. Family Ampullariidae.
Ampullariidae are also large. globular, egg-laying snails that have a worldrvide disiribution. Two
of the many genera in thrs family are of medical signi0cance. Pila luzonica and P. conica sert'e as
second intermediate hosts for E. ilocanum in the Philippine Island of Luzon. Marisa cornuarietis
(Linnaeus) is an aquatic carnivorous snail that has been utilized in the attempted biologic control
of Biomphalaria species that can transmit Schistosoma mansoni in South America and the
Antilies. Family Thiaridae. Although these snails have a worldwide distribution, their medicai
importance rs principally in the Orient and Southeast Asia. One African genus is involved in the
transmission of disease. The genus Thiara have tall, turreted shells measuring 2.5 to 5 cm as
adults. There is a prominent axial beaded sculpture. Thiara granifera (Lamarck) (Fig. 111-i) in
Taiwan and the islairds of Southeast Asia and noll, introduced in Central America, the Antilles
and the United States; Melanoides tuberculata in both Africa and Asia; and Brotia asperata
(Lamarck) in the Philippines all are reported to serve as first intermediate hosts for the lung fluke
Paragonimus westermani.
SUBCLASS EUTHYNEURA. This subclass is separated into four orders, three of which_the
Basommatophora, the Stylommatophora, and the Systellommatophora have representatives of
medical importance. Order Basommatophora. This order has four families with genera of
medical importance, all for their role as intermediate hosts of tremitodes. These are the families
Ancylidae, Lymnaeidae, physidae, and planorbidae. Ferrissia Family Ancylidae.(Bourguignant).
A single genus has been of the implicated Ancylidae, as the intermediate host for Schistosoma
haematobium in India. Family Lymnaeidae. This fanrily is large and geographically
widespread. The liver flukes Fasciola hepatica, Fasciola gigantica urilize genera of this family as
intermediate hosts. Several species of Trichobilharzia that can cause schistosome deimatitis in
man also use Lymnaeidae as hosts. Nine species of. Lymnaec serve as intermediate hosts of F.
hepatica.
CONTROL

One obvious means of eliminating snail-related diseases is to control ihe intermediate host. The
success of control measures is variable, and many factors affect their use. As a consequence,
there is no simple protocol for control measures. Each attempt at control needs to consider the
host, intermediate host, infecting agents, and physical setting, as well as the relationships among
these four variables, if a workable approach is to be identified. Control methcds teke the form of
protection from exposure to the detinitive host and the intermediate host, as well as antisnail
measures.
EXPOSURE CONTROL. Logical approaches to controlling mollusk-transmitted diseases
include restriction of human exposure to the mollusk and/or restriction of exposure of the
mollusk to infecting organisms, Control of human contact with infected mollusks is largely
accomplished by quarantine and posting of infected patients. This is effective, realistically, only
in dealing with commercial food-processing operations. Regulation of shellfish beds is effective
in the control of oyster- and cian-transmitted viral hepatitis as well as of transmission.
ANTISNAIL MEASURES. Four mechanisms for direct snail control may be employed. These
include snail removal by mechanical or manual means, snail control by environmental
manipulation, the use of molluscicides, and the use of biologic control. Snail Removal by
Mechanical Means. This is largely a measure of the past. No selective mechanisms currently
exist to concentrate snails for removal. Environmental Manipulation. This has proved to be a
useful tool in snail control, but costs as well as local engineering problems severely limit its
application. Where transmission of infection involves irrigation schemes or fish farms, it is often
possible to plan for intervals of desiccation. Molluscicides. Four compounds are currently
employed in the chemical control of mollusks. These compounds have been subjected to
extensive irial and are commonly available in quantity. Copper Sulfate. This compound has been
used the longest and is effective only against aquatic snails. Its effect is considerably reduced by
organic matter in the environment, and it currently has limited application. Sodium
Pentachlorophenate (NaPCP), This compound is available in many formulations, some of which
have slow-release residual capability. NaPCP is absorbed by mud and is broken down by
sunlight, It is a toxic substance and must be employed with attention to the safety of workers.
Niclosamide. Niclosamide (Bayluscid) is effective at a much lower concentration than NaPCP. It
may be applied as a powder or an emulsion and is effective against amphibious snails. NTritylmorpholine, N-Tritylmorpholine (Frescon) is available in many forms, including bait. It is

less soluble than the other compounds mentioned. It has excellent stability in the environment
and is effective in low concentration

BAB 112
TICKS AND MITES IN DISEASE TRANSMISSION
Daniel E. Sonenshine and Abdu Fahrang Azad
Ticks and mites are members of the subclass Acari; one of the dominant subclasses of the
Arachnida (chelicerate arthropods). Arachnids are believed to have appeared during the late
Archeozoic or early Paleozoic eras.. i.e., during the period of proliferation of bottom feeding
invertebrates (e.g., Trilobites). Adaptive radiation followed colonization of the terrestrial
environment, with explosive multiplication of new life forms. Virtually all of the arachnid taxa,
including the Acari, are believed to have evolved during this warm, moist period (Savory, 1977).
Arachnids, including the ticksa and mites, are distinguished from insect by the lack of clearly
defibes head, by chelicerae instead of mandibles, by the absence of antennae. and bv the
presence of 4 pairs of walking legs (except in larvae of the Acari). The body is subdivided into
the anterior prosoma, bearing the appendages, and the posterior opisthosoma. The Acari are
readily distinguished from.other arachnids by the general absence of segmentation, so that the
prosoma and optsthosoma are fused (in all but a few adult mites), and by the presence of the
gnathosoma (i.e., capituluii in ticks), a unique structure at the anterior end of the body bearing
rhe mouthparts.
TICKS (Suborder Ioxodida)
All ticks are obligate bloodsucking parasites. Most ticks are relatively large, i.e., 5 to 10 mm long
in adults, as compared with mites, which usually measure less than 1 mm in length. There is a
single pair of respiratory pores, or spiracles. The hypostome is prominent and covered with
retrose teeth for anchoring the tick to its host. This is the primary holdfast for attaching the tick
to the host body. In ioxodids, copious quantities of cemment, secreted during the first few hours
of attachment process, surround the hypostome and secure the tick to host skin. Genus Ixodes.
This is the largest genus of hard ticks, with approximately 245 species.These ticks are readily
recognized by the anal groove, which curves anterior to and encloses the anus. In the males, the
ventral surface is covered by sclerotized ventral plates. Most species of the genus are nest- or
burrow-inhabiting parasites with cryptic, nonfeeding males. Several species, however, are non-

nidiculous,distributed widely throughout wooded or grassy environments. All are 3-host ticks;
each life stage drops off after feeding to molt on the ground or in the nest. Genus Amblyomma.
This is one of the largest of the ixodid tick genera, found mostly in tropical and subtropical
regions of the world. these ticks are easilr. recognized by their remarkably ornate multicolored
scutum and their unusually long mouthparts, particularly palpal.article two, which is about twice
as long as article three. All species are 3-host ticks. In Africa, A. hebraeum and A. variegatum are
important vectors of animal disease, especially heartwatei, and are also important as pests of
livestock. Congo-Crimean hemorrhagic fever (CCHF) has also been rlcovered from A.
variegatum on many occasions, and specimens have also been found to be infected with the
yellow fever virus. In the United States, A-. americanumi an important pest of livestock, deer,
and humans, is a known vector of Ricketsia rickettsii, the agent of RMSF.
MEDICAL AND VETERINARY IMPORTANCE OF TICKS.
Ticks transmit a greater diversity of disease causing agents than any other group of arthropod
vectors. These include protozoan parasites, e'g', the babesias and theilerias infecting livestock,
bacterial agents such as the borrelias, numerous rickettsiae, and an even greater variety of
arboviruses. In addition, some ticks cause severe toxemias and fatal paralysis of their hosts.
Disease Relationships of the Ixodidae (Hard Ticks)
Lyme Disease. In the United States, the most prevalent tick-borne disease is Lyme borreliosis,
also known as Lyme disease. This dise.ase is caused by a spirochete and is transmitted by
certain.species of the geius lxodes. The disease was first described from the vicinity of Old
Lyme, Connecticut, -United States, but has spiead and is now reported-in 43 states throughout
the country. Approximately 5000 cases were reported in 1988, especiallv in southeastern New
York state and eastern Connetticut. The disease is now regarded as epidemic. In the eastern and
central United States, the major vector is the deer tick. Rocky Mountain Spotted Fever. Until
the epidemic rise of Lyme disease, RMSF was the most prevalent tick-borne disease in the
United States This disease is caused by Rickettsia rickettsii. Despite its name, most cases of
RMSF occur in the eastern regions of the country. The primary vector is the American dog tick,
Dermacentor variabilis, although a variety of other species can also transmit the rickettsiae. Ticks
are the reservoir hosts, and the organism persists in the vector ticks from generation to generation
by transovaria1 transmission. Thus, rickettsia-infected ticks inoculate mice and other small
mammals on which they feed, spreading the disease and providing opportunities for uninfected

ticks to acquire the infection by simultaneous blood feeding on rickettsemic hosts. Humans
acquire the disease when biten by rickettsia-infected, human-biting ticks. Congo-Crimean
Hemonhagic Fever. CCHF is a viral disease that is widespread throughout large areas of central
and western Asia, Europe, and Africa. CCHF is a true tick-borne arbovirus, because it passes
trans-stadially and transovarially within the tick population and survives interseasonally in these
vectors. At least 25 tick species and subspecies have been reported to serve as vectors and/or
reservoirs for this virus. The 2-host vectors Hyalomma marginatum rufipes and other subspecies
are especially important because the immatures may feed on migratory birds as well as hares and
hedgehogs, whereas the adults select artiodactyls and, when available, humans. Thus, these ticks
are important in disseminating the virus intercontinentally along the migratory routes followed
by migratory birds. Omsk Hemorhagic Fever (OHF). This is an acute, febrile disease with a
distinct hemorrhagic syndrome, It is caused by a virus of the genus Flavivirus, family
Togaviridae. This virus is in the same category as the causative agents of the closely related tickborne encephalitis (TBE) (i.e., RSSE), Powassan, Louping ill, and Kyasanur Forest disease and
other tickborne Togaviridae. These agents were formerly known as group B viruses. Relapsing
Fever. Perhaps the most important human disease transmitted by argasid ticks is relapsing fever,
a spirochetal disease caused by species of. Borrelia. In East Africa, relapsing fever is transmitted
6y species of the Ornithodoros moubata complex (sensu Walton). Relapsing fever outbreaks have
alio occurred in the western United States, particularly in rodent- and tick-infested cabins or
similar shelters for hikers or campers.
MITES
In contrast to the ticks, mites exhibit much greater diversity in their body structure and biology.
Most mites are small when compared with ticks, although a few reach sizes as great as 7 mm
long. This vast assemblage of tiny arthropods consists of more than 200 families and over
30,000 species; thousands, perhaps tens of thcusands, more ipecies remain to be described. In
contrast to the ticks, the chelicerae of mites are quite variable, but usually scissorIike, with their
cutting edges most often located on the medial facets. Mites occupy an exceptionallv diverse
habitats. Numerous species live entirely in the soil, feeding on fungi, bacteria, other
microorqanisms, or decomposing organic matter. Others li'.e on the ground, especially in the
upper layers of the soil. ai the interface with the duff, deiritus, incli or ieafr laver that
characterizes the top of the root zone oi the ve-qetation. These may include predaceous species.

dung-feeding species, and others feeding on ingestion. Numerous species are phytophagous
feeding on a wide variety of plants or stored foods.-Many miteJare parasitic, including some that
have obligate parasitic life cvcles. Many are parasitic on insects, others on vertebrates. Some,
such as the itch mite, Sarcoptes scabei, live their entire lives in the tjssues of their host. Although
most could be classified as ectoparasites, living in the skin, in feathers, or in the fur of-their
hosts, others, such as the nasal mites (Halarachnidae), are. endoparasitic, living in the nasal
passages

of

seais

and

walruses

or

in

the

lungs,

bronchi,

tiacheae.

or

sinuses of various mammalian hosts. The typical life cycle includes the egg, proton.v-mph.
deutonymph, tritonymph, and the adult. Often. one or more of the immature stages is omitted as
development is accelerated. In the insect-parasitizing hay itch mite. Pyemotes ventricosus, the
female does not iay eggs but reproduces viviparously. The opisthosomal region of the female
swells during feeding, forming a billoon-like structure. Young mites develop within this sac and
emerge when they are sexually mature adults.
MEDICAL AND VETERINARY IMPORTANCE OF MITES
Mesostigmatoid Mites. These mites transmit a variety of human and animal diseases. Some
transmit rickettsial diseases, e.g., rickettsialpox, caused by Rickettsia akari, and transmitted by
the house mouse mite, Liponyssus sanguineus. Others are serious pests of domestic fowl, such as
the chicken mite, Dermanyssus gallinae; the northern fowl mite, Ornithonyssus sylviarum; and
the tropical fowl mite, O. bursa, which are serious pests of chickens, turkeys, and other domestic
fowl in various parts of the world. Prostigmatid Mites. These include the chigger mites, the
vectors of scrub typhus. This disease, caused by Rickettsia tsutsugamushi, is the most important
miteborne disease of humans (Chapter 25). Scrub typhus is prevalent in eastern Asia, especially
Japan, eastern China, Taiwan, Vietnam, India, the Philippines, and many islands of the South
Pacific and Australia. It does not occur in the Americas, Europe, or Africa, even though
trombiculid mites (i.e., chigger mites) occur in those regions. Astigmatid Mites. These include
many

species

that

are

serious

pests

or

causative

agents

of

disease

and

allergy. Among the best known are the mange mites especially the families Psoroptidae,
Sarcoptidae, and Demodicidae. Species of. Psoroptes pierce the skin and suck fluids, which
congeal to induce scabbing and related growths; the scabs provide shelter for the mites, which
reproduce rapidly in the protected environment. In rabbits, the rabbit ear mite, P. cuniculi,
proliferates deep in the ear canal and can penetrate into the brain; the mites eventually kill these

animals unless the patient is treated. In human's, females of the human itch mite, Sarcoptes
scabei,.tunnel

into

the

stratum

corneum

of

the

skin.

estations

are

seif-limiting.

Dust Mite Allergy. An increasingly recognized rniteassociated illness is dust mite allergy.
Proteins in mite feces, rather than the mites themselves, are regarded as the primary allergen
responsible for the ailergic reactions (Chapter 105.1). In the United States, after pollen or hay
fever, house dust is the most common cause of allergic reactions. The problem may be seasonal
in northern temperate climates, declining during the heating season, but is perennial in more
mild, humid climates. Common symptoms resemble allergies to pollen and other dustlike
substances, with upper respiratory distress, swellings of nasal membranes and sinuses, sneezing,
tearing, and related symptoms. Dust mite allergies occur worldwide but are most commonly
associated with warm, humid environments. In households, mattresses, pillows, stuffed furniture,
carpets, and other household objects where human or animal dander accumulates in large
quantities may provide optimal environments where the mites find food

BAB 113
INSECTS IN DISEASE TRANSMISSION
Duane J. Gubler
An Arthrophod may transmit a disease agent from 1. person or animal to another in 1 of 2 basic
ways. Mechanical Transmission. This consists of a simple transfer of the organism on
contaminated mouth paris or feet or by regurgitation or defecation. There is no multiplication or
developmental change of the pathogen on or in the insect during this type of
transmission.Examples include a variety of enteroviruses, bacteria, and protozoa of humans that
have a direct fecal-oral transmission cycle. Insects such as houseflies may become contaminated
with these pathogens while feeding on feces and transport them directly to the food of people.
Biologic Transmission, The second and most important type of transmission by insects is
biologic. As the name implies, the pathogen must undergo some type of development in the body
of the insect vector in order to complete its life cycle. There are 3 types of biologic
transmission.

Propagative

Transmission.

This

type

occurs

when

the

organism ingested with the blood meal undergoes simple multiplication in the body of the insect.
Examples

are

the

arboviruses,

which

replicate

extensively

in

the

tissues

of the insect. Cyclopropagative Transmission. In this type of.transmission, the pathogen

undergoes a developmental cycle (changes from 1 stage to another) as well as multiplication in
the body of lhe insect. The best example of this type is malarial in which a single zygote may
give

rise

to

over

200,000

sporozoites.

over

200,000

sporozoites.

Cyclodevelopmental Transmission. In this third type of biologic transmission, the pathogen

undergoes developmental changes from 1 stage to another but does not multiply. With the
filariae, for example, a single microfilaria ingested by a mosquito may result in only one
infective larva. Extrinsic Incubation Period. In all types of biologic transmission, time is
required for development of the pathogen to the infective stage that can be transmitted. With
arboviruses, this means infection and replication in the salivary glands; with the malaria parasite,
it means invasion of the salivary glands by the infectious sporozoites; and with fitariae, it means
development of the juvenile wonns to the active slage III larvae. This period of time is called the

extrinsic incubation period and is generally 7 to 14 days in duration, depending on the pathogen,
the vector, and a variety of environmental factors. Transovarial Transmission. Some viral and
rickettsial diseases are transmitted from the female parent arthropod through the eggs to.the
offspring. This is termed transovarial transmission. The newly hatched insect larval stages are
infected with the pathogen, which is then transmitted to subsequent developmental stages of the
arthropod (trans-stadial transmission). Finally, venereal transmission of certain viruses has been
documented. Thus, male mosquitoes that become infected transovarially can transferihe infective
virus to uninfected female mosquitoes in the seminal fluid during copulation. These latter types
of transmission have obvious epidemiologic importance in the ultimate infection of humans or
other animals and in the maintenance of the pathogen in nature.
DISEASE

TRANSMISSION

BY

MAJOR

INSECT

GROUPS

FLEAS (ORDER STPHONAPTERA)

Fleas make up the order Siphonaptera. The adults are small, wingless, laterally flittened, obligate
bloodsuckers that parasitize a wide variety of vertebrate hosts. The larvae are normally free
living, legless, eyeless, and wormlike. They generally live in the nest or habitat of the host and
feed on- organic matter. There are over 2000 species of fleas; with representatives on all
continents, including the Arctic and Antarctic. The majority (94%) of species parasitize
mammals, with the remainder parasitizing birds. Only a relatively few species are of importance
in transmitting disease to humans. The-developmental cycle of fleas from egg in adult normally
takes place in the nest of the hosi. Eggs are generally laid in the nest, where the elongate-l-arvae
feed on organic material such as scales, diied blood, ard fe-ces deposited by the adults, After 2 to
3 weeks, the fully grown larvae spin a cocoon and pupate. The pupal stage may last from 1 to 2
weeks, after which the adult emerges, often after the stimulus of movement or vibration caused
when a host enters the nest. The entire period.of development may last 3 to 4 weeks or longer,
depending on temperature in the nest. The larvae-require high hurnidity. Disease Transmission.
Fleas are important natural vectors of 2 diseases of humans-plague and murine typhus.
In.addition, they have been implicated as, but not proved to be, vectors of a variety of other
diseases such as tularemia, pseudotuberculosis, erysipeloid, hemorrhagic nephrosonephritis,
boutonneusi fever, and a fever and are known intermediate hosts for at least 2 tapeworms.
Plague. Caused by Yersinia pestis, plague is a typical zoonosis of rodents and small mammalJ
that

exists

in

much

of

the

world

in

flea-rodent-flea

transmission

cycle. Large epidemics of plague, which in the past caused millions of deaths, no longer occur.
Although it is a less important means of transmission, fleas have also been known to transmit
plague bacilli in their feces. In this case, the organism is rubbed into the bite wound, other skin
abrasions, or mucous membranes. Transmission has also been reported when infected fleas are
crushed between the teeth. Finally, pneumonic plague is transmitted from person to person
by aerosol. Murine Typhus. murine or flea-borne typhus is a rodent zoonosis caused bv
Rickettsia typhi (mooseri). This is a disease primarily of rats and mice and has a u'orldqide
distribution, mainly in the tropics. Clinically, it is similar to epidemic or louseborne typhus, but
somewhat milder, The rash is the same. Humans become infected incidentally by a flea that has
strayed from its host, Rickettsiae are ingested by the flea with a blood meal from an infected rat.
The organisms multiply within the gut and are passed in the feces of the flea. The mechanism of
transmission is by rubbing infected feces into skin abrasions or by transfer to mucous
membranes. Transmission may also occur by inhalation of dust contaminated with infected flea
feces. Cestode Infections. In addition to serving as vectors, fleas also act as intermediate hosts
for at least 2 tapeworms that may infect humans, Dipylidum caninum of dogs and Hymenolepis
dimhura of rats. Eggs of both parasites are passed in the feces of their respective vertebrate hosts
and are ingested by larval fleas feeding on detritus in the nest, They hatch, and the cysticeroids
develop in the body cavity of the immature ffea. The adult flea is thus infected at the time of
emergence from the pupa, and transmission occurs when the flea is ingested or crushed between
the teeth of a dog, rat, or person.
SUCKING LICE (ORDER ANOPLURA). Sucking lice are small, wingless, obligate
ectoparasites of mammals belonging to the order Anoplura. The body is flattened, and the legs, in
part, are adapted for clinging to hairs and feathers, Most species are very host speciflc, and the
entire life cycle is spent on one host. The life cycle of all 3 species is incomplete, takes about 3
weeks, and is completed on the human host. The head and crab lice glue their eggs to hairs,
whereas the body louse lays eggs in the seams of clothing. Epidemic (Louse-Borne) Typhus.
Epidemic typhus is caused by Rickettsia prowazekii. The disease has a wide distribution in
Europe, Africa, Asia, and the Western Hemisphere. Large epidemics are generally associated
with cooler temperatures during times of war, famine, and natural disasteis where people are
crowded together in conditions of poor sanitation and hygiene. Epidemic typhus has a humanlouse-human cycle. A person is rrsually infectious for the lice during the febrile period, and lice

become infected when taking a blood meal at that time. The rickettsiae enter the epithelial cells
of the midgut and multiply to such an extent that the cells rupture in 3 to 5 days, releasing large
numbers of rickettsiae into the lumen of the intestine, from which they are then passed in the
feces of the louse. People become infected when infectious feces are rubbed into abrasions of the
skin caused by scratching or into mucous mernbranes. Less commonly, infectious rickettsiae can
be released from lice by crushing. Lice feces may dry in the clothing and can remain infectious
for 60 to 90 days. As a result, the feces may become airborne, causing transmission by
inhalation. Transmission of R. prowaekll does not occur by the bite of lice. reservoir hosts of R.
prowezekii. Trench Fever, Trench fever is caused by Rickettsia quintana. It takes its name from
the trenches of World War I, where it was first described and where it was a major problem. It
was reported again in Eastern Europe during World War II. Trench fever has been reported from
Europe, Africa, Mexico, and Central and South America but is an uncommon disease today.
BUGS (ORDER HEMIPTERA). Medically important bugs belong to 2 families in the order
Hemiptera. These are the families Cimicidae (bedbugs) and Reduviidae (triatome bugs).
Members of the order Hemiptera are the true bugs and are recognized by the characteristic
forewing, the basal half of which is membranous. The mouth parts are of the piercing-sucking
type and are segmented. The proboscis is attached anteriorly and is kept folded back between the
coxae of the first pair of legs. The life cycle is simple, with all instars requiring a meal of blood,
hemolymph, or plant juices, depending on whether the species is hematophagous, predaceous
on other insects, or phytophagous.
FAMILY CULICIDAE (MOSQUITOES). Mosquitoes are by far the most important group of
insects in terms of human disease transmission; more people die each year from mosquito-borne
disease than from any other single cause. There are over 3000 described species in 34 genera, but
only relatively few are important in disease transmission. The most important genera, Aedes,
Culex, and Anopheles, contain vector species for viruses, protozoa, and filariae of humans.
Diseases transmitted by mosquitoes are worldwide and affect millions of people
each year. In temperate regions, mosquitoes overwinter in the egg, larval, or adult stage,
depending on the species. Depending on the location, there may 6e one generation per year
(tundra), or there may be a new generation every 10 to 14 days (tropics). In temperate regions,
the cycle usually continues as soon as the ice melts; adult blood-feeding mosquitoes are usually
present from about March to October. In the tropics, mosquitoes are present_year round, but in

some areas wheie the dry season is extended, mosquitoes may estivate as adulti
or in the egg stage. Disease Transmission. At least 265 viruses have been isolated from
mosquitoes, mostly from culicines. Of these, 109 have also been isolated from humans, and there
is serolosic evidence that many more infect humans in nature. Alphaviruses. Chikungunya virus
is undoubtedly the most widespread and one of the most important alphaviruses in terms of
human health. This virus, firsf described in Africa, probably exists there in a mosquitoprimate
mosquito cycle involving forest mosquitoes. Humans are also susceptible and may carry the
virus back to the village where a person-aedes aegypti-person transmission cycle may exist. The
virus is presently widespread in the large urban areas of Asia, where it exists in this type of cycle.
periodically, transmission may occur in epidemic form. Flavivirues. Flaviviruses are
considerably more important to human health than any other group of arboviruses. Important
viruses that collectively infect millions of persons each year inclurle dengue, yellow fever, and
Japanese encephalitis viruses. All have a wide distribution and are transmitted by, species of
mosquitoes that may have close human contact. Dengue fever is an acute infection characterized
by suden onset of fever and a variety of nonspecific symptoms in its classic form. These viruses
also have the potential to cause severe and fatal disease in humans, and larse epidemics of
dengue

hemorrhagic

fever

(DHF)

are

not

uncommon

in

several

countries

of

Southeast Asia. There are 4 serotypes of dengue viruses (types l, 2, 3, and 4), all closely related
antigenicalIy. The viruses, have a tropicopolitan distribution that is closely linked to the
distribution of the principal vector, Ae. aegvpti. Today, there are more people (approximately 2
billion at risk for dengue virus infection than for any other arbovirus infection. Other work has
shown that there is also variation among strains of dengue viruses in their epidemic potential.
This variation among different strains of mosquito and dengue viruses could help explain why
some areas or cities that appear to be permissive to dengue virus transmission do not have large
epidemics of either dengue fever or DHF, whereas others do. Yellow fever; Yellow fever is a
flavivirus that is closely related to the dengue viruses ecologically, antigenically, and clinically.
Antigenically, there is considerable crossreaction between dengue and yellow fever viruses,
although there is not complete cross-protective immunity. Clinically, yellow fever is
characterized by sudden onset of fever and a variety of nonspecific symptoms similar to those of
dengue fever. This may be followed by a more severe disease involving jaundice, hemorrhagic
manifestations, and death. Japanese encephalitis virus: Japanese encephalitis (JE) virus is

another important flavivirus that is related antigenically to dengue viruses. It is strictly an Asian
virus, ranging from India in the west to Japan and Siberia in the east. The illness in humans
ranges from inapparent infection to severe viral encephalitis and death. It is primarily a rural
disease, but in Asia, where dense human populations occur, large epidemics occur.periodically.
Thousands of cases have occurred in India, especially in West Bengal and Bihar State, and in
Nepal. St. Louis encephalitis vlrus. St. Louis encephalitis (SLE) virus is the most important
arbovirus in North America. SLE virus is maintaincd in nature in a bird-Culex mosquito-bird
cycle. Depending on the area, the species-of bird and mosquitoes may change. In the central and
eastern United States, for example, a variety of domestic and peridomestic birds, such as house
parrows, pigeons, blue jays, and. robins, are the important maintenance and amplifying hosts.
Culex pipiens pipiens and Cx. pipiens quinquefasciatus, which breed in storm drains, sewage
treatment ponds, and other polluted water, are the principal mosquito vectors. Both vertebrate
and mosquito hosts bring the virus into the human habitat, where transmission to humans may
occur. Other Culex species such as Cx. resituans and Cx. salinarius have been shown to be
efficient vectors of SLE virus and are probably important maintenance hosts in locations such, us
the Ohio-Mississippi River basin, where they are involved in enzootic transmission. In Florida,
Cx. nigripalpus is the important epidemic vector. In the western United States, however, SLE is
primarily a rural infection. The principal vector there is Cx. tarialis, which brceds in a variety of
clear

or

foul

water,

irrigation

ponds,

ditches,

and

other

sources

of

ground water in areas fcd by irrigation systems. Although mosquitoes of the Cx. pipienscomplex are common in western United States and may transmit SLE virus, they are not the
principal vectors in that part of the country. Protozoa. Of the prootozoan parasites of humans
transsmitted by insects. The rnalarial parasites are by far the most important. Although malaria
was nearly under control by 1970 in many parts of the tropics, it is again the most important
vector-borne disease in the world. A combination of insecticide resistance in the mosquito
vectors and drug resistance by the malarial parasites has resulted in a resurgence of malaria in
most major endemic areas of the tropics. Malaria is a disease of humans caused by 4 species of
Plasmodium. P. fatciparurn is widespread in the tropics and causes the most severe disease in
humans (malignant tertian malaria). P. vivax, which causes benign tertian malaria, is also
widespread in the tropics but occurs in temperate regions as well. P. malariae, the cause of
quartan malaria, is relatively rare but is found in temperate regions and subtropics. P. ovule,

which causes benign tertian malaria, is uncommon occurring primarily in Africa, but has also
been reported in South America and Asia. In addition, there are many other species of
Plasmodium that are natural parasites. of primates. Some of these are indistinguishable
morphologically from the parasites of humans and, in fact can infect humans. Filariasis. There
are 3 species of filaria of humans that are transmitted by mosquitoes. These are Wuchereria
bancrofti, Brugia malayi, and Brugia timori. In addition, there are many other mosquito-borne
filariae parasitizing orher animals. These inClude some species in monkeys that can also infect
humans, the common heartworm of dogs, and other species that infect a variety of mammals,
birds, reptiles, and amphibians. nd important mosquito vectors. The basic life cycle is the same
for all filarial parasites. The embryonic microfilariaeare circulating in the peripheral blood are
ingested by the mosquito when they take blood meal. The microfilariae immediately exsheath,
penetrate the midgut wall, and migrate to the thorax of the mosquito, where they enter a muscle
cell and begin to cievelop. I'he juvenile filariae molt twice during a developmeniperiod of 10 to
14 days and emerge from the muscle cells as active third-stage or infective larvae. These larvae
migrate throughout the body of the mosquito, including- the proboscis or mouth parts. When the
infective mosquito takes a subsequent blood meal, the larvae escape from the labium onto the
skin of the person and penetrate the skin.
FAMILY MUSCIDAE (HOUSEFLIES). The family Muscidae contains the common housefly,
Musca domestica, and a number of other synanthropic species that live in intimate association
with humans. Although the family contains several species that have evolved the bloodsucking
habit, none of them have been incriminated in biologic transmission cf human disease agents.
The importance of houseflies lies in their indiscriminate feeciing habits, which may include feces
of humans and animals and the food of humans. They are thus capable of mechanically
transmitting many organisms, primarily enteric pathogens belonging to a number of taxonomic
groups. These flies are strong fliers and may be feeding or resting on uncovered food only
moments after having fed on or visited feces. Transfer of the organisms can be by simple
contamination of the mouth parts, feet, and body hairs or by ingestion and subsequent
regurgitation or defecation on food. Although there is little doubt that houseflies play a role in the
transmission of a variety of human pathogens, their actual importance in the epidemiology of the
diseases is hard to assess, because most of the evidence is circumstantial.

FAMILY CHLOROPIDAE (EYE GNATS). These are small, robust flies that are attracted to a
variety of body secretions and sores of humans and animals. They are strong fliers and are
persistent in their feeding habits, continuing to return after being brushed away. Breeding sites
are usually loose, sandy soil that has a high content of organic material. The medical importance
of both genera is mechanical transmission of conjunctivitis and yaws. Although these flies are
not bloodsuckers, their habits of frequenting sores, wounds. the eye, and other secretions make
them ideal for mechanical transmission. Again, most evidence is circumstantial, but it seems
highly probable that Hippelates and Siphunculina species play important roles in the
transmission of both bacterial and viral conjunctivitis, outbreaks of which usually occur during
the fly season.
COCKROACHES (ORDER DICTYOPTERA). Other insects, such as cockroaches, are also
capable of mechanical transmission of a variety of organisms, but in general, the evidence for
this is, again, circumstantial. Furthermore, they are probably not as important as flies in this
respect because of their habits and less frequent contact with feces.