COMMUNICABLE DISEASE II

insect, (class Insecta or Hexapoda), any member of the largest class of the phylum Arthropoda,

which is itself the largest of the animal phyla. Insects have segmented bodies, jointed legs, and

external skeletons (exoskeletons). Insects are distinguished from other arthropods by their body,

which is divided into three major regions:

(1) the head, which bears the mouthparts, eyes, and a pair of antennae,

(2) the three-segmented thorax, which usually has three pairs of legs (hence “Hexapoda”) in adults

and usually one or two pairs of wings, and

(3) the many-segmented abdomen, which contains the digestive, excretory, and reproductive

organs.

Insect-borne (Vector-borne) diseases: are illnesses that are transmitted by vectors, which include

mosquitoes, ticks, and fleas. These vectors can carry infective pathogens such as viruses, bacteria,

and protozoa, which can be transferred from one host (carrier) to another.

List of vector-borne diseases, according to their vector

The following is the list of vector-borne disease, ordered according to the vector by which it is

transmitted. The list also illustrates the type of pathogen that causes the disease in humans.

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MOSQUITOS SPECIES.

1. Aedes: the known to transmit the following viral etiological agents such as

Chikungunya virus, Dengue virus, Rift Valley fever virus, Yellow Fever virus, Zika virus and

Lymphatic filariasis parasite.

2. Anopheles: transmit the following:

Malaria and Lymphatic filariasis parasites

3. Culex Spp: transmit the following:

Japanese encephalitis (Virus), Lymphatic filariasis (parasite), West Nile fever (virus).

FLIES

• Simulium Spp (Black flies). Transmit onchocerciasis

• Glossina (Tse-tse fly). Transmit Trypanosomiasis

• Cyclop (Water flea). Transmit Guinea-worm disease

• Chrysops. Transmit. Loaloasis

• Sand flies. Transmit. Leishmaniasia and Sand fly fever (virus)

Tick

Haemorrhagic fever (virus), Lyme disease, Rickettsial diseases (eg: spotted fever and typus fever

(bacteria).

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 COMMON DISEASES CAUSE BY VECTORS

Mosquito-Borne Diseases: Mosquitoes are prevalent worldwide from the Tropics to the Arctic

region. Anopheles, Aedes and Culex are the main genera that bring about the transmission of

various epidemic and endemic diseases. The list of major diseases that are transmitted by the

mosquitoes is listed below:

1. DENGUE VIRUS

Dengue fever is an illness that is similar to a serious case of the flu. It is caused by a virus carried

by mosquitoes. Most people who have dengue fever recover in about a week. Sometimes, the

infection is more serious and occasionally it is fatal. You can catch dengue fever if you are bitten

by an infected mosquito. Aedes aegypti

Clinical Symptoms

fever (mild to incapacitating), headache, pain behind the eyes, muscle and joint pain, nausea and

vomiting, swollen glands, a rash, bleeding nose or gums, fatigue (feeling very tired).

Severe symptoms

Bruising to only minor bumps, nose bleeds and bleeding gums, stomach pain, breathing

difficulties, persistent vomiting or poo with blood in it, confusion, restlessness, cold, clammy skin

Diagnosis

Your doctor will assess you by talking to you and examining you. They may order blood tests to

help diagnose dengue fever.

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Treatment

There is no specific treatment for dengue fever. But you can ease the symptoms by resting, drinking

plenty of fluids and taking painkillers such as paracetamol.

There is no vaccine to prevent dengue fever. The best way to prevent it is to avoid being bitten by

mosquitos.

How to prevent mosquito bites:

Stay inside during mornings and evenings when mosquitos are active.

Use air-conditioning and window screens; use mosquito nets in the bedroom.

Wear long-sleeved clothes and covered shoes.

Use a mosquito repellent that contains DEET or picaridin.

Regularly check and drain any still water around your home. Mosquitos breed in still water, such

as water in empty containers.

2. ZIKA VIRUS

The Zika virus is transmitted by Aedes mosquitoes, the same type of mosquito that carries dengue

fever, yellow fever, and chikungunya virus. A mosquito bites an infected person and then passes

those viruses to other people it bites.

Zika can be spread through sex, usually after a person travels to an area where Zika has broken out

and contracted the virus, and the infected pregnant women can pass the virus on to their fetus.

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Symptoms of Zika Virus

Fever, rash, joint pain, and redness in the whites of the eye (conjunctivitis, or pinkeye). But most

people won’t know they have it. Symptoms can appear anywhere from 3 to 14 days after a bite

from an infected mosquito.

Treatment of Zika Virus

Treatment. There is no specific treatment available for Zika virus infection or disease. People with

symptoms such as rash, fever or joint pain should get plenty of rest, drink fluids, and treat

symptoms with antipyretics and/or analgesics.so.

3. MALARIA

Malaria is one of the life-threatening parasitic diseases. It is caused by the Malarial (Parasite):

protozoan, Plasmodium. The genus includes four species P.vivax, P.falciparum, P.malarie and

P.ovale. The causative organism is transmitted through the bite of infected female Anopheles

mosquito.

• Mosquito transmission cycle

Uninfected mosquito. A mosquito becomes infected by feeding on a person who has malaria.

Transmission of parasite. If this mosquito bites you in the future, it can transmit malaria parasites

to you.

In the liver. Once the parasites enter your body, they travel to your liver — where some types can

lie dormant for as long as a year.

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Into the bloodstream. When the parasites mature, they leave the liver and infect your red blood

cells. This is when people typically develop malaria symptoms.

On to the next person. If an uninfected mosquito bites you at this point in the cycle, it will become

infected with your malaria parasites and can spread them to the other people it bites.

Signs and Symptoms

Symptoms of malaria include chills, fever, headache, nausea - vomiting,malaise and myalgia

general feeling of discomfort, rapid heart rate, rapid breathing, fatigue, . Symptoms may develop

as early as 7 to 14 days after initial infestation. Falciparum malaria can result in seizures, mental

confusion, kidney failure, and lung disease, which may require emergency treatment.

Diagnosis

Malaria is diagnosed based on physical examination, signs and symptoms experienced by patient,

and blood tests. Polymerase chain reaction test is also used to detect malaria parasite.

Treatment of Malaria

Malaria is treated with antimalarial drugs. The drug regimen is optimized based on the species of

malaria parasite, concomitant medication and underlying condition of the patient.

4. FILARIASIS: (parasitic nematode)

Filariasis is caused by the parasite Wuchereria bancrofti that is transmitted by the infected

mosquitoes of species Culex quinquefasciatus and Mansonia annulifera/M.uniformis. The parasite

moves inside the body to reach the lymphatic system.

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Symptoms

The disease causes swelling of legs with thickening of skin and underlying tissues and skin rash.

W.bancrofti may also affect legs, ear lobes, arms, vulva, breasts and scrotum. Elephantiasis, which

consists of oedema with thickening of the skin and underlying tissues, is the most striking

symptoms of lymphatic filariasis. Elephantiasis develops when parasites become established in the

lymphatic system.

Diagnosis

Finger prick test is used to diagnose microfilariae in the blood to identify filariasis. Treatment

involves the administration of anti-filarial medications.

Treatment of Filariasis

Your treatment plan varies depending on what symptoms you have and how severe they are. In

general, filariasis treatment may include:

Medication: You may take anti-parasitic medicines such as ivermectin (Stromectol®),

diethylcarbamazine (Hetrazan) or albendazole (Albenza). These drugs destroy the adult worms in

your blood or keep them from reproducing.

5. LEISHMANIASIA

Leishmaniasis is a disease caused by a protozoa parasite from over 20 Leishmania species. Over

90 sandfly species are known to transmit Leishmania parasites. There are 3 main forms of the

disease:

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Visceral (the most serious form because it is almost always fatal without treatment), also known

as kala-azar, is fatal if left untreated in over 95% of cases. It is characterized by irregular bouts of

fever, weight loss, enlargement of the spleen and liver, and anaemia.

Cutaneous (the most common, usually causing skin ulcers), is the most common form and causes

skin lesions, mainly ulcers, on exposed parts of the body. These can leave life-long scars and cause

serious disability or stigma.

Mucocutaneous (affecting mouth, nose and throat). leads to partial or total destruction of mucous

membranes of the nose, mouth and throat.

Leishmaniasis is caused by protozoan parasites which are transmitted by the bite of infected female

phlebotomine sandflies. The disease affects some of the world’s poorest people and is associated

with malnutrition, population displacement, poor housing, a weak immune system and lack of

financial resources.

Transmission

Leishmania parasites are transmitted through the bites of infected female phlebotomine sandflies,

which feed on blood to produce eggs. Some 70 animal species, including humans, can be the source

of Leishmania parasites.

Diagnosis of leishmaniasis

It’s important to tell your doctor if you lived in or visited a place where leishmaniasis is common.

That way your doctor will know to test you for the parasite. If you have leishmaniasis, your doctor

will use other tests to determine which species of Leishmania is the cause.

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 • Diagnosing cutaneous leishmaniasis

Your doctor may take a small amount of skin for a biopsy by scraping one of the ulcers. They’ll

often look for the DNA, or genetic material, of the parasite. They can use a variety of methods to

identify the species of parasite causing the infection.

• Diagnosing visceral leishmaniasis

Many times, people don’t remember a bite from a sand fly. This can make the condition hard to

diagnose.

A history of living or traveling to an area of leishmaniasis is helpful. Your doctor may first perform

a physical exam to look for an enlarged spleen or liver. They may then perform a bone marrow

biopsy or take a blood sample for examination.

Treatments of leishmaniasis

Antiparasitic drugs, such as amphotericin B (Ambisome), treat this condition. Your doctor may

recommend other treatments based on the type of leishmaniasis you have.

6. SCHISTOSOMIASIS

Schistosomiasis is an infection caused by trematodes (flukes). These schistosomes (also called

blood flukes) are parasitic flatworms that belong to the genus Schistosoma. Parasites are creatures

who live in or on another organism (host) and get their food from the host.

In the case of schistosomiasis, the flukes are found in snails and then are shed into the water. If

your skin comes in contact with contaminated water, the parasites can move into you and live there

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for years. The form of the parasite that infects humans after developing in the snail has a kind of

forked head that allows it to penetrate your skin.

The three main types of schistosomes are responsible for the two main forms of the condition:

• urogenital schistosomiasis

• Intestinal schistosomiasis.

This condition is also known as bilharzia or snail fever.

Symptoms of schistosomiasis

Many people have no symptoms of schistosomiasis. Early signs and symptoms (those that happen

within days of being infected) may include itchiness and a skin rash.

Later symptoms (those that develop within 30 to 60 days of being infected) may include:

Fever, Chills, Cough, Muscle aches and pain.

If you aren’t treated, symptoms that develop after years of being infected may include:

Pain in your stomach. Enlarged liver (hepatomegaly), Blood in your urine (pee), also called

hematuria, Difficulty or pain while urinating (dysuria), Blood in feces (poop), also called

hematochezia, Miscarriage.

Chronic (long-lasting) schistosomiasis may make it more likely that you’ll develop scars on your

liver or bladder cancer.

In rare cases, you might have eggs in your brain or spinal cord. If this is true, you may have

seizures, become paralyzed or have an inflamed spinal cord.

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Diagnosis of Schistosomiasis

Stool or urine samples can be examined microscopically for parasite eggs (stool for S. mansoni or

S. japonicum eggs and urine for S. haematobium eggs). The eggs tend to be passed intermittently

and in small amounts and may not be detected, so it may be necessary to perform a blood

(serologic) test. Moreover, there are other advance diagnostic test method of detecting the

schistosoma infection such as; PCR, cytoscopy, endoscopy, CT scan, ultrasound, chest X-ray,

colonoscopy, liver biopsy etc.

Treatment for schistosomiasis

Currently, the drug used in most people is praziquantel (Biltricide); however, it only is effective

against adult worms and does not affect eggs or immature worms. Treatment with this drug is

simple and its dose is based on the patient's weight with two doses given in one day. However, the

drug causes rapid disintegration of the worm which, in turn, allows the human immune system to

attack the parasite.

SYMPTOMS OF INSECT-BORNE DISEASES

Symptoms will vary depending upon the type of insect that bit you. Common symptoms of insect-

borne diseases can include:

Nonspecific symptoms

 Fever

 Chills

 Headache

 Sore muscles

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  Skin rash

 Nausea

 Stomach pain

More serious symptoms can include:

 Difficulty breathing

 The feeling that your throat is closing

 Swelling of your lips, tongue, or face

 Chest pain

 A racing heartbeat that lasts more than a few minutes

 Dizziness

 Vomiting

VECTOR-BORNE DISEASE TRANSMISSION MECHANISMS

There are two ways that vector-borne diseases are transmitted:

A. Mechanical transmission

Takes place when a vector simply carries pathogenic microorganisms on their body and transfers

them to food, which we then consume. Flies and cockroaches are in this category. Flies like to rest

on faecal matter and then may move on to fresh food. They can carry infectious agents through

their mouth and on their legs and other body parts. They deposit these agents on ready-to-eat foods

and the recipient gets infected if they consume the contaminated food.

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 B. Biological transmission

occurs when the pathogen reproduces within a biological vector that transmits the pathogen from

one host to another. Arthropods are the main vectors responsible for biological transmission.

Most arthropod vectors transmit the pathogen by biting the host, creating a wound that serves as a

portal of entry. The pathogen may go through part of its reproductive cycle in the gut or salivary

glands of the arthropod to facilitate its transmission through the bite. For example, hemipterans

(called “kissing bugs” or “assassin bugs”) transmit Chagas disease to humans by defecating when

they bite, after which the human scratches or rubs the infected feces into a mucous membrane or

break in the skin.

CHAIN OF INFECTION

As described above, the traditional epidemiologic triad model holds that infectious diseases result

from the interaction of agent, host, and environment.

More specifically, transmission occurs when the agent leaves its reservoir or host through a portal

of exit, is conveyed by some mode of transmission, and enters through an appropriate portal of

entry to infect a susceptible host. This sequence is sometimes called the chain of infection.

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 1. Reservoir (the normal location of the pathogen)

2. Portal of exit from the reservoir

3. Mode of transmission

4. Portal of entry into a host

5. Infectious agent (pathogen)

6. Host (Susceptibility)

I. RESERVOIR

The reservoir of an infectious agent is the habitat in which the agent normally lives, grows, and

multiplies. Reservoirs include humans, animals, and the environment. The reservoir may or may

not be the source from which an agent is transferred to a host. For example, the reservoir of

Clostridium botulinum is soil, but the source of most botulism infections is improperly canned

food containing C. botulinum spores.

II. PORTAL OF EXIT

Portal of exit is the path by which a pathogen leaves its host. The portal of exit usually corresponds

to the site where the pathogen is localized. For example, influenza viruses and Mycobacterium

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tuberculosis exit the respiratory tract, schistosomes through urine, vibrio cholerae in feces,

Sarcoptes scabiei in scabies skin lesions, and enterovirus 70, a cause of hemorrhagic

conjunctivitis, in conjunctival secretions.

Some bloodborne agents can exit by crossing the placenta from mother to fetus (rubella, syphilis,

toxoplasmosis), while others exit through cuts or needles in the skin (hepatitis B) or blood-sucking

arthropods (malaria).

III. MODES OF TRANSMISSION

An infectious agent may be transmitted from its natural reservoir to a susceptible host in different

ways. There are different classifications for modes of transmission. Here is one classification:

Direct Transmission

• Direct contact

• Droplet spread

Indirect Transmission

• Airborne

• Vehicle borne

• Vector borne (mechanical or biologic)

Transmission by Direct Contact

Direct contact transmission: occurs through skin-to-skin contact, kissing, and sexual intercourse.

Direct contact also refers to contact with soil or vegetation harboring infectious organisms. Thus,

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infectious mononucleosis (“kissing disease”) and gonorrhea are spread from person to person by

direct contact. Hookworm is spread by direct contact with contaminated soil.

Droplet spread: refers to spray with relatively large, short-range aerosols produced by sneezing,

coughing, or even talking. Droplet spread is classified as direct because transmission is by direct

spray over a few feet, before the droplets fall to the ground. Pertussis and meningococcal infection

are examples of diseases transmitted from an infectious patient to a susceptible host by droplet

spread.

Transmission by Indirect Contact

Indirect contact transmission: Refers to the transfer of an infectious agent from a reservoir to a

host by suspended air particles, inanimate objects (vehicles), or animate intermediaries (vectors).

Airborne transmission occurs when infectious agents are carried by dust or droplet nuclei

suspended in air. Airborne dust includes material that has settled on surfaces and become

resuspended by air currents as well as infectious particles blown from the soil by the wind. for

example, has occurred in children who came into a physician’s office after a child with measles

had left, because the measles virus remained suspended in the air.

Vehicles that may indirectly transmit an infectious agent include food, water, biologic products

(blood), and fomites (inanimate objects such as handkerchiefs, bedding, or surgical scalpels). A

vehicle may passively carry a pathogen — as food or water may carry hepatitis A virus.

Alternatively, the vehicle may provide an environment in which the agent grows, multiplies, or

produces toxin — as improperly canned foods provide an environment that supports production of

botulinum toxin by Clostridium botulinum.

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Vectors such as mosquitoes, fleas, and ticks may carry an infectious agent through purely

mechanical means or may support growth or changes in the agent. Examples of mechanical

transmission are flies carrying Shigella on their appendages and fleas carrying Yersinia pestis, the

causative agent of plague, in their gut. In contrast, in biologic transmission, the causative agent of

malaria or guinea worm disease undergoes maturation in an intermediate host before it can be

transmitted to humans

IV. PORTAL OF ENTRY

The portal of entry refers to the manner in which a pathogen enters a susceptible host. The portal

of entry must provide access to tissues in which the pathogen can multiply or a toxin can act. Often,

infectious agents use the same portal to enter a new host that they used to exit the source host. For

example, influenza virus exits the respiratory tract of the source host and enters the respiratory

tract of the new host.

In contrast, many pathogens that cause gastroenteritis follow a so-called “fecal-oral” route because

they exit the source host in feces, are carried on inadequately washed hands to a vehicle such as

food, water, or utensil, and enter a new host through the mouth. Other portals of entry include the

skin (hookworm), mucous membranes (syphilis), and blood (hepatitis B, human

immunodeficiency virus).

V. HOST (SUSCEPTIBILITY)

The final link in the chain of infection is a susceptible host. Susceptibility of a host depends on

genetic or constitutional factors, specific immunity, and nonspecific factors that affect an

individual’s ability to resist infection or to limit pathogenicity. An individual’s genetic makeup

may either increase or decrease susceptibility. For example, persons with sickle cell trait seem to

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be at least partially protected from a particular type of malaria. Specific immunity refers to

protective antibodies that are directed against a specific agent. Such antibodies may develop in

response to infection, vaccine, or toxoid (toxin that has been deactivated but retains its capacity to

stimulate production of toxin antibodies) or may be acquired by transplacental transfer from

mother to fetus or by injection of antitoxin or immune globulin. Nonspecific factors that defend

against infection include the skin, mucous membranes, gastric acidity, cilia in the respiratory tract,

the cough reflex, and nonspecific immune response. Factors that may increase susceptibility to

infection by disrupting host defenses include malnutrition, alcoholism, and disease or therapy that

impairs the nonspecific immune response.

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