Arthropod Disease

Surbhi Modi, MD, MPH Preventive Medicine Resident Emory University School of Medicine September 20, 2007

OBJECTIVES
1.

2.

3.

Understand the role of arthropods in human disease Recognize arthropods implicated in important human diseases Describe important vector-borne diseases

WHAT ARE ARTHROPODS?

Largest phylum of animals 80% of described animal species are arthropods

Include insects, spiders, crustaceans

MEDICAL ENTOMOLOGY

Direct parasitism or injury

Indirect injury as disease vectors

DIRECT DISEASE AGENTS

SCABIES

Caused by the mite Sarcoptes scabei Mites burrow under the skin takes <3 minutes Linear burrows that contain mites & their eggs
Especially in the webbing between fingers and the folds of the wrists Genital lesions common

Spread by skin-skin contact Secondary infections Norwegian scabies

SCABIES

SCABIES

Clinical diagnosis, but can confirm by microscopy Treatment:

Ivermectin Lindane, Permethrin, Crotamiton

Prevent Re-infection
Treat ALL family & close contacts Clean environment

Warn patients that itching may continue for 2 4 weeks after treatment initiated

BROWN RECLUSE SPIDER BITES

Found in midwest & southcentral US Reclusive nature Found inside shoes, clothing, attics, cardboard boxes, etc. Be careful of misdiagnosis!

BROWN RECLUSE SPIDER BITES

Painless bite Followed by erythema, swelling, tenderness

BROWN RECLUSE SPIDER BITE

Skin necrosis Sphingomyelinase D Rare systemic reactions Routine treatment Dapsone? Antivenom not widely available

BLACK WIDOW SPIDER BITES

Found throughout US & worldwide Red hourglass Neurotoxic venom Pain but NO necrosis Abdominal rigidity Rx = antivenom

OTHER ARTHROPODS DIRECTLY CAUSING DISEASE

Allergic reactions
Bites/Stings Dust mites/Cockroaches

Myiasis

ARTHROPODS AS VECTORS

VECTOR-BORNE DISEASES

MAJOR VECTORS: 1. MOSQUITOS 2. TICKS 3. FLEAS

MOSQUITO-BORNE DISEASES

DENGUE FEVER

Dengue virus is a flavivirus Transmitted by aedes mosquitoes Composed of single-stranded RNA Has 4 serotypes (DEN-1, 2, 3, 4)

TRANSMISSION OF DENGUE VIRUS

CDC Dengue Map

DENGUE IN THE UNITED STATES

Small risk for dengue outbreaks in US endemic & among travelers

Treatment:
Supportive care: fluids, rest, antipyretics Monitor blood pressure, hematocrit, platelet count, level of consciousness

YELLOW FEVER

Flavivirus transmitted by Aedes mosquito Illness varies from flu-like to severe hemorrhagic fever Case fatality rate of up to 20%

YELLOW FEVER DISTRIBUTION

Endemic areas: Africa/South America

YELLOW FEVER VACCINE

Effective vaccine is available Side effects are generally mild, flu-like symptoms Rare occurrence of serious complications encephalitis, yellow fever vaccine-associated viscerotropic disease (YEL-AVD)

WEST NILE VIRUS

Culex mosquito laying eggs

WNV isolated in Uganda in 1937 First identified in the US in 1999 Important public health problem in US Recent fatality in GA from WNV

WEST NILE VIRUS: EPIDEMIOLOGY

Peak incidence: August September Transmission occurs primarily via bite of infected mosquito Mosquitoes are infected by feeding on infected birds Secondary modes of transmission :
Organ transplant Blood transfusion Breastmilk/transplacental Occupational exposure

WEST NILE VIRUS

Clinical suspicion is key to making early diagnosis 80% never develop clinical symptoms Mild Disease: West Nile Fever Severe Disease: West Nile Meningitis, West Nile Encephalitis, and West Nile Poliomyelitis

WEST NILE VIRUS

Supportive treatment Clinical trials for alpha-interferon WNV is on the list of nationally notifiable arboviral encephalitides GA also investigates dead birds

OTHER MOSQUITO-BORNE ILLNESSES

Malaria Lymphatic filariasis Rift Valley fever Other encephalitides:

Eastern equine encephalitis St. Louis encephalitis Western equine encephalitis Japanese encephalitis

PREVENTION OF MOSQUITOBORNE ILLNESS

Primary prevention relies on measures to decrease mosquito bites

Insect repellants: Permethrin, DEET, Picaridin, Oil of lemon eucalyptus Protective clothing Environmental control

TICK-BORNE DISEASES

TULAREMIA

Pathogen: Francisella

tularensis

10 organisms can cause disease Vector: Deer flies, Dermacentor & Amblyomma ticks Occurs throughout N. America & Europe

TULAREMIA

Multiple clinical syndromes Clinical course: febrile, flu-like attack Cutaneous form is most common Inhalational form is most likely route for BT attack Vaccine under FDA review Treatment = streptomycin

LYME DISEASE

Pathogen: Borrelia

burgdorferi

Vector: Black-legged or Deer Tick (Ixodes) Occurs throughout the US but majority of cases in the Northeast and Great Lakes area Most common vectorborne infxn in US

LYME DISEASE

Stage 1: Early Localized Stage 2: Early Disseminated Stage 3: Late Chronic Clinical Diagnosis Treatment: doxycycline

SOUTHERN TICK-ASSOCIATED RASH ILLNESS

Pathogen: Borrelia

Lonestari??

Vector: Lone Star Tick (Amblyomma americanum) Southern US & along coast to Maine

STARI

Erythema migrans No arthritis, neurological or chronic symptoms True incidence unknown

OTHER TICK-BORNE DISEASES

Rocky Mountain Spotted Fever Ehrlichiosis Babesiosis Relapsing Fever Colorado Tick Fever Tick-Borne Relapsing Fever Tick Typhus

PREVENTION OF TICK-BORNE DISEASE

Proper clothing Combination of skin & clothing repellant Avoid grassy areas with shrubs Perform daily skin checks for ticks

FLEA-BORNE DISEASES

PLAGUE

Pathogen: Yersinia pestis Vector: Oriental rat fleas (Xenopsylla cheopsis) Occurs worldwide: 1000 3000 cases annually

PLAGUE

Most common form = bubonic plague (swollen, tender lymph nodes) Pneumonic plague: high fever, cough, hemoptysis, difficulty breathing 50 - 60% case fatality without abx Treatment: streptomycin 2nd line: gentamicin, tetracyclines

THANK YOU!

SOURCES
The Physicians Guide to Arthropods of Medical Importance Introduction to Medical Entomology
www.cdc.gov www.who.int http://www.wikipedia.org/ (For all the great pictures!)