ARTHROPODS

Phylum Arthropoda – Ectoparasites of humans

- Parasites established in or out of the host body
- Particular interests to Parasitologists
- Vectors for transmissions of:
- Parasites
- Bacteria
- Viruses
- Rickettsial Diseases
- Directly causing Human disease

Distinguishing Characteristics of Arthropods:

1. Paired of Jointed Appendages
2. Chitinized Exoskeleton- Insoluble Polysaccharides
- Provides support for internal organs
3. Hemocele – Blood containing spaces
4. Bilateral Symmetry
5. Life Stages – more than one involved in human interaction
Laboratory Diagnosis:
- Can be examined directly
- Can use preservatives – Ethanol 70% - Maintains the Morphology and color of specimen
- Chloroform or Ether – Flying insects
- 5% formalin or Sterile Saline Solution
- Berlese”s Solution – Permanent to kill and Fix specimens
- Some - To small to be seen – Microscopy
- - Place under glass slides
- Note for the distinguishing Characteristics

Arthropod-Human Relationships
- may affect humans in various ways
1. Temporary Occupants Producing disease themselves
2. Permanent Occupants
3. Mechanical Transfer agents – transmit disease – flies , cockroaches – Typhoid & Cholera
4. Arthropods part of parasite life Cycle - Direct transmission - During blood meal – Ticks, mosquitoes, kissing bugs.
5. Infestation –
6. Venomous arthropods – spiders & scorpions
Two Mechanism Arthropod Causes Clinical Symptoms:
1. Bite itself or Presence of Arthropod
2. Invasion by Specific pathogen transferred by arthropods

Treatment
- Lotions or ointments
- Removal of Arthropods
- Additional Treatment – From disease brought by Arthropods

Prevention And Control

- Chemical sprays
- Insecticides
- Destruction of arthropod breeding grounds
- Increasing Natural predators
- Use of Protective clothing
- Repellants
Disease Organism Transmission Location of Org. Clin. Manifxn. Lab. Diagnosis Treatment
 Ticks Mites Fleas Lice

True flies Mosquitoes True Bugs

Tsetse fly
MITES
Scabies – cause by itch mite – Sarcoptes scabiei
Mode of Transmission
- Direct contact with infested skin
- Contaminated clothing or bedding

Geographic Distribution
Worldwide
Higher prevalence – Crowded condition & Poor hygiene

Location
- Burrows – Upper layers of epidermis

Morphology
Females – 0.5 mm in diameter, males – smaller
Eggs – deposited in the burrows
- Hatched in 3-4 days  Larvae  mature into adults in 4 days

Clinical Manifestations
Commonly affected – Interdigital webs, Genitalia, umbilicus, axillary folds
Extensor areas – elbows, knees , flexor areas of the wrists
Initial lesions – small, erythematous papules or vesicles
2nd to mites secretion – allergic reaction
- Intensely pruritic , excoriation – with 2nd bacterial infection
- Resolves within months – chronicity – persists for years
- Norwegian scabies - In immunocompromised individuals
- Generalized scaling & crusting dermatitis

Laboratory Diagnosis
Clinical observation – Hand lens
- Look for burrows
Scrapings – from skin lesions
- Eggs and mites in scrapings

Treatment
Lindane
Crotamiton
Benzyl benzoate
Permethrin Cream 5% - highly effective
Mild Dermatitis caused by Species Other than Sarcoples scabiei

1. Chigger Bites - Caused by Trombiculid mites

- Six-legged larvae – not the adult mites ( not parasitic)
- Attached to skin & suck tissue fluids
- Saliva – causes intense pruritic inflammatory reaction - Maculopapular lesions
- Locations – areas where clothing is tight – ankles, groin, waistlines, armpits.
LICE
Pediculosis – Caused by three Species of Louse
1. Pediculus humanus humanus or Pediclusus humanus corporis - Body louse
2. Pediculus humanus capitis – Head louse
3. Pthirus pubis – Crab louse or Pubic louse

Mode of Transmission
Louse Infestation – Direct contact
Head louse – sharing of contaminated comb
Pubic louse – Sexual contact, contaminated toilet seats or clothings

Geographic Distribution
Worldwide – populated areas – Crowding & poor personal hygiene
- Refugee populations
- Wars and Population displaced by wars
Head louse – common in 3-10 years old , regardless of good hygiene
Prevalence Rate in U.S – range from 10-40%

Habitat
P. humanus – clothing, intermittently feeds on skin
P. capitis - hair of scalp
P. pubis – hair about genitalia also hair of axilla and eye lashes, perianal areas
Morphology or General Characteristics
Head & Body louse – measures 2-3mm in length
Pubic louse – 2mm in diameter, oval in shape
Claw-like legs and rounded body – resembles miniature crab
Body louse – lives clothings , lay eggs( Nits ) along seams of materials
Head & Pubic louse – glue their nits to hair shafts.
- Nymph hatch from the eggs and grow to adult ( 1 month )
- Both feed on blood

Clinical Manifestations
- Hemorrhagic macules & Papules - site of bite
- Pruritus & excoriation – intense itching

Laboratory Diagnosis
- Adult lice or nits – seen in hair and clothings
- Eggs or nits – white round objects attached to hair shafts and or clothing

Treatment and Prevention – Education and Practice of Good health

Head lice – Lindane- , permethrins
Body Louse – Treatment of clothing or insecticides or dry cleaning, boiling
Patients – Lindane – Applied to whole body x 24 hours
Pubic lice – Lindane or Pyrethroids . Shaving the area- Adjunct
- require retreatment after 10 days - Elimination
TICKS
General Characteristics
- Vertebrate, Blood sucking ectoparasites
- Opportunistics rather than host specific
- Have four-stage Life Cycle
- Eggs  Larva  Nymph  Adult
- Larva, Nymph & adults – Blood suckers
- Adults – Usually bites humans

Families of Ticks
1. Ixodidae or Hard Ticks - Dorsal plate or Scutum, Mouth parts clearly visible
- Feeds slowly , taking 7-9 days to become engorged.

2. Argasidae or Soft Ticks - leathery body, lacks hard dorsal scutum, mouth parts located ventrally , is not visible
- Completely engorge in a matter of minutes or most few hours
Epidemiology
- Wooded and rural areas of the world
- North America – Hard Ticks - Dermacentor variabilis * American Dog Tick
andersoni – Rocky Mountain Wood tick
Amblyomma americanum – Lone Star Tick
Rhipicephalus sanguinues - Brown Dog Tick
Ixodes dammini – Deer Tick

- These are vectors of Several Infectious Diseases

RMSF Dermacentor species
Tularemia
Q fever
Lyme Disease Ixodes species
Babesiosis –
Ehrlichiosis – D.variabilis & A. americanum

Soft Ticks -
Genus Ornithodoros – Relapsing Fever – Borrelia species

- General: People at risk – Outdoor activities in wooded areas

- Stays in rural cabins inhabited by small rodents - serves as host for ticks & other ectoparasites
Clinical manifestations
Tick bites – minor consequences – erythematous papules
- Serious consequences – Tick Paralysis - Substances released by ticks
- Transmission – Rickettsial, Viral, Spirohetal, Protozoan dieases
Attachments – Scalp, hairline, ears, axilla & groin
Initial bite – painless, latter become reddened, painful and pruritic
- 2nd infected wound , necrotic and if mouth part not removed

Causes of Tick Paralysis

1. D. andersoni
2. D. variabilis
3. A. americanum

TICK PARALYSIS - Due to toxic substances released in the saliva of ticks

- Common in young children – Scalp, head and neck areas
- reversed by removal of ticks
Manifestations :
Ascending Flaccid paralysis
Fever, intoxication
Respiratory compromise
Death
Clinical and Laboratory Diagnosis
Rest on finding of a tick
History of exposure to tick-infested areas
Observation of Organism – Morphology
- Dorsoventrally flattened, four pairs of legs , no visible segmentation
Better to Consult – Entomologist or Parasitologist – for further identification

Treatment and Prevention

Early removal of attached tick – important
- Steady traction on the tick body grasp by forceps close to the skin as possible
- Avoid twisting or crushing the tick to avoid leaving the mouth part
- Cleaning the area after removal of tick
- Use gloves, proper hand washing
- Proper disposal of ticks
Preventive Measures ( Tick Infested Areas )
- Protective clothing
- Insect repellants
-
FLEAS
- Siphonaptera – small wingless insects
- Laterally compressed bodies
- Long legs adapted to jumping
- Mouth parts – adapted for sucking or siphoning blood
- Does not penetrate the skin

Epidemiology
- Cosmopolitan in distribution
- Most species – adapted to a particular host
- feed on humans when deprived of their preferred host
- Important Vectors of : 1. Plague
2. Murine Typhus
- Intermediate hosts for dogs ( Dipylidium caninum ) and Rodents Hymenolepis species

- Tunga penetrans or Chigoe flea – actively invades the skin

- under the toenails and between the toes – sucks blood and lays eggs
- not known to transmit human pathogens
- Infected Tissues – severely inflamed and ulcerated
- Complicated by Tetanus or Gas gangrene  Amputation
Clinical Manifestations:
Bites – pruritic, erythematous lesions – varying severity
- Intensity of infestation
- sensitivity of bitten person
- Irritation – due to the fleas saliva
- Small red welts  Diffuse red rash
- Secondary infection – may occur

Clinical and Laboratory Diagnosis

- Patients with annoying bites and a pet (Dog or Cat ) owner

Treatment and Prevention

Antipruritics
Antihistamines
Surgical removal – Chigoe flea is indicated
Topical repellants
Pets – Flea collars or powders
Flea control – Insecticides
MOSQUITOES
Morphology
Small delicate legs, 2 pairs of wings, long antennae, greatly elongated
mouthparts – adapted for piercing & sucking

Culicidae Family
1. Anophilanae Subfamily
2. Culicinae Subfamily

Eggs – layed on or near water, good flyers , feed on nectars and sugars
Females – feed on blood every 2-4 days
- Required for each clutch of 100-200 eggs Aedes aegypti – Yellow fever Mosquito
- Flower pots, gutters, cans
Epidemiology
Anophilinae – Anopheles
- Species responsible for transmitting malaria
- Tropics – Bread continuaaly in relation to rainfall

Culinae – Aedes
- Largest genus of the Family
- Habitat – tropics to Arctic
- Tundra, marshes, pasture or flood water
MOSQUITOES
Clinical Syndromes
Mild pain and irritation – Itching , swelling
Small flat wheal surrounded by a red flare

Treatment, prevention and Control

Medical attention- not sought
Antihistamines or Anesthetics
Window screens
Netting and protective clothings
Insect repellants
SPIDERS
CHELICERATA OR ARACHNIDA
- Eight legged, no antennae
- Body divided into:
1. Cephalothorax
2. Abdomen
True Spiders – venomous & kill their prey by bitting
Chelicerae – have fangs – pierces human skin , inject venom powerful – local irritation

Venomous Spiders Classification According to Effects or Tissue Damage Produced

1. Systemic Arachidism – caused by Tarantulas ( Theraposidae ) – large hairy spiders of Tropics & Subtropics
- Not aggressive & avoid human habitations
- Bite – Intense pain  Agitation  Stupor  Smnolence
- Black Widow Spider – Latrodectus mactans
- Mortality Rate – 4-5%
2. Necrotic Arachidism – Genus Loxosceles
- Loxosceles reclusa ( Brown recluse Spider )
- Severe Tissue Necrosis
Black Widow Spiders
- Globose shiny black abdomen with orange or redding hourglass markings
- Venom – potent peripheral neurotoxin

Clinical Manifestations
Depends on
1. Amount of venom injeted
2. Location of the bite
3. Age, weight and sensitivity of the patient
Systemic Manifestation – within an hour after bite. Subsides in 48 hours
- Muscular cramps
- Chest pain, nausea & vomiting
- Intestinal spams, diaphoresis
- Visual difficulties
- Boardlike abdomen – mimics surgical abdomen

Treatment and prevention

Calcium gluconate
Specific Antivenin
Good house keeping
Brown Recluse Spider
Yellow to brown, medium in size
Relatively long legs
Dark-fiddled or Violin-shaped marking on the dorsal side of cephalothorax
Six eyed arranged in pairs forming semicircle
Necrotoxin – Hemolytic properties  Deep tissue damage

Clinical Manifestations
- Painless Later itching, swelling, soreness – Bite site
- Blebs – in 3-4 days  Ulceration  radiating Necrosis  Does not heal  Continuously spreading
- Intravascular Coagulation  Hemolysis  Hemoglobinuria  Cardiac and renal Failure – Visceral Loxoscelism

Clinical Diagnosis
Appearance of Bleb formation around puncture marks
Nature of developing lesions

Treatment and Prevention

Cleansing the bite wound
Antit-etanus prophylaxis
Systemic Steroids – Hemolytic syndrome
Control Indwellings with insecticides
SCORPIONS
Elongated, conspicuous pincer-like claws ( Pedipalps)
4 pairs of walking legs, regimented abdomen tapers
Curved, hallow, needle-like stingers
- Stinger for defense
- Nocturnal , but invades shoes, towels, clothings and closets

Epidemiology
- U.S – 1000 Deaths annually – Genus Centruroides
- Latin America – Tityus

Clinical manifestations:
Scorpion Sting – Highly Variable
- Species and age of scorpion
- Kind and amount of venom injected
- Age, size and sensitivity of the person stunged

Two Types of Venom:

1. Neurotoxin – Chills, diaphoresis, Excessive salivation, difficulty in speaking & Swallowing,
muscle spasm, tachycardia, generalized seizures
Death  Pulmonary edema and Respiratory paralysis
2. Hemorrhagic or Hemolytic – radiating & burning pain , swelling, discoloration and necrosis
Clinical Diagnosis
- Physical evidence of a single point of skin penetration – sufficient

Treatment and Prevention

Non- systemic manifestations – Analgesics
- Local anesthetics – Xylocaine
- Local Cryotherapy – reduce swelling and retard systemic Absorption of toxin
Antivenin administration
FLIES
Blackflies
- Buffalo gnats
- Mouth parts with 6 blades- for tearing skin
- Blood sucking insects
- Vectors of Onchocerciasis
- Africa and South America
- Black fever – headache, fever and adenitis
- Hemorrhagic Syndromes – in Brazil
- Resembles Thrombocytopenia Purpura
- Local and Disseminated cutaneous hemorrahages with mucosal bleeding
- Either a Hypersensitivity phenomenon or response to toxin
BUGS
Bedbug and Triatomid Bugs – or Known as Kissing bugs
Long proboscis –folded ventrally when not in use]
Bed bugs – Cimex lectularius
- Reddish brown insect, short wings and cannot fly
Triatomid bugs – or Kissing bugs
- Yellow to orange markings on the body
- Elongated head
- have wings , are aerial
Epidemiology
Nocturnal , feed indiscriminately on mammals
Bedbugs – cosmopolitan distribution
Triatomid – limited to Americas

Clinical Manifestations
Both bites – lesions are small red marks to hemorrhagic bullae
Bedbugs – linear fashion trunk and arms
- May be associated with nervous disorders & sleeplessness in children and adult.
Triatomid – Higher frequency on the face
Romana Sign – Classic Periorbital edema secondary to triatomid bite
Clinical Diagnosis
- Pattern and location of the bites - Suggests Bedbugs or triatomids
- Bedbug Infestation – Detection of tiny spots of blood on bedding and dead insects themselves

Treatment and Prevention

relief of Pruritus – Topical palliatives
Antihistamines
Proper hygiene
Environmental control