Introduction

Medical entomology is the study of arthropod in relation to human health. MEDICAL ENTOMOLOGY
by

Henri Lucien Kamga,PhD

Associate Professor Vice-Dean/RC/FHS HOD/MLS UBa

Arthropods are a group of invertebrate animals whose bodies are supported by rigid framework of chitinous substances called exoskeleton.

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These animals, by nature of their structure and opportunistic habits play major roles in the transmission of many parasitic and tropical diseases, the knowledge of which is very essential for a successful prevention and control of human infection. The aim of medical entomology is therefore to control, prevent and if possible eventually eradicate arthropod related human diseases.
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CLASSIFICATION OF MEDICALLY IMPORTANT ARTHROPODS Arthropods of medical importance are those ones that constitute health hazards or transmit human infections. They are of 3 main classes namely: Insecta, Arachnida, and Crustacea. The class insecta consist of flies, fleas, lice and bugs. The arachnida consist of the ticks, mites, spiders and scorpions The crustacean are the crabs and Cyclops.
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Class Arachnida

Class Insecta

Members of the Arachnida have bodies divided into 2 main regions: cephalo-thorax and abdomen. The cephalo-thorax bears four pairs of appendages with no antenna. Members of this class include the ticks and the mites. There are only 2 order of Arachnidae that commonly infect man. They are the Acrania or ticks and the Arcariformes or the mites. The order Acrania is subdivided into 2 families namely Argasidae (Soft ticks) and Ixodidae (hard ticks)
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All members of the class insecta have bodies divided into 3 regions: the head, the thorax and the abdomen. The head bears month parts and a single pair of antenna. There are 2 pairs of wing. The abdomen bears no appendage except the terminal circus. There are 5 orders of medical importance. This include Diptera (flies) Anaplura (lice) Hemiptera (bugs) Siphonaptera (fleas) Dictyoptera (cochroaches)
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 Class Crustacea

Members of the class have their bodies divided into head, thorax and abdomen but the head and thorax are fused into cephalo-thorax a pair of antenna. The class crustacean includes the Cyclops and the crabs.

MEDICAL IMPORTANCE OF ARTHROPODS The ways in which Arthropods are related to human health and well-being can be classified in 3 divisions as follows: 1- Arthropods as direct agents of diseases or discomfort Entomophobia Exsanguinations Injury to sense organs Envenomization Dermatosis Myiasis and related infestation Allergy and related conditions
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Arthropods transmitted pathogens 2- Arthropods as vectors or developmental hosts Mechanical carrier (transmission more or less accidental) Obligatory vectors (involving some degree of development within the arthropods) Intermediate host 3- Arthropods as natural enemies of medically harmful insects Competitors Parasites or predators
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Pathogens transmitted by arthropods are grouped as follows:

1. Protozoa

Vertebrates do not generally acquire strong immunity to these pathogens, and repeated infection is possible. Entamoeba histolytica: The dysentery amoeba, along with other intestinal protozoa may be transmitted by contamination between fecal sources and foodstuffs by cockroaches and houseflies. Sprorozoa: Plasmodium sp. is a sporozoa, blood parasite of man transmitted by the Anopheles mosquitoes to man and by many other mosquitoes to other vertebrates. Trypanosoma: blood flagellates of man, domestic animals and other vertebrates are transmitted by Ts-ts and by triatomine bugs, tabanid flies (mechanically) and by flies. Leishmania: flagellates transmitted by phlebotomine sand flies to man, dogs and other wild animals. Prof HL Kamga 10

2. Helminths Immunity responses in vertebrates are weak and repeated infections are possible. Insect serves as developmental host of tapeworm, flukes, and roundworms. Flies and cockroaches may convey helminthes eggs on their body surface or via their digestive tract. Mosquitoes and flies serve as vectors of filarial worms which affect man and other vertebrates.
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3. Bacteria Vertebrates recovering from arthropods transmitted bacterial infections develop a strong immunity. The majority of common bacteria are transmitted by mechanical contamination; eg: Salmonella and Shigella transmitted by houseflies, mechanical transmission of Bacillus antracis by tabanid flies, etc. Bacteria can multiply within a vector and be transmitted during the act of food feeding. Rickettsia is a group of very small pathogemic bacteria that are mainly dependent on living cells for their growth. Rickettsia can be transmitted mechanically by Ixodid ticks after it had fed on a diseased person.
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4. Viruses These exceptionally small pathogenic a gents are made up of a nucleic acid with a protein coat. Vertebrate recovering from infections generally develop a strong and lasting immunity. Arthropod act as vectors of several viruses. Eg: Dengue virus and viral encephalitis, all transmitted by mosquitoes Aedes aegypti.

Pathogen development in Arthropods The biological transmission of pathogens is by far commonest method of pathogen development among arthropod associated diseases of vertebrates. This clearly suggest a long-standing evolutionary partnership between arthropods, which feed on vertebrates and parasitic pathogens that exploit this link or transfer into vertebrates. This basic classification of these types of biological transmission centering on pathogen development is as follows:
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a). Cyclopropagative transmission The causal organisms undergo different multiplications in the body of the arthropod, as in the transmission of malaria plasmodia by anophelus mosquitoes. There are great multiplication in number within the vector, and there are distinct intermediate growth stages of the pathogens during which it is incapable of infecting the vertebrate host. Only the final growth stage is infective
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b). Cyclodevelopment transmission In this case, the organisms undergo cyclinal changes but do not multiply in the body of the Arthropod. The pathogen develops to the vertebrates infective stage but there is no multiplication in number. This type of development is characteristic to helminthes using arthropods as agent of transfer: eg: mosquito transmission of filarial worms such as Wuchereria bancrofti, the causal organism of bancroftian filariasis.
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c). Propagative transmission The organisms undergo no cyclical change but multiply in the body of the vector. This term is used to describe bacterial and viral multiplication in vectors, for example, the plague organism in fleas, or the relapsing fever organism in ticks. Any stage of the pathogens can infect a vertebrate host;
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Chapter 1: CLASS ARACHNIDA: ORDER ACRANIA This order is divided into two main groups: The Ixodid (hard ticks)and the argasid (soft ticks) The Ixodid attach for prolonged period to hosts and are therefore familiar to host and are therefore familiar to most people who have seen these on themselves. The Argasid mainly feed for every brief period and at night. Consequently most people have never seen these. The bites of the ticks are characterized by vascular trauma and edematous swelling, and accumulation of hosts neutrophiles at the attachment site. Prof HL Kamga 18

Amblyoma (Hard tick)

Once attached, great care should be taken in removing a tick for the mouth part are easily left in the flesh as an irritant and source of secondary infection. The length of time a tick remains attached depend on the family, the species, whether or not mating has taken place and the stage of development. Like many Arthropods, both male and female tick, such blood; great enlargement occurs in female Ixodid only but in both sexes of Argasid.
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Ornithodorus (Soft tick) Prof HL Kamga

Many disorders on man and animals are traceable to ticks; among these are: dermatosis: inflammation, itching, swelling and ulceration at the site of the bite, or skin ulceration and lesion resulting from improper or partial removal of ticks mouth-parts. Exsanguinations, a serious in which a heavily infected animal develops anemia. Otoacariasis, infestation of the auditory canal by ticks with possible serious secondly infection. Diseases transmitted by ticks including Rocky Mountain spotted fever and tick-borne relapsing fever.
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High vector potential of ticks

Factors accounting for the potency of ticks in the spread of diseases of man and animals are the following:

They attach firmly while feeding and do not detach easily. This contributes in the transfer of pathogens to the host (especially Ixodid) Slow feeding: this allows ample time for the transfer of pathogens to the host (especially Ixodid) The wide host range in some species insures more certain sources of blood and opportunities to acquire and transmit pathogens.
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The Argasid live every long and this enhances the chances of acquiring and transmitting pathogen. Transovarial transmission of some pathogens ensures infectivity in some members of the next generation, a matter of greatest importance in one-host ticks. The high sclerotisation of the nymphe and adult make them very resistant to environmental stresses. The reproductive potential of tick is great, as some species may deposit as many as 18.000 eggs daily. This helps to enhance the transmission.
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Life Cycle of ticks All ticks pass through four stages (egg, lava, nymph, adult) in 6 weeks to 3 years. Fully engorged females usually deposit their eggs on the ground. The larvae are hexapod and remain in this condition until after the first molt. The nymph emerging from first molt has 4 pairs of legs and remains in this stage until transformation to the sexually mature adult. Ixodid ticks have only one nymphal stage, but there may be as many as five nymphal molt in Argasids. The majority of tick species drop off the host animals to molt, but in several species molting takes place on the host.
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 Ixodid ticks have only nymphal stage, but there may be as many as five nymphal molt in Argadids. The majority of ticks species drop off the host animals to molt, but in several species molting takes place on the host. The longevity and handiness of ticks are very remarkable and must be considered when control measures are applied, particularly among the Argadid which are known to survive under starvation conditions for as long as 16 years in some species.
Life Cycle of ticks
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Ticks and Diseases

Disease Pathogen Relapsing fever Spirochaete Bacterium Borrelia recurrentis

Host Vector Human Argas Rodent Ornithodorus

Turlareamia Bacterium Francisella tularensis Spotted fever Bacterium Rickettsia rickettsi

Human Several Ixodids Human ixodids

Control of Ticks Ticks control consists of close observation of host premises and habitat. Protection against ticks can be achieved by use or repellent which may be applied to skin, but impregnated clothing particularly garments provides best control.

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Chapter 2: CLASS INSECTA ORDER ANOPLURA (SUCKING LICE) This order is subdivided into 3 groups Crab lice or pubic lice Head lice Body lice
Head louse (left) Crab or pubic louse (right).

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1- Crab Louse: Phthirus pubis The crab louse also called the public louse is easily recognized by its crabs like appearance. It infests the public regions, particularly, but also the armpits and more rarely other hairy parts of the body, such as mustache, bear and eyes lashes. These lice are remarkably stationary in their habits after remaining attached for days at one point with mouthparts. Crab louse infestation known as phthiriasis is characteristic of human adults. Children under the age of puberty are not usually being affected. It is in a sense a venereal disease. The infection is spread by contact with infested humans or objects used by them such as blankets. Prof HL Kamga 31

Head Louse: Pediculus humanus capitis The Head house is gray in color but tends to resemble the color of the hair. Head lice are easily disseminated by physical contact, particularly among school children.

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Body louse: Pediculus humanus corporus The body louse is more common where the clothing comes in contact with the body continuously, for example on under wears, the forks of the trouser, the armpits, the necks and shoulders. Suitable temperature is essential for the continued existence of louse population and the optimum temperature for the adult body louse is approximately the temperature of the normal human body. They do not voluntarily leave unless the body grows cold in death or becomes hot with high fever.
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Louse infestation is mainly the result of contact with lousy persons or their infested clothing. The presence of lice at any part of the body is called pediculosis. Louse bite may produce certain systemic disturbances such as general tiredness, irritability, depression, and body rash. The skin of persons who continuously harbor lice becomes hardened and deeply pigmented, a condition designated as vagabonds disease.

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Biology of lice Lice have simple or gradual metamorphosis. The immatures and adults look similar, except for size. Lice do not have wings or powerful jumping legs so they move about by clinging to hairs with clawlike legs. Head lice prefer to live on the hair of the head although they have been known to wander to other parts of the body. Head lice do not normally live within rugs, carpet, or school buses. Body lice live in the seams of clothing, generally where it touches the skin, and only contact the body to feed, usually holding on to the clothing while they do this. However, sometimes they will move to the body itself.
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The eggs of lice are called nits. They are oval white cylinders (1/16 inch long). The eggs of head lice are usually glued to hairs of the head near the scalp. The favorite areas for females to glue the eggs are near the ears and back of the head. The eggs of body lice are laid on clothing fibers and occasionally on human body hairs. Under normal conditions the eggs will hatch in seven to 11 days. The young lice which escape from the egg must feed within 24 hours or they will die. Newly hatched lice will periodically take blood meals and molt three times before becoming sexually mature adults. Normally a young louse will mature in 10 to 12 days to an adult (1/8 inch in length). Adults range in color from white to brown to dark gray

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Female lice lay six to seven eggs (nits) per day and may lay a total of 50 to 100 eggs during their life which may last up to 40 days. Adults can only survive one to two days without a blood meal. The nymphs and adults all have piercingsucking mouthparts which pierce the skin for a blood meal. The reaction of individuals to louse bites can vary considerably. Persons previously unexposed to lice experience little irritation from their first bite. After a short time individuals may become sensitized to the bites, and may react with a general allergic reaction including reddening of the skin, itching, and overall inflammation.
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Crab louse egg (left)

body louse egg (right).

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Symptoms of Louse Infestation Head lice should be suspected when there is intense itching and scratching of the scalp and the back of the neck or when there is a known infestation in the community. Close examination of the scalp will reveal small, whitish or dark eggs (nits) firmly attached to hair shafts, especially at the nape of the neck and above the ears. Inspection may reveal active lice and many itchy, red marks resulting from irritation caused by the saliva of the louse.
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Although dandruff may resemble eggs, it can be removed easily from hair, whereas louse eggs are attached firmly to the hair with cement secreted by the louse and cannot be removed easily by pulling. When an infestation becomes known, it is advisable to examine all members of the family, especially other children, and others who have been in contact with the infested person within recent weeks to be sure that they have not become infested.
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Body lice are found in tight-fitting sites or seams of clothing, usually close to the skin. Only in heavy infestations will body lice be seen on other layers of clothing. Infestations usually occur where humans continuously wear several layers of clothing due to inadequate heating or during periods of war or natural disasters. Louse infestations may also occur in poorly managed nursing homes, and among the poor and homeless. The main reasons for these infestations are the failure to change garments and/or poor hygiene.
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Lice and disease

1 Epidemic typhus Pediculus humanus corporus is probably the sole agent in the transmission of Rickettsia, the typhus organism, from man to man, although both the head louse and crab louse can serve as host in which it can multiply. The usual route by which man becomes infected is through fecal contamination. The bit of the louse is not directly involved: Rickettsia do not Prof occur in the salivary good. HL Kamga 42

 Louse-borne typhus is a povertyassociated disease. Unsanitary conditions, hot climates with infrequent bathing and ineffective laundering lead to multiplication of lice, and consequent opportunities for transmission. Typhus is characterized by high fever, backache, bronchial disturbance, and mental confusion. On the 5th to 6th day, a red macular eruption appears on the chest and abdomen, later spreading to the other parts of the body.
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2. Epidemic relapsing fever The disease is caused by Borrelia recurrentis. The louse can acquire the pathogen by a single feeding on an infected person, but cannot pass it to second human in this way. Man acquires the pathogen by crushing the louse, usually in the act of scratching to alleviate the irritation caused by the bite, and in this way releases the spirochete, which then enters the excoriated skin or mucus membrane.
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The incubation period in the human is 3 to 10 days. The onset of the disease is sudden, with headaches, chills and fever and generalized pains. Fever remains high for several days and subsides abruptly, with an afebrile period of 3 to 10 days followed by one more relapses. Lice control Head louse and crab house of humans are all controlled in the same way. Prevention of lousiness is accomplished mainly by reducing intimate contacts. For the body louse, control may be achieved by frequent changes of clothing treating infected garments with hot water, or fumigation. Lotions containing a persistent insecticide, or an insecticide with short residual activity plus an ovicide, are highly successful.
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Chapter 3: CLASS INSECTA ORDER SIPHONAPTERA (FLEAS) Fleas are small wingless insects laterally compressed with long head, compact thorax and relatively large rounded abdomen. The eyes and antenna are small. Each antenna when not extended lies on the grooves of the sides of the head. Ventrally the head bears a series of appendages for sensory and feeding function. Adult fleas of all species are obligate ectoparasites of birds or mammals. They are moderately host-specific and their development takes place in the body of the particular host. The period of development from egg to pupa is about 2 weeks depending on the temperature. There are 2 larval stages before the pupal stage. They feed regularly on blood, this is the reason why they can transmit pathogen from host to host.
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Diagrammatic representation of a flea

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Morphology and behavior Fleas are small, agile, usually dark coloured, wingless insects with tube-like mouthparts adapted to feeding on the blood of their hosts. Their bodies are laterally compressed, (i.e., flattened side to side) permitting easy movement through the hairs (or feathers etc.) on the host's body. Their legs are long, the hind pair well adapted for jumping (vertically up to seven inches (18 cm); horizontally thirteen inches (33 cm) - around 200 times their own body length, making the flea the best jumper out of all animals (in comparison to body size).
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 The flea body is hard, polished, and covered with many hairs and short spines directed backward, allowing the flea a smooth passage through the hairs of its host. Its tough body is able to withstand great pressure, likely an adaptation to survive scratching etc. Even hard squeezing between the fingers is normally insufficient to kill the flea; it may be necessary to crush them between the fingernails or roll them between the fingers.
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Fleas lay tiny white oval shaped eggs. Their larvae are small and pale with bristles covering their worm-like body. They are without eyes, and have mouthparts adapted to chewing. While the adult flea's diet consists solely of blood, their larvae feed on various organic matter including the feces of mature fleas. In the pupae phase the larvae are enclosed in a silken, debris covered cocoon.
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Life cycle and habitat Fleas are holometabolous insects, going through the four life cycle stages of embryo, larva, pupa and imago (adult). The flea life cycle begins when the female lays after feeding. Adult fleas must feed on blood before they can become capable of reproduction. Eggs are laid in batches of up to 20 or so, usually on the host itself, which easily roll onto the ground. As such, areas where the host rests and sleeps become one of the primary habitats of eggs and developing fleas. The eggs take around two days to two weeks to hatch.
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Flea larvae emerge from the eggs to feed on any available organic material such as dead insects, feces and vegetable matter. They are blind and avoid sunlight, keeping to dark places like sand, cracks and crevices, and bedding. Given an adequate supply of food, larvae should pupate within 1-2 weeks. After going through three larval stages they spin a silken cocoon. After another week or two the adult flea is fully developed and ready to emerge from the cocoon. They may however remain resting during this period until they receive a signal that a host is near - vibrations (including sound), heat and carbon dioxide are all stimuli indicating the probable presence of a host. Fleas are known to overwinter in the larval or pupal stages.

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Once the flea reaches adulthood its primary goal is to find blood - adult fleas must feed on blood in order to reproduce. Adult fleas only have around a week to find food once they emerge, though they can survive two months to a year between meals. A flea population is unevenly distributed, with 50 percent eggs, 35 percent larvae, 10 percent pupae and 5 percent adults. Their total life cycle can take as little as two weeks, but may be lengthened to many months if conditions are favourable. Female fleas can lay 500 or more eggs over their life, allowing for phenomenal growth rates.
Micrograph of a flea larva
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Fleas and Diseases a)- Flea transmits plague to its host in biting by a mechanical transfer of the bacilli, by its infected mouthparts, or regurgitation of infected blood. Plague is caused by the bacterium Yersinia pestis, formerly characterized by the epidemic that has decimated human population of the old world. As soon as the etiologic agent is inoculated, it initially produces inflammation of the lymphatic gland giving a burbonic type.

Secondarily there is frequent involvement of blood (giving septicemia type) or the lung (giving the pneumonic type) with profuse hemorrhage. Plague develops rapidly with a rise of temperature within 2 to 3 days. There is headache, the eyes are injured and the face is characteristic of extreme illness. There is intensive rate dark coloration of the skin and mucus membrane in the fatal cases. This is the basis for the popular designation of diseases as the cause of Black Death. .
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Septicemic plague develops when the bacilli become distributed through the blood stream. Pneumonic plaque may be the terminal episode of an original burbonic plaque, may be secondary to septicemic plague or may be acquired directly by droplets spread inoculation from man to man through the respiratory tract. Plague is managed with drugs such as sulfonamides and tetracycline, once the diseases have been contracted. There is a vaccine available for immunization
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b)- Tunga penetrans, female is permanently adapted to the intracutaenous life on its host. It regularly infact man, pig and dog. The larvae are free living in dusty and sandly soil.when the adults are also free living, the fertilized female find a suitable host and penetrate in the skin, often between 8 to 12 days. The infection begins to irritate so that scratching helps to expel a large number of white eggs from the gigar.
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Flea treatments and control

For humans Flea "dirt" in the fur of a cat is actually excess blood (from host) consumed by the adult flea, passed as feces. The itching associated with flea bites can be treated with anti-itch creams, usually antihistaminics or hydrocortisone. Calamine lotion has been shown to lack any effect on itching. For pets The fleas, their larvae, or their eggs can be controlled with insecticides. Lufenuron and fipronil are popular veterinary preparation that attacks the larval flea's ability to produce chitin. Flea medicines need to be used with care as many, especially the acetylcholinesterase inhibitors, also affect mammals. Popular brands include Bayer Advantage, Advantix, and Frontline.
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For the home Combating a flea infestation in the home takes patience as for every flea found on an animal there are many more developing in the home. A spot-on insecticide will kill the fleas on the pet and in turn the pet itself will be a roving fleatrap and mop up newly hatched fleas. The environment ought to be treated with a fogger containing an insect growth regulator, such as pyriproxyfen or methoprene to kill eggs and pupae, which are quite resistant against insecticides.
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Chapter 4: CLASS INSECTA ORDER HEMIPTERA (TRUE BUGS) They have piecing and sucking mouthparts. Hemiptera usually have four wings folded flat over the body. There is often a visible triangle at the center of the back that the wing bases do not cover called the scutellum. The front pair are thickened and leathery at the base with membranous tips or ends. Mouthparts are formed for piercing and sucking and the beak arises from the front part of the head. They are found on plants and animals, or in water. Some true bugs cause considerable plant damage by their feeding. Some are beneficial because they prey on other insects. A few bite humans on occasion. Metamorphosis is gradual, with immatures usually quite like the adults but wingless. Most are under 1/2-inch long but some forms especially aquatic ones may be over 2 inches long
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They are also found on crevices of walls, ceiling, foams and furniture during the day. They come out to feed at night. They bits are characterized by severe and prolong itching and inflammation may result in secondary infection. Bite may also cause general allergic symptoms such as blurred vision, heart palpitation, headache and fever. Identifying characteristics for the order Hemiptera include: Front wings generally hemelytrous, i.e., thickened at the base and membranous at the tip. Hind wings membranous and shorter than the front wings. Antennae with 5 or fewer segments. Mouth with a 3- or 4-segmented beak arising from the front of the head. Tarsi with 3 or fewer segments.
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Photography of a Bug
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Bugs and diseases Bed bug has been experimentally incriminated as carrier of relapsing fever, plague, typhoid fever, kalaazer, epidemic typhus, but there is no direct evidence to show that they transmit these infections to man under natural conditions. Two species attack man: Cimex lectularis and Cimex hemipterus Reducviid bug, kissing bug and assassin bug are agents of chagas diseases. Trypanosoma cruzi multiples in the mid-gut and the arthropod may remain infective for about 2 years. One of the methods to diagnose chagas disease is to allow clean uninfected laboratory-bread reduviid bug to feed on suspected patient. This method is called Prof HL Kamga 64 Xenodiagnosis.

Chapter 5: CLASS INSECTA ORDER DIPTERA (True Flies) Diptera are 2 wings insects. All the wing members have only one paire of wings. Instead of a second posterior paire, there is a paire of short knobbed structure called haptere used in balancing the body. This order is divided into 3 Sub-order Nematoara subdivided into 5 families
Culicidae true mosquitoes Simulidae black flies Psychodidae sand flies Ceratopogonidae biting midges Chronomidae non biting midges
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Sub order Brachysera. With only one medically important family Tabanidae ex: Chrysops. Sub-order cyclorrhapda or muscoid flies subdivided into 6 families
Chloropdae or eye gnat Muscidae or house flies Glossinidae Tse-tse flies Callophoridae blow flies Sarcophagidae sarcophages Hypoboscidae house flies
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1 Sub-order Nematocera 1.1 True mosquitoes They have conspicuous proboscis and are important transmitting agents of viral, protozoan and helmintic diseases of man and animals. They can be distinguished from other diptera by Elongated mouth parts of the female adapted for piecing and sucking blood The long antenna The wing venation is characteristic with flat striated scales on the longitudinal veins and the posterior border. The body is divided in 3 main regions; the head which bears the eyes, the antenna and the mouth parts, the thorax to which the wings and legs are attached, and the abdomen bears the external genitalia.
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1.1.1 Habits and habitats of mosquitoes Mosquitoes are found throughout the world. Some species are essentially rural are, others are urban and domesticated. Still other are found only in the jungle and forest. All types of fresh water, marsh or polluted water provide breeding ground. Poorly drained or transiently inundated (temporary flooded) land support heavy population of mosquitoes. Favourable temperature, ample food supply for larvae and adult and protected breeding ground provide an abundance of mosquitoes.
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Homeothermal animals including man are the sources of blood for female mosquitoes. Some species are anthropophilic that is they prefer humans for food, while others are essentially zoophilic. Most mosquitoes are endophagic when they obtain their blood meal within man shelter and other are exophagic when they suck their blood meal out doors. Mosquitoes have been classified as endophilic when they remain inside manmade shelter and as exophilic, they spend a greater part of their genethrophic cycle out of doors.
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As a rule a pregnant female mosquito cant produce fertile eggs without taking blood. Most anopheles mosquitoes are aggressive biters by twi-light but stay inactive in bright daylight. The time of digestion of blood meal varies with the species of mosquitoes and also the temperature. Longer time is required in cold weather than warm weather.

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1.1.2 Life cycle of mosquitoes Mosquitoes undergo complete metamorphosis. The eggs produce voracious rapidly growing larvae that mold 4 times before they enter the non-feeding pupal stage from which the fully developed insect emerges. The length of time required from oviposition to adult varies from 2 weeks to 6 months depending on food supply and temperature. Moisture is necessary for the hatching of the eggs. Prof HL Kamga 72

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 The hatching time of the egg varies widely and the eggs of different species vary in their ability to withstand high and low temperatures. The larva breaks out of the anterior end of egg by using a sharp projection of his head. The pupa has the form of a question mark and the emergence of the adult often takes place at night when water is calm. The non-breeding stage lasts for about 4 to 5 days.
Life cycle of a mosquito
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1.1.3 Mosquitoes as vectors of diseases Mosquitoes serve as cyclical or mechanical vectors of 4 types of organisms pathogenic to man. Protozoa: Mosquitoes serve as vectors of plasmodium, causative agent of human malaria. In some areas of the world there are cases of mosquitoes without malaria. This phenomenon is explained on the basis of
Lack of suitable vectors Vector density below a critical level sufficient to maintain the disease Climatic condition infavourable to the development of mosquitoes.
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In certain areas however, 4 factors are important in the maintenance of the disease. Those that determine the stability of the diseases (mosquito longevity mosquito biting habit, the mosquito cycle of the malaria parasite Those that determine the initial transmission (eg mosquito density Those which determine the normal season of transmission (eg: climatic factors) The inoculation rate (how many sporozoites the mosquito infects in the human) and the state of communal immunity.

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It is recognized that malaria occurs in relatively stable and unstable conditions. In stable malaria, there is high rate of transmission to the affected population, no marked fluctuation occurs over the year, and a high collective immunity of the population makes epidemic unlikely. In unstable malaria, there is a marked seasonal or other fluctuation, and immunity of the population is often low. If there is some measurable incidence of the disease continuously present in a given area, the disease is said to be endemic and various degree of endemicity are recognized by the prefixes hyper hypo-holo.
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Filariasis: Filarisis is an infection of man by filarial nematodes, and mosquitoes are the vectors of 2 of those nematodes Wuchereria bancrofti Brugia malayi The development of both follow similar feature. The microorganism develops in the peripheral blood during feeding. The development of microfilaria takes place in the thoraxic muscles of the mosquito from where they migrate toward the stomach.

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 They undergo 2 molds before reaching the infective stage, they can then migrate to proboscis of mosquito from where they enter the definitive host during the mosquito blood meal. Infective larva enters the vertebrates host and develops into mature parasites. They produce microfilaria in the peripheral blood. In obstructive filarisis (elephantiasis) there is gross enlargement of structures (scortum, brest and legs) due to blockage of lump drenage as a consequence of many years of exposure.
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The microfilarias are particularly prevalent in the peripheral blood at night: they are periodic. The selective factor which dictate the periodictity is the response to the vector with the incidence of peripheral blood, microfilaria coinciding with the natural biting period of the local vectors. The periodic form with marked nocturnal periodicity is characteristic of humid tropics and is transmitted by night biting mosquitoes (eg: Culex fastigans). Bancroftian filariasis is largely an urban and suburban disease due to the habit of the principal vector (culex) while Brugian filariasis is a predominant disease of the far-East where its transmitted by Mansonia mosquito Prof HL Kamga 80

Yellow fever: Yellow fever is a disease of high mortality in adult and is transmitted by the domestic mosquito Aedes aegypti which breads in water tanks and containers near houses. The mosquito can only be infected by biting a patient during the first 3 days of the disease. The virus requires an incubation period of 11 days to become infective. Aedes africanus and Aedes simpsoni are also important natural hosts but Aedes aegypti is the vector of the epidemic disease. Dengue: Dengue is an endemic viral disease of low fataity characterized by abrupt onset, fever, rash, intramuscular and joint pains and marked hemorrhagic complication can also occur. The vector mosquito is Aedes egypti. The mosquito can acquire the infection up to 3 days after the initial symptoms, transmit it after being infected for about 7 days and may remain infectious for life. Viral encephalitis: This disease is transmitted by culine mosquito. There are various forms of viral encephalitis but only about 1% show clinical symptoms like fever, vomiting rigidity and mental confusion.
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Typical Anopheles mosquitoes

Aedes mosquitoes

Typical illustration of culex moscutoes (left) taking blood meal (right)

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1.1.4 Mosquito control The control of mosquito involves the knowledge of the habit of the particular species, the topography and the climate of the areas, racial and economic status of the population. Mosquitoes may be controlled in several ways. Elimination or reduction of breeding ground can be done in the following ways i)Local measures of Emptying containers of stagnant water Filling of depression and pools Screening of cisterns and others bodies of water that can be drained ii) Alternation of water level, flushing of streams which periodically alters the water levels as well as agitating the water iii) Removal of vegetation from bank and water surfaces and exposing water to wave action inhibit the breeding of mosquitoes.
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Destruction of mosquito larvae using i)Natural enemies (eg: fish gambusia) ii) Poison (larvicide) eg: oil Measures directed against the adult mosquito destroyed by trapping and screening of windows and doors using insecticides i)For the immediate killing of adult mosquito ii) For the residual killing of mosquito Protection against mosquito by building light airy rooms in which mosquitoes attack less readily than the dark rooms. In mosquito infested area the individual will be protected by applying mosquito repellents the skin and any other exposed parts of the body.
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1.2 Family Simulidae or black flies eg: Similium damnosum Characteristics: These flies are stout and small The mouth parts include blade and little style in the female used for peering The eyes are separated in the females but continuous above the antenna in males They are usually found in areas of swift flowing streams. They are nearly always found in water, shallow mountain torrent being the favoured breeding places.
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Black fly (Simulium damnosum)

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The larvae attach themselves to rocks or other solid materials in the steam. Nectar from flowers provides a very good support for male, but female usually require blood meal for ovarian development. As in other Nematocera the male never sucks blood. Larval food consists of small suspended crustacean, protozoa, algae and plants. There are about 6-7 larval stages. Pupation takes place in basket like cocoon. Cold weather retards the emergence of the adults. Simulies are daytime biters and are rarely found indoors.
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Black flies and disease

The most important human parasitic disease transmitted by Simulium flies in Onchocerciasis or river blinders causes by the filarial worm Onchocerca vulvulus. Both sexes occur in the subcutaneous nodules just under the skin and they are found mostly on the lower parts of the body. Deep nodules or bundles of worms may also occur against the joints, between the muscles and against the periostum of bone where they give rise to deep pain or rather they cause deep abscesses.
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The microfilaria produced viviparously by the female worms migrate to the skin from where they are picked up by the Simulium fly during the blood meal. They then migrate to the thoracic muscle of the fly where further development takes place. They then migrate to the vectors head and proboses from where they are transferred to the host during the flys blood meal. Reproduction and multiplication of the worms occurs only in the vertebrate host.
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In man, prolonged and repetitive exposure to infection by fly biting will progressively build up parasitemia. Only the Sarcophagia and not the adult worm produce important pathology in man; the lymph gland may be swollen and a form of elephantiasis may occur. Serious systemic involvement of lung and liver may develop.

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 The most important effect is the blindness resulting from microfilaria migration from the nodule through the skin of the face and the conjunctive to the eyes. Though massive involvement is needed to produce blindness, impaired vision may occur in up to 50% of the population. It requires a lot of worm to cause blindness.

Family ceratopogonidae or biting midges They are very small slender gnats. Their biting habits resemble those of simulid flies. They are anthropophagic and often mistaken for simulid. Only the females suck blood. Some of them are autogenic, although the females suck blood. Culicoides furens is vicious biter and has been known to be involved in the transfer of pathogemic nemathods, protozoa and viruses
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The night-biting Culicoides austeni is the intermedia host of Dipetalonema pestans. The microfilaria of D.pestans are found in the peripheral circulation both by day and night. The microfilaria undergo metamorphosis in the body of the fly and they appear on the proboses. Culicoides grahami is another intermediate host of D. streptocerca and Mansonella ozzardi to man.
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Family psychodida or sandfly. Genus: Phlebotomus The adults are small, with conspicuous black eyes, heavy body, wings and legs. The oval lanceolate wings are carried erect. The male and the unfed female can readily pass through the mosquito net, but fully engorged female is too large to pass through. Only the female feed on blood. Feeding occurs at right when there is little or no wind. Typical breeding places are indoor stores, cracks poultries, houses, and other situations combining darkness, humidity and the supply of organic matters which serve as food for the larvae. The bleeding place is never aquatic
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 The long ovoid eggs are laid in batches of about 50 in cracks and crevices in darks moist areas. The larvae feed on organic matters like excrements of lizards and rats. After 4 laval stages and the necked pupal stage, the adult emerges after 30 to 40 days. Most species of Phlebotomus are found in the warmer climates in the world and are noted for the transmission of sand fly fever the pathogen of Leishmaniasis and other viral infectious diseases.
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Sand-flies and diseases Sand-fly fever is an acute infection characterized by fever and severe headache. It is caused by an arbovirus and develops after rain. Only the female transmits the infection. Sand fly feed at daylight time, usually at ground level but rarely higher. Leishmaniasis are caused by parasitic protozoa which develop in the digestive tract of the insect. The disease is classified as visceral Leishmaniasis or Kala-azar and cutaneous Leishmaniasis.
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Kalaazar is a tropical spenomegalic disease cause by Leishmania donovoni. In man there is a progressive enlargement, the spleen and later of the liver. As the disease progresses the skin become greenish. Non-treatment leads to fatality. After some few weeks the conditions is still acute, but after 2 days, it evaluates to a chronic case.

Cutaneous leishmaniasis is a chronic disease known by various names: espundia, cuteneous leishmaniasis, chicklero ulcer. Leishmania is widely distributed in the tropics but the most serious cases are found in America. Espundia involves the nasopharyngeal region and may result in horrible disfiguring ulcer that may destroy the nasal cartilage and born. The most pathogenic is Leishmania braziliensis. A number of animals serve as reservoir of the infection eg: the rat.
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Sub-order Brachysera Family Tabanidae or horse flies They are large blood sucking flies known by the variety of names: horse flies, deer flies, mango flies or mangrove flies. They are heavy bodies and strong flyers. Only female bite and suck blood. Their eyes are very large and widely separated (dichroptic) in females. Males eyes are usually holoptic and together. The wing venation is characteristic. The mouthparts of the female are blade-like and function as cutting instruments, though it is fitted for sponging.
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 The breeding habit of most species is aquatic or semi aquatic. The eggs are deposited in layers on objects in slow water, or situation favorable to the larvae, eg: overhanging vegetation, projecting rocks and sticks and emerging aquatic vegetation. The larvae have a slender cylindral contractile body consisting of small head and 12 additional segments. The pupa resembles that of the butterfly. The adult fly emerges from the pupa case.
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Biological adaptation for transmission of pathogen

Anautogeny or requirement of blood meal for the maturation of eggs stimulates the hostsucking tabanid, to which transfer of pathogen from a carrier to the host is accidental Telmophagy or pool feeding is a rule. Microorganism from the lacerated superficial tissues and peripheral blood are drawn into the pool from which the fly such blood.

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Tabanid take relatively large blood meal which consequently can contain a large number of pathogens. Some species have a relatively engorgement time which permit adequate contact for the transfer of the pathogen Because of the intermittent feeding of Tabanid the likelihood of their being involved in the mechanical transmission, sick and healthy individuals may be attacked in succession by the same fly.

Horse flies and Disease Loa loa is an African worm that occurs in the tropical belt. The adult is found in the superficial subcutaneous connective tissue. Microfilaria of Loa loa are found in the peripheral blood fluid either at a diurnal or nocturnal periodicity. They are infected by Tabanid of the genus chrysops where they undergo development in the thoracic muscle. Metamorphosis is completed in 10 12 days and when the infected fly bits, the mature infective larva from the proboscis of the insect enters the skin of the host.
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Sub-order cyclorphapha or Muscoid flies (non-biting flies) This group includes 6 families, viz: Chlorpidae or eye flies Muscoidae or house flies Glossinidae or Tse-Tse flies Collophoridae or blow-flies Sarcophagidae or arcophagi Hypoboscidae or house flies
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All the cyclorrhapha have the following characteristics i) A pair of large compound eyes separated from each other in the female ii) An individual flagellum iii) The typical larvae is a maggot with the following characteristics Legless More or less cylindrical Distinctively segmented iv) They all have a complete metamorphosis
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Family Chloropidae They are very small They are attracted by sebaceous secretions, pus, blood, exposed genital organs of mammals They do not bite They cause myasis Medical importance of chloropidae Their habit of freely visiting sources of contamination readily predisposes them to mechanical transmission. They are suspected to be the transmitters of the organism causing bacterial conjunctivitis as well as organism responsible of the bacterial yaws. Prof HL Kamga 109

Family Glossinidea Tsetse flies are large, yellow-brown or brown-black and measure 6-15m in length. They are distinguished by a rigid projecting proboscis and a long pair of accompanying palps. There is a characteristic axe-shaped venation of the wings when viewed dorsally resembling an inverted hatchet in the central cell. The antennae appear short and feathery, and the abdomen is segmented and often striped or patched. Both males and females suck blood every 4-5 days, outside in open spaces.
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Female Tsetse flies are unique in the sense that they deposit larvae and do not lay eggs. The eggs mature within the female and are supplied with essential nourishment to complete larval development. This cycle requires a large number of blood meals to maintain and thus the female requires regular feeding. The larvae are normally deposited in shaded areas. There are three larval instars with the mature larva appearing white, visibly segmented with a pair of lobes at the posterior end. Pupation of the third instar results in a dark colored puparium with posterior lobes. The pupal period is extended (3-7 weeks) depending on the surrounding environmental conditions. Prof HL Kamga 111

Tsetse flies are vectors for African sleeping sickness (Trypanosoma brucei sp.) The two subspecies of T. brucei that infect Man are morphologically identical. T. b. gambiense causes Gambian sleeping sickness in Western Africa and T. b. rhodesiense causes Rhodesian sleeping sickness in East Africa. Another subspecies, T. b. brucei, causes nagana in cattle.
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Initially the patient has a headache, fever, chills and loss of appetite but specific clinical signs are absent. Parasitaemia comes in characteristic waves. Later, the spleen, liver and lymph nodes enlarge (Winterbottom's sign). Finally, there may be CNS involvement leading to coma and death within several years. Trypanosoma brucei rhodesiense (rural East Africa): this is so acute that the patient invariably dies before classical symptoms develop. Without appropriate treatment, both forms are fatal.
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Family Muscoidea Many of them are found indoors and are actual or potential menaces of human health. They habitually enter the house, come in contact with human food after breeding and feeding on excrement, death animals and other contaminated media. Those flies that have entered the man dominated ecological community and consequently coexist with man over an extended period of time are called Synanlthropic species. Various degree of synanlthropy exist from the total associated with man to quite a loose and facultative association. Total association involves complete dependence on the man-controlled environment including his households food for the complete development. The main medical significance of synanlthropy lies in its potential hygienic implication and the individual requirement of the fly. The classification of synanlthropy is highly significant medically.
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Tse-tse fly

Life Cycle of the Domestic fly

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Domestic fly

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Flies and Diseases

Buzzing flies may have a serious impact on individuals mental health, and some persons have pathological fear of flies. Generally a noisily buzzing blowfly within the house does not lead to mental well being. Flies as germ carries Houseflies are a danger to the health of man and animals principally because it carries and spreads disease organisms. They move from garbage and sewage to our dinner plates. It carries bacteria on the outside of its body, it regurgitates saliva and deposits wastes on human food. By comparison the cockroach is sanitary
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The house fly, by the nature of its structure and opportunistic habit is an important pathogentransmitting insect: It is an eusynanlthrope over most of its life. It freely enters houses and area where persons aggregate, as well as restaurants, stores and other places where human food is available, and it freely leave houses to frequent human and animal excrements. If feeds on human food and animal excrements alike. Because this fly can only take liquid food, it constantly vomits for the purpose of liquefying solid materials. In this deeding process, droplets Prof HL Kamga 118 of excrements are constantly deposited.

Structurally the fly is well adapted for picking up pathogens. Its proboscis is lined with a provision of fine hairs and pseudo-tracheal channels that readily collect contam inants. The foot of the fly presents a complexity of structure. Each of the 6 feet is fitted with heavy structures and parts that secrete a sticking material that adds to its collecting abilities. These habits and structure result in a remarkably effective mechanism, for mechanical transmission of any pathogen, small enough to be carried, particularly microorganism and helminthes.
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Diseases transmitted by house flies 1. Bacteria i) Bacterial enteric disease: housefly is involved in the transmission of the pathogenic enterobacteriacea. The bacteria involved belong to 3 genera Species of Shigella: important agents of bacterial dysentery and shigellosis man and can be transmitted through food, water and milk. Salmonella, the agent responsible of typhoid fever and other salmonellosis, Pathogenic Serotype of E.Coli: often associated with infant diarrhea and travelers disease in adults.
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 ii) Cholera: House flies have been incriminated as vectors of Vibrio cholerae, the causative agent of cholera, because, in 1886 this organism were found in flies caught. Subsequent isolation from flies and their feces, together with epidemiological evidence, confirmed that flies play important roles in transmitting the pathogen from human feces to uninfected individuals in endemic areas where water is not the major vehicle. iii) Yaws: This disease is caused by a spirochete Treponema Pertenue widely distributed in the tropics. The pathogen is found in superficial ulcers in the hands, feet, face and other parts of the body. Presence of the Yaws organism has been demonstrated in the mouthparts and legs of flies that has been feeding on ulcers of yaw patients. iv) Tuberculosis: Although flies have been incriminated in the transmission of Mycobacterium tuberculosis, no conclusive evidence have shown that that flies can transmit this organism in natural condition, though flies have been observed to feed on human sputum, and infective mycobacteria have been found in their feces.
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2. Poliomyelitis and other enteroviral infection Although non-biting and billing flies, as well as mosquitoes have been suspected as vectors of the polio virus, the greatest suspicion now rest on flies that feed and bred on excrement and garbage. A series of evidence suggest that houseflies can harbor the polio virus and under certain circumstances can transmit it either by external contamination or by internal passage following feeding on human food.
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3. Parasitic diseases Intestinal protozoa Entamoeba histolyhtica, the most frequent cause of amoebic dysentery in man and Giadia lamblia the agent of giardiasis have both been isolated from flies taken from around food destined for human consumption. Flies involvement assumes great importance in areas where unsanitary conditions prevail. The pathogen may also be transferred from feces to host by careless handling of food or contaminated water. Eggs of parasitic worms: Extensive work has confirmed the dispersal of eggs of parasitic worms by houseflies. The list includes eggs of Taenia species and nematodes species. The ability of houseflies to transmit these helminthes is unquestionable.
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Chapter 6: MYASIS
Myasis are defined as the invasion of living tissues of man and other animals by dipterial larvae.

Myasis producing flies belong to 4 families: Ostridae Sarcophagidae Calliphoridae Muscidae

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Classficiation of myasis Myasis is clinically classified as

Cutaneous myasis when the larvae live in or under the skin Intestinal myasis when the larvae are present in the stomach or/and the intestine. Atial myasis when the larvae I made the oral, nasal, ocular, sinual, vaginal and urethral cavities; all these are natural openings. Wound myasis: when the larvae invade artificial lesions.

Myasis can also be grouped according to their oviposition or larviposition habit into 3 classes.
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Specific myasis The diptera deposit their eggs or larva in or near living tissues and the larva inevitably become parasite. This group may be subdivided into: - Flies that deposit their eggs or larvae in the habitat of the host (bed, chair, etc) - Flies that deposit their eggs or larvae on the bobby of the host. - Flies that deposit their eggs or larvae in wound and diseased tissues. Semi-Specific myasis Semi-specific myasis flies usually deposit their eggs or larvae in the flesh or vegetable matters and less frequently in diseased tissues and neglected wounds. Large number of larvae so deposited often cause extensive tissue destruction. Accidental myasis Accidental myasis producing flies usually deposit their eggs or larvae in excrement or decay, organic matter and sometimes in food. Their larvae produce intestinal or urinary Prof HL Kamga 126 myasis.

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Myasis-producing flies important in human and veterinary medicine fall into 3 main families
Family Ostridea genera Dermatobia Gasterophilus Hypoderma Oestris Rhinoestris Calliphora Calliboga Calliphoridae Cordylobia Lucilia Phormia Sarcophagidae Sarcophagi
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Type of myasis Specific Specific Specific Specific Specific Non specific Specific

Location Cutaneous Atrial Internal Cutaneous Cutaneous Atrial Atrial Wound Cutaneous Atrial Wound Cutaneous Wound Wound Atrial Cutenaous Wound

Specific Specific Specific Specific

Common Myasis 1- Intestinal Myasis Intestinal myasis is largely accidental in man although 30 species of dipterous larvae have been found in gastro intestinal tract. These accidental invaders are from flies that breed on decay and organic matter such as Fannia canicularis and Eristalis tenax. The intestine is the normal environment of the parasitic gasterophilus larvae. The larva of the flesh fly Sarcophaga may gain entrance through the anus when the eggs are deposited in the anal orfice of infants. Many larvae may be destroyed by the digestive juice but many others survive to cause intestinal destruction.
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2- Urinary myasis The larvae of some 36 species of fly have been found in the urine; urethral infections are probably due to the invasion from the genitalia. 3- Cutaneous myasis The larvae of some 36 species of fly have been associated with cutaneous myasis. These larvae are able to burrow through necrotic or healthy tissues. Their progressive is facilitated by a secondary bacterial infection and possibly by their proteolytic secretions.
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Diagnosis of Myasis The identity of the parasite causing a particular myasis may be determined by rearing the adult fly from the larvae, except in case of obligation parasites that cannot be separated from the host. Their identity can also be determined from the morphology of the larvae itself, particularly the morphology of the posterior spiracles. The part containing the spiracle should be removed from the larva, treated overnight with sodium or potassium hydrate, washed and finally mounted for microcopic examination.
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Field improvised debridement During the First World War, it was noted that maggots infected wound healed more rapidly than other, probably because the maggots eat up the death tissues therefore reducing secondary bacterial infections. Maggots were used in deep tissues of soldier, and after war, they were used for similar purposes on civilians. Eventually flies were reared under sterile conditions and used in treatment of chronic osteromyelitis.
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Maggot therapy used in a small wound In controlled and sterile settings, maggot therapy (also known as Maggot Debridement Therapy (MDT), larval therapy, larva therapy, or larvae therapy) introduction of live, disinfected maggots or fly larvae into non-healing skin or soft tissue wounds of a human or other animal. This practice was widely used before the discovery of antibiotics, as it serves to clean the dead tissue within a wound in order to promote healing.
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Forensic Some types of maggots found on corpses can be of great use to forensic scientists. By their stage of development, these maggots can be used to give an indication of the time elapsed since death, as well as the place the organism died. The size of the house fly maggot is 9.5-19.1 mm (3/8 to 3/4 inch). At the height of the summer season, a generation of flies (egg to adult) may be produced in 12-14 days.
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Maggots are classified using "instar" stages. An instar I is about 2-5 mm long; instar II 6-14 mm; instar III 15-20 mm. These correspond to an age of 2-3 days, 3-4 days, and 4-6 days (for average house flies or bottle flies) since the eggs were laid. Some forensic scientists use this data to determine the approximate time of death of a human body.

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Control of myasis Sreaming of susceptible young domestic animal, treatment of wounds. Persons with catarrh or superlative lesions should not sleep in open air The eggs or larvae deposited on hair or skins may be destroyed by Kerosene. In cuteneous myasis, the larva paralyzed with chloroform or cocaine may be extracted by manual pression. Antihelmenthic drugs may be used for intestinal forms
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Chapter 7: CLASS CRUSTACEA A/ Cyclops Cyclops is a water flea measuring about 0.5mm long. The cephalothorax is ovoid bearing up to 5 segments, a pair of antennae and a double tail. Cyclops are free living aquatic arthropods seen more abundantly during dry seasons in shallow ponds, step wells and open wells.

Illustration of a Cyclops
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Cyclops and Diseases

Cyclops has been shown to be the developmental host of Dracunculus medinensis. Dracunculus medinensis, the guineas worn is a common parasite endemic in the tropics. Although a tissues parasite resembling the filaria, it does not have a true microfilarial stage. The small male worms are rarely several months development in the internal connective tissues, appear in the subcutaneous tissues. The skin of the ulcerates at the anterior end of the worm and larvae escape, usually when the leg is submerged in water. These larvae developed in the Cyclops. If humans drink water containing practices cyclops, infection occurs. The chitenous membrane of the Cyclops will help overcome the acidity of the stomach.
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The released larvae penetrate the duodenal mucosa and develop in the loose connective tissue. The worms are very long with the females measuring up to 2mm width. The male is much smaller and inconspicuous (2cm). The human infection, possibly the fiery serpent of the Bible is associated few symptoms which usually subside when the lesion erupts on the leg or the arm and the female worm emmerges. If the worm is removed, healing usually occurs without any problems. If the worm is damaged or broken during removal, there may be intense inflammatory reaction with possible cellulitis along the worms migratory tract. This can result in arthritis and synovitis. Prof HL Kamga 138

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In some region of the female worm is gradually removed from the tissues by rolling it up on the stick

Prawn (craw-fish) This is crustacean bearing a long narrow curved segmented body. The head bears two pairs of antennal and a pair of stalked eyes. Thoracic segments bear eight pairs appendages the first 3 bearing maxillipeds for feeding, while the remaining five act as walking legs (chela). The abdomen bears five pairs of paddle-like structure (swimmerets) while the last segment bears a fan shaped tail(telson) for swimming. The prawn is a familiar aquatic arthropod living in rivers and streams, feeding on dead, organic matters. The common genera Palaemon has been shown to serve as larval developmental host for the lung fluke, Paragonimus species.
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THE END. Thank you for your attention

Illustration of a prawn
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