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Appendix A of -Borne Diseases

The following is an alphabetical listing of common signs and symptoms of arthropod-borne diseases. Unfortunately, few signs and symptoms are specific to anyone disease. Further differen• tiation by appropriate laboratory or radiologic tests may be needed. By no means should this listing be considered as a com• plete differential diagnosis of any of the symptoms discussed. Adenopathy: Generalized adenopathy may occur in the early stages of African trypanosomiasis-the glands of the poste• rior cervical triangle being most conspicuously affected (Winterbottom's sign). Adenopathy may also be seen in the acute stage of Chagas' disease. Anemia: Anemia may be seen in cases of , , and trypanosomiasis. Anemia can be especially severe in falciparum malaria. Blister: A blister may occur at arthropod bite sites. Blistering may also occur as a result from blister beetles contacting human . Bulls-Eye Rash (See Migrans) Chagoma: An indurated, erythematous lesion may occur on the body-often head or neck-caused by Trypanosoma cruzi (Chagas'disease). A chagoma may persist for 2-3 mo. Chyluria: The presence of chyle (lymphatic fluid) in the urine is often seen in . Urine may be milky white and even contain microfilariae. Coma: Sudden coma in a person returning from a malarious area may indicate cerebral malaria. African trypanosomia• sis (sleeping sickness) may also lead to coma after a long period of increasingly severe symptoms of meningoencepha• litis. Rocky Mountain and other rickettsial may also lead to coma.

203 204 Infectious Diseases and

Conjunctivitis: Chagas' disease and may lead to chronic conjunctivitis. Dermatitis: Several arthropods may directly or indirectly cause dermatitis. Chiggers and other mites may attack the skin, causing a maculopapular rash. Scabies mites may burrow under the skin's surface making itchy trails or . Lice may give rise to hypersensitivity reactions with itchy pap• ules. Chigoe burrow in the skin (especially on the feet), causing local irritation and itching. Macules or erythema• tous nodules may result as a secondary cutaneous manifes• tation of leishmaniasis. Diarrhea: Leishmaniasis (and specifically visceral leishmania• sis-kala-azar) may lead to mucosal ulceration and diarrhea. In falciparum malaria, plugging of mucosal capillaries with parasitized red cells may lead to watery diarrhea. Edema: Edema may result from arthropod bites or stings. Loia• sis (a nematode worm transmitted by deer ) may also cause edema-a unilateral circumorbital edema as the adult worm passes across the eyeball or lid. Passage of the worm is brief, but inflammatory changes in the eye may last for days. Loiasis may also lead to temporary appearance of large swellings on the limbs, known as Calabar swellings at the sites where migrating adult worms occur. Unilateral edema of the eyelid, called Romana's sign, may occur in Chagas' disease. African trypanosomiasis (sleeping sickness) may result in edema of the hips, legs, and face. Elephantiasis: Hypertrophy and thickening of tissues, lead• ing to an "elephant leg" appearance, may result from lym• phatic filariasis. Various tissues may be affected, including limbs, the scrotum, and the vulva. Eosinophilia: Helminth worms may cause eosinophilia. Atopic diseases, such as rhinitis, asthma, and hay fever also are characterized by eosinophilia. Eosinophilic Cerebrospinal Fluid Pleocytosis: Cerebrospinal fluid eosinophilic pleocytosis can be caused by a number of infectious diseases (including rickettsial and viral infec• tions), but is primarily associated with parasitic infections. Epididymitis: Epididymitis, with orchitis, may be an early complication of lymphatic filariaisis. : Erythema migrans may follow bites of infected with the causative agent of , Bor- Signs and Symptoms 205

relia burgdorferi. Typically the lesion consists of an annular erythema with a central clearing surrounded by a red migrating border. Although erythema migrans does not always occur, it is virtually pathognomonic for Lyme disease. Eschar: A round (generally 5-15 mm) spot of may result from (a spotted fever group ill• ness) or scrub . An eschar develops at the site of or chigger bite. Excoriation: Lesions produced by "self-scratching" may be a sign of imaginary or mite infestations (delusions of parasitosis). Fever: Fever is a common sign of many arthropod-borne diseases, including the rickettsioses, thyphus, dengue, yellow fever, , the encephalitides, and others. In some cases, there are cyclical peaks of fever, such as in (tick-borne) or malaria. Falciparum malaria is notorious for causing extremely high fever (107°F or higher). Filariasis may be marked by fever, especially early in the course of infection. Hematemesis: Coffee-ground color or black vomit may be a sign of yellow fever. Hemoglobinuria: Falciparum malaria can cause "blackwater fever." Hydrocele: Hydrocele may result from lymphatic filariasis, developing as a sequel to repeated attacks of orchitis. Kerititis: Inflammation of the cornea is sometimes a result of ocular migration of Onchocerca volvulus microfilariae. It may lead to blindness. Leukopenia: Leukopenia is a prominent finding in cases of . It may also occur (3000-6000/ mm3) with a rela• tive monocytosis during the afebrile periods of malaria. Lymphadenitis: Inflammation of one or more lymph nodes may be a sign of lymphatic filariasis-especially involving the femoral, inguinal, axillary, or epitrochlear nodes. : Lymphangitis can be an early symptom of lym• phatic filariasis, involving the limbs, breast, or scrotum. Lymphocytosis: Lymphocytosis may occur in Chagas' disease. : The presence of larvae in human tissues is termed . Various blow flies, bot flies, and other muscoid flies are usually involved. Meningoencephalitis: Meningoencephalitis has many causes, but may be a result of trypanosomes in the case of African 206 Infectious Diseases and Arthropods

trypanosomiasis (sleeping sickness) or Chagas' disease (although generally milder). Falciparum malaria infection may be cerebral, with increasing headache and drowsiness over several days, or even sudden onset of coma. Myocarditis: Chagas' disease may lead to myocardial infec• tion. African trypanosomiasis may also cause myocarditis to a lesser extent. Neuritis: Neuritis may be caused by bee, ant, or wasp venom. Occasionally stings to an extremity result in weakness, numbness, tingling, and prickling sensations for days or weeks. Neuritis may also result from infection with the Lyme disease spirochete. Nodules, Subcutaneous: Onchocerciasis may present as skin nodules (see Onchocercoma). Tick bites may also result in nodules. Fly larvae in the skin (myiasis) may also present as nodules. Common species involved are the human bot• fly , Dermatobia hominis, the Tumbu fly, Cordylobia anthropophaga, and rodent botfly larvae, Cuterebra spp. Onchocercoma: Coiled masses of adult O. volvulus worms beneath the skin enclosed by fibrous tissues may occur in patients living in tropical countries endemic for ochocerciasis. Orchitis: Orchitis may be a symptom of lymphatic filariasis; repeated attacks may lead to hydrocele. Paralysis: Ascending flaccid paralysis may result from tick attachment. The paralysis is believed to be caused by a sali• vary toxin injected as the tick feeds. Proteinuria: Proteinuria, with hyaline and granular casts in the urine, often occurs in falciparum malaria. Puncta: A small, point-like pierce mark may mark the bite or sting site of an arthropod. Paired puncta may indicate spi• der bite or centipede bite. Rash: There are myriad causes of rash, but rash may accom• pany many arthropod-borne diseases, such as Rocky Moun• tain Spotted Fever, ehrlichiosis, , and African trypanosomiasis. The rash may appear to be ring-like, and expanding in the case of Lyme disease (see Erythema Migrans). An allergic urticarial rash may be seen in the case of bites or stings. Romana's Sign: A common sign early in the course of Chagas' disease, Romafia's sign is a unilateral palpebral edema, involving both the upper and lower eyelids. This generally Signs and Symptoms 207

occurs when a kissing bug (the vector of the Chagas' organsism) bites near the eye. Shock: Shock may occur from arthropod stings (rarely bites) as a result of hypersensitivity reactions to venom or saliva. Shock may also accompany falciparum malaria. Splenomegaly: Splenomegaly can be a result of lymphoid hyperplasia in both African and American trypanosomia• sis. It may also occur in visceral leishmaniasis (kala-azar). Tachycardia: Both African and American trypanosomiasis may produce tachycardia. In Chagas' disease tachycardia may persist into the chronic stage where it may be associated with heart block. Ulcers, Cutaneous: A shallow (slow to heal) may be a sign of cutaneous leishmaniasis. In the New World,lesions from cutaneous leishmaniasis are most often found on the ear. Also, a firm, tender, raised lesion up to 2 cm or more in diameter may occur at the site of infection in African trypa• nosomiasis. Urticaria: Urticaria may result from an allergic or generalized systemic reaction to arthropod venom or (more rarely) saliva. Verruga Peruana: A benign dermal eruption (peruvian warts) is one manifestation of . The verrugae are chronic, lasting from several months to years, and contain large numbers of bacilliformis . Winterbottom's Sign: In the early stages of African trypanoso• miasis, patients may exhibit posterior cervical lymphadenitis. Appendix B Diagnostic Tests Used in Arthropod-Borne Diseases

1. Agglutination Agglutinations are that cause clumping together (agglutination) of microorganisms, erythrocytes, and often anti• genic particulates. If the serum being tested is specific, aggluti• nins present will cause cultured parasites or bacteria to clump when the serum is introduced.

2. Complement Fixation In CF tests, the suspected serum is incubated with a known source of , permitting the antigen- interaction to bind complement and remove it from the reaction mixture. A sheep-blood indicator is then added which hemolyzes in the pres• ence of free complement. If the sheep cells fail to hemolyze, complement is absent; its absence testifies to the prior occurrence of an antigen-antibody reaction. By varying the serum or antigen dilution, one can achieve a crude approximation of titer.

3. Direct Fluorescent Antibody A DFA test (some texts refer to it as direct or DIF) utilizes fluorescent tagging of antibodies produced against the in question. These tagged antibodies can be pur• chased commercially against a wide variety of organisms. When tagged antibodies are placed on a microscope slide containing the pathogen, the organisms fluoresce when viewed by fluorescent microscopy. DFA is a one-step procedure involving the placement of tagged antibody on a suspect smear of tissue or blood and view• ing (after a brief phosphate-buffered saline [PBS] ) with a UV light-equipped microscope.

209 210 Infectious Diseases and Arthropods

4. Enzyme Immunoassay (EIA) There are numerous modifications, but in general, EIA deter• mines the presence or absence of an organism by the reaction between the suspected organism's antigen or antibodies, an enzyme• coupled corresponding antibody or antigen, and an enzyme sub• strate. Color is generated by the interaction of a chromogenic substrate and an enzyme that has been coupled to the detector antibody. Degree of color change is dependent on the concentra• tion of antibody or antigen present, and can be assayed either qualitatively or quantitatively.

5. Enzyme-Linked Immunosorbent Assay (ELISA) Similar in principal to EIA, the ELISA test may be used for quan• titative determination of either antigen or antibody. The appro• priate antigen or antibody is bound to (usually) plastic micro titer plates, and the specimen to be tested is then added and given time to react with the already present antigen or antibody. After a wash to remove any unbound test material, an enzyme-linked antigen or antibody is added. After a second wash, a substrate is added that will react with the remaining enzyme to produce a color change.

6. Hemagglutination Inhibition (HI) The HI test measures the presence of hemagglutination-inhib• iting antibody toward a particular organism. The suspected serum is incubated with fluid medium known to be capable of aggluti• nating red cells. After the incubation period, the agglutinating potency is measured, and the absence of subsequent agglutina• tion indicates the presence of specific antibodies in the serum.

7. Indirect Fluorescent Antibody (IFA) The IFA test is a two-step test involving the placement of patient serum suspected of containing antibodies on a slide with fixed, known antigen. After an incubation period and PBS washing, the slide is then covered with a solution containing fluorescent-tagged antihuman antibodies. After a second incubation period and PBS washing, the slide is viewed by fluorescent microscopy. Fluores• cence of antigen on the slide is considered evidence of patient Diagnostic Tests 211 antibodies toward that particular organism. By serially diluting patient serum, a titer can be determined.

8. Leishmanin (Montenegro Test) The leishmanin test (not available in the United States) is some• times used to help diagnose cases of cutaneous and muco-cutane• ous leishmaniasis. It involves an intradermal injection of a suspension of killed promastigotes. A high percentage of Leish• mania tropica and Leishmania braziliensis infections will test posi• tive by this test.

9. Mazzotti The Mazzotti test is used to determine if a patient has onchocer• ciasis. It can be dangerous and is not used in many areas. It con• sists of oral administration of 25 or 50 mg of diethylcarbamazine to a patient suspected of having onchocerciasis. If the patient is infected, an intense itching occurs in a few hours (as the microfi• lariae die within the skin). The itching is then controlled by short• term administration of corticosteroids, or will subside on its own within 2-3 d.

10. Neutralization The neutralization test (NT) is the most specific immunologic test for the majority of viral infections. The identification of an unknown viral isolate is made by analyzing the degree to which antisera of known reactivity prevent the from infecting tis• sue-culture cells, eggs, or . If neutralizing antibody is present, virus cannot attach to cells, and infectivity is blocked

11. Polymerase Chain Reaction (PCR) The peR has dramatically changed diagnostic microbiology in recent years. peR makes specific identification of possible, even when only a few organisms are present. peR is a highly sensitive technique by which minute quantities of DNA or RNA sequences are enzymatically amplified to the extent that a sufficient quantity of material is available to reach a threshold signal for detection using a specific probe. The scientific basis of peR is that each infectious disease agent (in fact, every living 212 Infectious Diseases and Arthropods thing) possesses a unique signature sequence in its DNA or RNA by which it can be identified. In other words, there is a unique se• quence of amino acids for each organism. By finding those unique sequences and constructing primers to amplify those specific areas of DNA, identification of an organism can be accomplished from a blood or tissue sample, or even from an infected arthropod vector. peR is carried out using a thermocycler, which produces a series of heat-cool cycles, whereby double-stranded DNA is dissociated into single strands that are in turn allowed to anneal in the presence of specific primers on cooling. Through the successive heat-cool cycles (usually about 30), the DNA sequence to be detected is amplified millions of times. The product is then visualized after separation on agarose gels by electrophoresis and appropriate staining. Index

A geographic distribution, 158f Accidental myiasis, 177-179 medical significance, 157-159 contributing factors, 183-184 prevention and control, 160-161 treatment, 185-186 symptoms, 159 Adenopathy, 203 treatment, 160 Aedes aegypti, 31 vectors, 160 (ATBF), biting patterns, 33 82t, 89, 90 breeding, 66 African trypanosomiasis, 13, 14, dengue virus, 55, 56, 58 157-161 geographic distribution, 59f Agglutination, 209 illustration,58f African sleeping sickness YF,62 diagnosis, 159 Aedes africanus Amastigote, 155 YF,66 , 11 t Aedes albopictus, 31, 32 , 93, 99, biting patterns, 33 102 dengue virus, 55, 56, 58 geographic distribution, 96f geographic distribution, 59f illustration, 93f Aedes mosquitoes, 11 t Amblyomma hebraeum, 89,90 breathing, 30f tick vectors, 82t dog heartworm, 74 American dog tick, 84, 93, 102, 119 egg laying, 32 American trypanosomiasis, 14 positions,30f Amodiaquine, 43 Aedes sollicitans, 31, 33, 46 Amoxicillin Aedes triseriatus, 31, 33, 45 LD treatment, 99 LAC, 52-53 Amphotericin B Aedes vexans, 31 leishmaniasis treatment, 146 African sleeping sickness, 11 t, Anaplasma marginale, 91 157-161 Anemia, 203 clinical and laboratory Anopheles darlingi findings, 159 geographic distribution, 40f diagnosis, 159 illustration, 39f , 160 malaria, 38

213 214 Index

Anopheles freeborni, 23, 25 Arkansas strain catholic feeder, 23 HME,91 malaria vectors, 38, 41 Arthropod-borne diseases, 14 Anopheles gambiae diagnostic tests, 209-212 geographic distribution, 39f dynamics, 17-25 illustration, 38f signs and symptoms, 203-207 malaria, 38 Arthropods Anopheles hermsi, 25 characterizations, 3, 4t malaria vectors, 40, 41 and health, 3-14 Anopheles leucosphyrus historical medical aspects, 11-12 geographic distribution, 41£ and HIV, 201-202 illustration, 41£ human diseases transmitted, malaria, 38 lIt Anopheles maculipennis, 25 medical importance, 9 Anopheles mosquitoes, lIt, 17,23, phylum list, 3 24,70 stings and bites, 13-14, 193-199 Bancroftian filariasis, 70 Asian tiger mosquitoes, 31, 32 breathing, 30£ dengue virus, 56 breeding, 31 cyclopropagative , LO treatment, 99 19 B dog heartworm, 74 egg laying, 32 Babesia bigemina, 105 positions,30f Babesia canis, 105 vector control, 41 Babesia divergens, 104, 105 vectors, 36 Babesia equi, 105 Anopheles punctipennis, 24, 25, 42 Babesia gibsoni, 105 malaria vectors, 38, 42 , 104, 106 Anopheles quadrimaculatus, 25, 32 life cycle, 106 malaria vectors, 38, 42 Babesiosis, I1t, 97 Anophelinae, 29 Bacillus thuringiensis, 163 Antibody-dependent Bacon therapy, 186 enhancement (AOE), 61 Bacterium tularense, 102. See also Antimalarial drugs, 43 geographic distribution, 44£ Bancroftian filariasis, 67 Antiparasitic drug biological transmission, 19 onchocerciasis treatment, 163 geographic distribution, 69£ Ants Wuchereria bancrofti, 70 sting apparatus, 194-196 , 147 stings, 13 , 136 , 7, 9 , 169 characterizations,4t Bartonellosis, 11t, 147 Arboviral encephalitis, 106 Bees, 3,5 , 77 sting apparatus, 194-196 illustration, 78£ stings, 13 Index 215

Beetles, 3, 5, 13 Boutonneuse fever, 82t, 88 larvae,6f Brown recluse, 8f Benign dermal eruption, 147 Brown widow spider Benznidazole venom, 13 Chagas' disease treatment, Brugia malayi, 72 156-157 lymphatic filariasis treatment, Biological transmission 74 classification types, 18-20 Brugian filariasis, 67, 72 disease agents, 18-20 geographic distribution, 70f example,19f Bubonic Bird-biting mosquitoes, 49-50 plague form, 129 Bite lesions, 13 Bulls-eye rash, 203 Bites, 193-199 Bunyavirus, 52-53 arthropods, 13-14 Burrowing fleas, 12 spiders, 13 Bush , 144 tick Butterflies, 3, 5 Rocky Mountain Spotted Fever (RMSF), 84 C Bite site Calliphora vicina, 180 erythema migrans (EM), 95 Campestral plague, 129 Biting flies Canine ehrlichiosis, 92 , 100 Cantharidin, 13 Biting midges, 11 t Carios rudis, 115 Black death, 128 's disease, 12, 149 Blackflies, llt, 162-163 Caterpillars, 5, 7 filarial worms, 74 Cat fleas, 127, 136 Black rat, 134 Catholic feeder Black soldierfly, 178 Anopheles freeborni , 24 Black widow spider, 8f Cat-scratch disease (CSD), 137- venom, 13 139 Blastomycosis, 144 clinical presentation, 137-138 Blister, 203 symptoms, 137 Blister beetles, 13 transmission modes, 138 Blowflies, 184, 186 treatment, 138-139 illustration, 181f Cattle disease agent, 91 larvae, 5, 7 Cebidae monkeys Body lice, llt YF,66 medical importance, 167-168 Cefuroxime burgdoiferi, 97, 98, 100 LD treatment, 100 detection, 99 Centipedes, 9, 10f Borrelia hermsi, 113-115 characterizations,4t illustration, 115f Central European TBE, 108 , 113, 114, 171 Cercopithecidae monkeys Borrelia turicata, 114 YF,66 Bot fly, 13, 180, 186 Cerebral malaria, 35 216 Index

Chagas' disease, lIt, 14, 151-157 Cochliomyia macellaria, 180 clinical and laboratory illustration, 181£ findings, 151-154 Cockroaches diagnosis, 153-154 mechanical transmission, 18 ecology, 154-156 transmission mode, 18t geographic distribution, 152f (CTF), 108, medical significance, 151 110-111 prevention and control, 157 diagnosis and treatment, 111 symptoms, 152 symptoms, 110 transmission mode, 18t Coma, 203 treatment, 156-157 Commensal rats, 136 vectors, 151, 156t Competent vectors, 20 Chagoma, 151, 203 Complement fixation, 209 Cheese skipper, 178 Conenose bugs, 154. See also illustration, 178f Kissing bugs Chiclero's ulcer, 144 Conjunctivitis, 152, 204 Coquillettidia perturbans, 47 Chigger-borne , 163 vector, 48-49 Chiggers, lIt Cotton rats, 136 life cycle, 166f Cowdria ruminantium, 91 Chigoe fleas, 12 Crimean-Congo hemorrhagic Chilopoda fever, lIt characterizations,4t Ctenocephalides felis, 136 Chloramphenicol, 86 Culex mosquitoes, lIt louse-borne disease treatment, 171 breathing,30f murine typhus treatment, 136-137 breeding, 31 treatment, 167 dog heartworm, 74 tularemia treatment, 105 egg laying, 33 Chloroquine positions,30f antimalarial drug, 43 SLE,49-50 Chrysomya albiceps Culex nigripalpus illustration, 183f SLE mosquito vector, 50 Chrysomya chloropyga Culex pipiens illustration, 183f SLE mosquito vector, 50 Chrysomya flies Culex quinquefasciatus illustration, 183f Bancroftian filariasis, 70 Chrysomya megacephalus SLE mosquito vector, 50 illustration, 183f Culex tarsalis Chrysomya rufifacies, 179 illustration, 51£ Chrysops discalis, 104 SLE mosquito vector, 50 Chyluria, 203 WEE,52 Ciprofloxacin Culex tritaeniorhynchus CSD treatment, 139 JE,54-55 Clindamycin Culicidae mosquitoes human babesiosis treatment, 107 subfamilies, 29 Index 217

Culicinae Dengue vaccine, 61-62 characteristics, 29 Dengue virus Culicoides, I1t geographic distribution, 57f Culiseta me/anura laboratory characteristics, 58 enzootic vector, 46 mosquito markings, 59f Cutaneous leishmaniasis, 12, 146 serotypes,55 geographic distribution, 143f spread, 56, 58 Cuterebra flies, 183 symptoms, 58 Cyclodevelopmental transmission treatment, prevention and disease agents, 18-19 control, 61-62 Cyclopropagative transmission andersoni disease agents, 19 CTF, 103, 110 geographic distribution, 85f D illustration, 85f Daddy longlegs, 7 interference phenomenon, Dark rice field mosquitoes, 31 22 Deer fly, 104 tick vectors, 82t illustration, 102f , 119 Deer fly fever, 101 Dermacentor marginatus, 91 Deer mice, 131 Dermacentor nuttalli, 91 , 104 Deer tick, 97 Dermacentor silvarum, 91 geographic distribution, 96f Dermacentor ticks, 11 t illustration, 96£ tick paralysis, 123 Deer tick virus, 111 , 84, 93 DEET, 47-48,86 geographic distribution, 86f leishmaniasis protection, 149 illustration, 85f Delusions of parasitosis (DOP), tick paralysis, 119 187-190 tick vectors, 82t Den 1 Dermatitis, 204 dengue virus serotype, 55 Diagnostic tests Den 2 arthropod-borne diseases, 209- dengue virus serotype, 55 212 Den 3 Diarrhea, 204 dengue virus serotype, 55 Diethylcarbamazine (DEC) Den 4 lymphatic filariasis treatment, dengue virus serotype, 55 72 Dengue,l1t onchocerciasis treatment, 161 Dengue fever, 14, 55-62 Diplopoda Dengue fever-like group, 108 characterizations, 4t Dengue hemorrhagic fever Dip-S-Ticks (DHF),56 scrub typhus diagnosis, 165 risk factors, 58, 60 Direct fluorescent antibody, 209 Dengue shock syndrome (D55), 56 Dirofilaria immitis, 74, 75 risk factors, 58, 60 Dirofilaria repens, 74 218 Index

Dirofilariasis,74 Ehrlichiosis, 11 t, 91-95 Dirofilaria tenuis, 74, 75 EIA. See Enzyme immunoassay Dirofilaria ursi, 74 (EIA) Disease agents Ekbom's Syndrome, 187-190 biological transmission, 18-20 Elephantiasis, 67-68, 204 mechanical transmission, 18 ELISA. See Enzyme-linked Diseases immunosorbent assay transmitted by arthropods, lIt (ELISA) Disease transmission Encephalitides group, 108 direct effects, 13-14 Encephalitis indirect effects, 14 mosquito-transmited, 45-55 Dog antiparalysis serum Envenomation, 13 tick paralysis treatment, 122 Envenomization, 13 Dog heartworm, 74 Enzootic cycle, 20 Dog tapeworm Enzootic vector transmission mode, 18t Culiseta melanura, 46 Dog tick, 84 Enzyme immunoassay (EIA), 210 Domestic rats, 136 scrub typhus diagnosis, 165 DOP,187-190 Enzyme-linked immunosorbent assay (ELISA), 210 CSD treatment, 139 African sleeping sickness ehrlichiosis treatment, 95 diagnosis, 159 LD treatment, 102 Borrelia burgdoiferi detection, 99 murine typhus treatment, 136- Chagas' disease diagnosis, 154 137 leishmaniasis diagnosis, 146 scrub typhus treatment, 167 microfilariae identification, 68 TBRF treatment, 115 plague diagnosis, 133 tick-borne encephalitis E diagnosis, 110 Eastern equine encephalitis (EEE), Eosinophilia, 204 20,45-49 Eosinophilic cerebrospinal fluid control, 47-49 pleocytosis, 204 differential diagnosis, 47f , lIt, 169 ecology, 46-47 Epididymitis, 204 geographic distribution, 46f Epizootic cycle, 20 life cycle, 47f Epizootic hosts onset symptoms, 45 fleas, 20 East Side agent, 22 Eristalis lena x, 178 Edema, 204 illustration, 179f Ehrlichia, 83, 91 Erythema migrans, 204-205 Ehrlichia canis, 92 bite site, 95 , 92-94 Erythromycin Ehrlichia equi, 91-93 CSD treatment, 139 Ehrlichia (near) phagocytophila, 92 Eschar, 205 Ehrlichia phagocytophila, 92 tick bite, 90f Index 219

Europe-borne typhus, 12 bot fly, 13, 180, 186 Excoriation, 205 butterflies, 3, 5 Extrinsic factors Chrysomya vector competence, 22 illustration, 183f Cuterebra, 183 F deer fly, 104 Facultative myiasis, 179-180 illustration,102f contributing factors, 184 Fannia, 179 treatment, 185-186 fleshflies, 184 Fa1ciparum malaria, 12,35 illustration, 182f Fannia flies, 179 Febrile anemia, 149 larvae, 5, 7 Fever, 205 life cycle, 6f Fiddle back spider, venom of, 13 hump-backed, 180f Field's stain larvae, 5, 6f, 13 microfilariae identification, 68 mechanical transmission, 18 Filarial worms, 74 Megaseiia, 179 biological transmission, 19 Musca, 178 life cycle, 72 Muscina, 179 Fire ants Sachophaga venom, 13 illustration, 182f -borne diseases, 125-137 sand, 11 t, 12 Fleas, 3, 5, 11t biology, 141 biology, 127 sand fly fever, lIt burrowing, 12 Sarcophaga, 179 cat, 127, 134 screwworm, 13, 180 chigoe, 12 illustration, 183f epizootic hosts, 20 Simulium, 161 labeled diagram structure, 126f soldierfly, 177 larvae,6f illustration, 178f mouthparts, 126f tsetse, 11t, 157 Oriental rat flea, 129, 131, 132 illustration, 158f illustration, 130f tularemia, 101 transmission mode, 18t Fomite house Fleshflies, 184 YF,65 illustration, 182f Forest scrub mosquitoes Flies, 3, 5, 12,29 YF,66 biting Francisella tularensis, 101-103 tularemia, 103 blackflies, I1t, 162-163 G filarial worms, 74 Gamma-interferon black soldierfly, 178 leishmaniasis treatment, 147 blowflies, 184, 186 Gentamicin illustration, 181£ CSD treatment, 139 larvae, 5, 7 tularemia treatment, 105 220 Index

Geographic distribution Glossina fuscipes, 160 Aedes aegypti, 60f Glossina morsitans, 160 Aedes albopictus, 60f Glossina pallidipes, 160 African sleeping sickness Glossina palpalis, 160 treatment, 158f Glossina sWlfnnertoni, 160 Amblyomma americanum, 94f Glossina tac-hinoides, 160 Anopheles darlingi, 40f Glucantime Anopheles gambiae, 39f leishmaniasis treatment, 148 Anopheles leucosphyrus, 41f Grasshoppers, 3 antimalarial drugs, 44f H Brugian filariasis, 68f Chagas' disease, 152f Haemagogus mosquitoes deer tick, 96f sylva tic cycle, 66 dengue virus, 57f Haemaphysalis , 85f tick vectors, 82t Dermacentor variabilis, 86f Haemaphysalis concinna, 91 eastern equine encephalitis Haemaphysalisflava (EEE),46f tick vectors, 82t holocyclus, 121f Hard ticks, 82 , 96f characteristics, 77 Japanese encephalitis (JE), 55f Harvestmen, 7 LaCrosse encephalitis (LAC), 91HE17 54f HME,92 LBRF,172f Head lice leishmaniasis, 143f life cycle, 5f lone star tick (LST), 94f Health louse-borne typhus, 170f arthropods direct effects, 13-14 malaria, 35f, 36f arthropods indirect effects, 14 ticks, 116f Hemagglutination inhibition (HI), plague, 130f 210 scrub typhus, 164f Hematemesis, 205 St. Louis encephalitis, 51f Hemipteran , 151 tick-borne relapsing fever Hemoglobinuria, 205 (TBRF), 116f, 117f Hemolymph test, 22 western equine encephalitiS Hermetia illucens, 177 (WEE),53f illustration, 178f yellow fever (YF), 63f Hetrazan Giant centipede, 10f lymphatic filariasis treatment, Giemsa stain 74 babesiosis diagnosis, 106 HGE. See Human granulocytic leishmaniasis diagnosis, 146 ehrlichiosis (HGE) micro filariae identification, 68 HIV transmission Giemsa Wayson stain and mosquitoes, 201-202 plague diagnosis, 131 HME. See Human monocytic Glossina, 11 t ehrlichiosis (HME) Index 221

House centipede, 10f Indigenous leishmaniasis, 148 Houseflies Indirect fluorescent antibody larvae, 5, 7 (lFA), 21O-211 life cycle, 6f African sleeping sickness House mosquito diagnosis, 159 Bancroftian filariasis, 70 Chagas' disease diagnosis, 154 Howler monkeys ehrlichiosis diagnosis, 93 YF,66 leishmaniasis diagnosis, 146 Human babesiosis, 105-108 micro filariae identification, 68 clinical and laboratory murine typhus, 135 findings, 106 plague diagnosis, 133 ecology, 106-107 scrub typhus diagnosis, 165 medical significance, 105-106 Infected tick bite treatment and control, 107-109 Rocky Mountain Spotted Fever Human botfly, 13, 180, 186 (RMSF), 84 Human diseases transmitted Infective sporozoites arthropods, 11 t malaria, 35-36 Human ehrlichiosis, 14 Inland floodwater mosquitoes, 31 Human granulocytic ehrlichiosis Insect (HGE),92 characterizations, 3, 4t ecology, 95 forms of development, 3, 5 Human immunodeficiency virus and HIV, 201-202 (HIV),201-202 pathogen pick up, 20 Human monocytic ehrlichiosis Insecta (HME),92 characterizations,4t Hump-backed flies, 180f Insect infestation Hyalomma, 11t imaginary, 187-190 tick vectors, 82t Hyalomma iongicornis description, 194 tick vectors, 82t illustration, 194f Hydrocele, 205 list, 193 Hymenoptera Insect pupae, activity of vs. sting apparatus, 194-196 mosquito pupae, 29, 31 Hypereosinophilia,68 Insect stings or bites, 193-199 diagnosis, 197-198 I infectious complications, 197 IF A. See Indirect fluorescent medical significance, 193 antibody (IFA) pathogenesis, 193-197 Imaginary insect and mite recognition, 197-198 infestation, 187-190 Interference phenomenon, 22 contributing factors, 188 Intrinsic factors differential diagnosis, 188-189 vector competence, 22 treatment strategies, 189-190 Ivermectin Immunoglobulin M lymphatic filariasis treatment, 72 LD,98 onchocerciasis treatment, 161, 163 222 Index

Ixodes cookei, 111 Leishmania braziliensis, 142, 144 , 122 Leishmania chagasi, 141, 143, 144 Ixodes dammini, 95, 97, 98, 106 Leishmania donovani, 142, 143 , 91, 121 Leishmania guyanensis, 142 geographic distribution, 121f Leishmania infantum, 142, 143 illustration, 120f Leishmania major, 140, 143 tick vectors, 82t Leishmania mexicana, 142, 144 Ixodes ovatus Leishmania panamensis, 142 tick vectors, 82t Leishmania parasites, 130-147 , 99, 107 Leishmaniasis, I1t, 139-147 , 109 clinical manifestations, 140-144 , 103-104, 106, 109 diagnosis, 144 illustration, 104f ecology, 144-146 Ixodes scapularis, 95, 97, 98-100, forms, 144 106, 107 geographic distribution, 141f geographic distribution, 96f life cycle, 145f illustration, 96f medical significance, 139-140 new TBE virus, 111 treatment and control, 146-147 Ixodes ticks, llt, 77-79 Leishmania tropica, 140, 143 illustration, 78f Leishmanin test, 144, 211 , 77, 80 Leptopsylla segnis, 134 Leptotrombidium akamushi J 5T vector species, 167t Japanese encephalitis (JE), 54-55 Leptotrombidium arenicola geographic distribution, 55f 5T vector species, 167t , 82t Leptotrombidium deliense Jungle YF cycles, 66 5T vector species, 167t Leptotrombidium fletcheri K 5T vector species, 167t Kerititis, 205 Leptotrombidium mites, 11 t Kissing bugs, llt, 151, 154 Leptotrombidium pallidum beak,155f 5T vector species, 167t illustration, 155f Leptotrombidium pavlovsky transmission mode, 18t 5T vector species, 167t , 110 Leptotrombidium scutellaris 5T vector species, 167t L Leptotrombidium species, 166 LaCrosse encephalitis (LAC), 52- Lesions 53 bite, 13 geographic distribution, 54f Leukopenia, 205 Larvae Lice, 3 mosquitoes, 29 head Latex agglutination (LA) tests, life cycle, 5f 133 Liponyssoides sanguineus, 82t Leishmania aethiopia, 140 Loiasis, 72 Index 223

Lone star tick (LSI), 93-95, 103 geographic distribution, 35f, geographic distribution, 94f 36f illustration, 94f history, 34 Louping ill, 108, 109 life cycle, 35-38, 36, 37f Louse-borne diseases mosquitoes, 23 treatment, control, and mosquito vectors and prevention, 171 behavior, 38-41 Louse-borne infections, 167-171 symptoms, 34-35 medical importance, 167-168 transmission mode, 18t Louse-borne relapsing fever treatment and control, 41-43 (LBRF),171 Malaria organism vectors geographic distribution, 172f mosquitoes, 17 Louse-borne typhus, 12, 169 Malaria plasmodia geographic distribution, 170f cyclopropagative transmission, Lutzomyia, lIt 19 Lutzomyia anthophora, 145 Malaria vaccine, 40-41 Lutzomyia Colombiana, 147 Malaria vectors Lutzomyia mexicana, 145 Anopheles mosquitoes, 38, 41 Lutzomyia verrucarum, 147 Malayan filariasis, 65, 70 Lyme disease (LD), 11t, 14, 95-100 Mansonella ozzardi, 72 clinical and laboratory Man sonella perstans, 72 findings, 98-99 Man sonella streptocerca, 72 ecology, 99-100 Mansonia, 70 history, 96-98 Mazzotti test, 211 symptoms, 95 onchocerciasis diagnosis, 162 tick bite, 17 Mechanical transmission treatment, 100 disease agents, 18 , 138 Mectizan Lymphangitis, 205 lymphatic filariasis treatment, Lymphatic filariasis, lIt, 65-72 72 clinical and laboratory onchocerciasis treatment, 161, findings, 66-68 163 ecology, 68-72 Mediterranean spotted fever, 88 medical significance, 65-66 Mefloquine, 43 symptoms, 65 Megaselia flies, 179 treatment, 72 Melarsoprol Lymphocytosis, 205 African sleeping sickness treatment, 160 M Mel-B7 infestation, 186 African sleeping sickness Maggots, 5, 13, 181, 183-184,205 treatment, 160 Malaria, 11 t, 14, 34-45 Meningoencephalitis, 206 causative agent, 35-38 Merozoites diagnosis, 34-35 malaria, 36 , 24 Microfilaramia, 66 224 Index

Microfilariae identification egg laying, 33 microscopic view, 69f positions,30f sheath showing, 69f SLE, 49-50 Millipedes, 9, lOf, 14 Culicidae characterizations, 4t subfamilies, 29 Mite infestation dark rice field, 31 imaginary, 187-190 dengue virus markings, 57f Mite islands, 163, 166 female bite Mites, 7, 8f, 9, 82t dengue virus, 54, 56 characterizations,4t filarial worms, 72 Leptotrombidium, 11 t forest scrub pathogen pick up, 20 YF, 64 trombiculid,166 Haemagogus Montenegro test, 211 sylvatic cycle, 66 Mosquito biology, 29-34 head and mouthparts, 32f Mosquito-borne diseases, 29-73 HIV transmission, 201-202 Mosquito-borne encephalitis, 20 house Mosquitoes, lIt, 12, 14 Bancroftian filariasis, 68 Aedes, lIt illustration, 102f breathing,30f infected, 24 dog heartworm, 72 inland floodwater, 31 egg laying, 32-33 larvae, 29 positions,30f malaria, 23 Anopheles, lIt, 17,24,70 malaria organism vectors, 17 Bancroftian filariasis, 68 mechanical transmission, 18 breathing,30f Plasmodium breeding, 31 malaria, 35-36 cyclopropagative vectors, 38 transmission, 19 Psorophora dog heartworm, 72 biting patterns, 34 egg laying, 32 egg laying, 33 positions, 30f VEE, 51-52 vector control, 42 pupae, 29 vectors, 36 Salt marsh, 33 Asian tiger, 31, 33 salt marsh, 31 dengue virus, 56 biting patterns, 34 biological transmission, 19 epizootic vector species, 45 bird-biting, 49-50 transmission mode, 18t biting patterns, 33-34 tree canopy, YF and, 64 changing transmission, 25 tree hole, 31 characteristics, 29 LAC, 50-51 Culex, lIt tularemia, 101 breathing, 30f tumblers, 29 breeding, 31 wigglers, 29 dog heartworm, 72 yellow fever, 31 Index 225

Mosquito house o YF,63 Mosquito pupae Obligate myiasis, 180-183 activity contributing factors, 184-185 insect pupae, 29, 31 treatment, 185-186 Mosquito-transmited encephalitis Obstructive filariasis, 66 viruses, 43-53 Oculoglandular tularemia, 101 Mosquito vectors , 108 malaria, 36, 40 Onchocerca volvulus, 161 SLE,50 Onchocerciasis, 11t, 72, 161-163 Moths, 3,5 clinical and laboratory larvae,6f findings, 161-162 Mucocutaneous leishmaniasis, diagnosis, 162 144 ecology, 162-163 geographic distribution, 141 f medical significance, 161 illustration, 143f treatment, prevention, and Murine typhus, 11t, 131-135 control, 163 clinical and laboratory vectors, 162-163 findings, 132-133 Onchocercoma, 206 ecology, 133-134 Opiliones, 7 medical significance, 131-132 Orbivirus,110 vs. Rocky Mountain spotted Orchitis, 206 fever (RMSF), 133 Oriental rat flea, 129, 131 , 132 symptoms, 132-133 illustration, 130f treatment, 134-135 , 163, 167 Mu sca flies, 178 Ornithodoros, l1t Muscina flies, 179 Ornithodoros erraticus, 115 Myiasis, 13, 177-186 geographic distribution, 117f contributing factors, 183-185 Ornithodoros hermsi, 114 prevention, treatment, and geographic distribution, 116f control, 185-186 , 115 Myocarditis, 206 geographic distribution, 117f Ornithodoros parkeri, 115 N geographic distribution, 116f Near phagocytophila, 92 Ornithodoros porcinus Neuritis, 206 geographic distribution, 117f Neutralization, 211 Ornithodoros rud is Nifurtimox geographic distribution, 116f Chagas' disease treatment, Ornithodoros tholozani 156-157 geographic distribution, 117f Nodules, subcutaneous, 206 Ornithodoros turicata, 114, 115 , 82t, 90- geographic distribution, 116f 91 illustration, 117f Norway rat, 134 Oropharyngeal tularemia, 102 Nosopsyllus fasciatus, 134 Oropouche fever, lIt 226 Index

Oroya fever, 149 ecology, 129-131 Otobius megnini geographic distribution, 128f illustration, 78f state by state, 130f p history, 128-129 life cycle, 21£ Panstrongylus megistus transmission mode, 18t Chagas' disease vectors, 156f treatment, 131 Papatasi fever, 147-148 Plague of Justinian, 128 Paralysis, 206 Plasmodium falciparum, 23,35-36, Parasite transmission 106 modes,18t Plasmodium malariae, 23, 35-36 Parinaud's oculoglandular Plasmodium mosquitoes syndrome, 136 malaria, 35-36 Pathogen transmission vectors, 38 mechanical vs. biological, 17-20 Plasmodium ovale, 35-36 modes,18t Plasmodium species, 23 PCR. See Polymerase chain Plasmodium vivax, 23, 35-36 reaction (PCR) Pleomorphic coccobacilli, 91 Pediculus,l1t Pneumonic Pediculus humanus corporis, 167 plague form, 129 Pentavalent antimonials Polymerase chain reaction (PCR), leishmaniasis treatment, 146 211-212 Pentostam Borrelia burgdoiferi detection, 99 leishmaniasis treatment, 146 Chagas' disease diagnosis, 154 Permanone 7B, 88f CSD detection, 136 Permanone Repel, 86 ehrlichiosis diagnosis, 93 Permethrin products, 86 (POW), Peromyscus leucopus, 107 108, 109 Peruvian warts, 149 Promastigotes, 146 Phaenicia sericata, 179, 184 Propagative transmission Phlebotominae, 144 disease agents, 19 Phlebotomus, 11t Prophylaxis, 43 Phlebotomus papatasi, 150 Proteinuria, 206 Phormia regina, 180 Pseudomyiasis, 177-179, 184-185 Pian bois, 142 Psorophora columbiae, 31, 33 Pimozide Psorophora mosquitoes imaginary insect and mite biting patterns, 34 infestation treatment, egg laying, 33 189-190 VEE,53-54 Piophilia casei, 178 Psychodidae, 146 illustration, 178f Puncta, 206 Piroplasmordia, 105 Pupae Plague, 11t, 20, 127-131 mosquitoes, 29 clinical presentation, 127 Pyrimethamine diagnosis, 131 antimalarial drug, 41 Index 227

Q conori, 82t, 88 Rickettsiae, 81 (QTT), , 82t 82t, 91 Rickettsial disease, 131 Quinidine Rickettsial pox, 82t antimalarial drug, 41 Rickettsia montana, 23 Quinine Rickettsia peacocki, 22 antimalarial drug, 41 , 169 Quinine sulfate Rickettsia rhipicepahali, 23 human babesiosis treatment, 107 Rickettsia ricketts ii, 22, 82t, 83 Rickettsia siberica, 82t, 90 R Rabbit fever, 101 murine typhus, 133 Radio-immunoassay (RIA) Rifampin Chagas' disease diagnosis, 154 CSD treatment, 137 Rash,206 Riparian habitat, 24-25 Rats, 134 River blindness, 161 Rat-tailed maggot, 178 Rochalimaea henselae, 136 illustration, 179f Rochalimaea quintana, 169 Rattus felis, 134 Rocky Mountain spotted fever Rattus norvegicus, 134 (RMSF), 22, 81-88 Rattus rattus, 129, 134 characteristics, 83-84 Rattus typhi, 134 clinical and laboratory aspects, Red-tailed monkeys 83-84 YF,64 ecology, 84 Reduviidae, 151 infected tick bite, 84 Relapsing fever, 11 t vs. murine typhus, 135 louse-borne vs. tick borne, prevention, 86 113-114 symptoms, 83-84 Reverse transcriptase (RT) PCR Rocky Mountain wood tick, 102- new TBE virus 103,122 Ixodes scapularis, 111 Romana's sign, 152, 153f, 207 Rhipicephalus Roof rat, 134 tick vectors, 82t Russian spring-summer Rhipicephalus appendiculatus, 88 encephalitis (RSSE), 108 Rhipicephalus snaguineus, 88 Rhodnius,l1t S Rhodnius prolixus Sachophaga flies Chagas' disease vectors, 156f illustration, 182f Rice culture, 24-25 Salivary excretions Rice rats, 134 arthropods, 13 , 82t, 90 Salt marsh mosquitoes, 33 , 82t Salt marsh mosquitoes, 31 , 82t, 91 biting patterns, 34 , 91 epizootic vector species, 45 228 Index

Sand flies, 11t, 12 Spider monkeys, YF and, 64 biology, 139 Spiders, 8f Sand fly fever, 11t, 147-148 bites, 13 Sand fly-transmitted diseases, black widow, 8f 139-148 venom, 13 Sarcophaga flies, 179 brown widow Sarcophaga haemorrhoidalis, 180 venom, 13 Scorpion characterizations, 4t, 7 stinging position, lOf daddy longlegs, 7 venom, 13 fiddle back Scorpions, 9 venom, 13 characterizations, 4t venom, 13 Screwworm flies, 13, 180 Splenomegaly, 207 illustration, 183f Spotless RMSF, 93 Scrub typhus, 11t, 163-167 Spotted fever group, 22, 81 clinical and laboratory epidemiologic information, 82t findings, 164-165 Spotted fever rickettsioses, 11 t diagnosis, 165 St. Louis encephalitis, 43, 47-50 ecology, 166-167 control, 50 geographic distribution, 164f ecology, 47-50 medical significance, 163-164 geographic distribution, 49f treatment, prevention, and life cycle, 48f control, 167 symptoms, 47 vectors, 166-167 Sting apparatus, 194-196 Sensu latu, 23 Stings, 193-199 Septicemic arthropods, 13-14 plague form, 127 Streptomycin Shock,207 plague treatment, 131 Siberian tick typhus (STT), 81, 82t, tularemia treatment, 105 90-91 Sulfonamides Simulium, 11 t antimalarial drug, 43 Simulium damnosum, 163 Suramin Simulium flies, 161 African sleeping sickness Simulium metallicum, 163 treatment, 160 Simulium neavei, 163 onchocerciasis treatment, 161 Simulium ochraceum, 163 Sylva tic plague, 127 Skin biopsies Sylva tic YF, 64 onchocerciasis diagnosis, 162 Symbiotic rickettsial organism, Sleeping sickness, 12, 14 121 Social insects, 13 Systemic tick-borne illness, 95 Soft ticks, 80, 114 T characteristics, 77 illustration, 78f Tachycardia, 207 Soldierfly, 177 Tapeworm illustration, 178f transmission mode, 18t Index 229

Tarantula,8f Lyme disease, 17 Tests Rocky Mountain Spotted arthropod-borne diseases, 209- Fever (RMSF), 84 212 characterizations,4t , 88 deer, 97 antimalarial drug, 43 geographic distribution, 96f ehrlichiosis treatment, 97 illustration, 96f louse-borne disease treatment, Dermacentor, lIt 171 dog, 84 murine typhus treatment, 134-135 hard,80 plague treatment, 131 characteristics, 77 TBRF treatment, 115 illustration, 102f tularemia treatment, 105 interference phenomenon, 22 Theileria, 106 Ixodes, lIt, 77-79 Three-day fever, 149-150 illustration, 78f Tick-borne diseases, 14,77-122 life cycle, 79f Tick-borne encephalitis, lIt, 47, lone star tick (LST), 93-95, 103 108-110 geographic distribution, 94f diagnosis and treatment, 109- illustration,94f 110 pathogen pick up, 20 Tick-borne relapsing fever removal, 84, 89t (TBRF),111-116 Rocky Mountain wood tick, clinical and laboratory 102-103, 122 findings, 112-113 saliva, 114, 121 diagnosis, 112-113 soft, 80, 114 ecology, 114-115 characteristics, 77 geographic distribution, 116f, illustration, 78f 117f testing method, 22 vs. louse-borne, 113-114 tularemia, 101 medical significance, 111 western black-legged, 105 symptoms, 111 Timoran filariasis, 65 treatment and control, 115 TMP-SMX Tick paralysis, 116-122 CSD treatment, 137 clinical features, 119 Toxorhynchitinae mechanisms, 119-121 characteristics, 29 medical significance, 116-118 Transmission of pathogens prevention and treatment, 121- mechanical vs. biological, 17-20 122 Tree canopy mosquitoes Tick removal YF,66 method,89t Tree hole mosquitoes, 31 Ticks, 7, 8f, 9, lIt, 23 LAC, 52-53 American dog, 84, 93, 103, 119 , 11 t, 168, 169 biology, 77-81 Triatoma brasiliensis bite, 114 Chagas' disease vectors, 156f eschar,90f Triatoma bugs, lIt, 154 230 Index

Triatoma dimidiata Vectors, 17 Chagas' disease vectors, 156f African sleeping sickness, Triatoma infestans 160 Chagas' disease vectors, 156f Anopheles mosquitoes, 36 Triatominae, 151, 154 Chagas' disease, 151, 156t Trombiculid mites, 166 competent, 20 True bugs, 3, 151 incrimination, 23-25 Trypanosoma brucei gambiense, 157, onchocerciasis, 162-163 159, 160 Plasmodium mosquitoes, 38 Trypanosoma brucei rhodesiensei, scrub typhus, 166-167 157, 159, 160 tick,82t Trypanosoma cruzi, 151, 154-157 Venezuelan equine encephalitis Trypanosoma rangeli, 154 (VEE), 51-52 Trypomastigote, 155 Venom, 13 Tsetse flies, 11 t, 157 black widow spider, 13 illustration, 158f brown widow spider, 13 Tularemia, 101-105 fiddle back spider, 13 arthropod transmission, 102- fire ants, 13 105 scorpion, 13 clinical and laboratory spiders, 13 findings, 101-102 Verruga peruana, 149, 207 medical significance, 101 Viral encephalitis, 11 t treatment, 105 Viruses Tumblers tick transmission, 108-111 mosquitoes, 29 Visceral filariasis, 11 t Typhus island, 163 Visceral leishmaniasis, 146 geographic distribution, 143f U Ulceroglandular, 101 w Ulcers, cutaneous, 207 Wasps, 3,5 Urban YF cycles, 64 sting apparatus, 194-196 Urine tests stings, 13 onchocerciasis diagnosis, 162 Western black-legged tick, 107 Urticaria, 207 Western equine encephalitis Uta, 12, 142 (WEE), 52 geographic distribution, 53f V White-footed mouse, 107 Vectors,ST and, 167t White-tailed deer, 93 Vector-borne diseases, 17-18, 20, Wigglers 151-171 mosquitoes, 29 Vector competence, 20-25 Wild rats, 134 Vector mosquitoes Winterbottom's sign, 207 sylva tic cycle Wood rats, 134 Haemagogus mosquitoes, Wright's stain 64 plague diagnosis, 131 Index 231

Wuchereria bancrofti Yellow fever (YP), 11 t, 60-65 Bancroftian filariasis, 68 geographic distribution, 61f life cycle, 71f history, 62-66 lymphatic filariasis treatment, 72 jungle vs. urban, 64 Wyeth-Ayerst Laboratories medical significance, 60-62 lymphatic filariasis treatment, 72 treatment and prevention, 64- 65 X Yellowjacket Xenopsylla,l1t sting apparatus Xenopsylla cheopis, 129, 131, 132 illustration, 195f illustration, 130f , 20, 127 Y Z Yaws, 144, 146 Zoonoses Yellow fever mosquitoes, 31 encephalitis, 43