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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
MEDICAL ENTOMOLOGY
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
SCABIES
SCABIES
Prevent Re-infection
Treat ALL family & close contacts Clean environment
Warn patients that itching may continue for 2 4 weeks after treatment initiated
Found in midwest & southcentral US Reclusive nature Found inside shoes, clothing, attics, cardboard boxes, etc. Be careful of misdiagnosis!
Skin necrosis Sphingomyelinase D Rare systemic reactions Routine treatment Dapsone? Antivenom not widely available
Found throughout US & worldwide Red hourglass Neurotoxic venom Pain but NO necrosis Abdominal rigidity Rx = antivenom
Allergic reactions
Bites/Stings Dust mites/Cockroaches
Myiasis
ARTHROPODS AS VECTORS
VECTOR-BORNE DISEASES
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)
YELLOW FEVER
Flavivirus transmitted by Aedes mosquito Illness varies from flu-like to severe hemorrhagic fever Case fatality rate of up to 20%
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)
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
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
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
Supportive treatment Clinical trials for alpha-interferon WNV is on the list of nationally notifiable arboviral encephalitides GA also investigates dead birds
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
Pathogen: Borrelia
Lonestari??
Vector: Lone Star Tick (Amblyomma americanum) Southern US & along coast to Maine
STARI
Rocky Mountain Spotted Fever Ehrlichiosis Babesiosis Relapsing Fever Colorado Tick Fever Tick-Borne Relapsing Fever Tick Typhus
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!)