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The Western Hemisphere was declared free of wild-type poliovirus in 1994, and the Western Pacifc Region was declared free in 2000. To ensure protection, all children should be immunized fully 1 against poliovirus. Importation of measles remains an important source for measles cases in the United States. People should be consid-3 ered susceptible to measles unless they have documentation of appropriate immuniza tion, physician-diagnosed measles, laboratory evidence of immunity to measles, or were born in the United States before 1957. For people born in the United States in 1957 or after, 2 doses of measles vaccine, the frst administered at or after 12 months of age, are required to ensure immunity (see Measles, p 489). The vaccine is available in the United States only in centers desig-1 nated by state health departments. Although rare, yellow fever continues to be reported among unimmunized travelers and may be fatal. Prevention measures against yellow fever should include protection against mosquito bites (see Prevention of Mosquitoborne Infections, p 209) and immunization. Whenever possible, immunization should be delayed until 9 months of age to minimize the risk of vaccine-associated encephalitis. In such cases, a notation of vaccine contraindication should be suffcient to satisfy local requirements. Travelers who have completed a 3-dose preexposure series or have received the full postexposure prophylaxis series do not require routine boosters, except after a likely rabies exposure. Periodic serum testing for rabies virus neutralizing antibody is not necessary for routine international travelers. In the tropics, transmission varies with monsoon rains and irrigation practices, and cases may occur year-round. Children returning to the United States who have signs or symptoms compatible with tuberculosis should be evaluated appro priately for tuberculosis disease. It may be prudent to perform a tuberculin skin test 8 to 12 weeks after return for children who spent 3 months or longer in a high-prevalence country. In addition to vaccine-preventable diseases, travelers to the tropics will be exposed to other diseases, such as malaria, which can be life threatening. Prevention strategies for malaria are twofold: prevention of mosquito bites and use of antimalarial chemoprophylaxis. For recommendations on appropriate use of chemopro phylaxis, including recommendations for pregnant women, infants, and breastfeeding mothers, see Malaria (p 483). Travelers diarrhea affects up to 60% of travelers but may be mitigated by attention to foods and beverages ingested (including ice). During international travel, families may want to carry an antimicrobial agent (eg, fuoroquinolone for people 16 years of age and older and azithro mycin for younger children) for treatment of signifcant diarrheal symptoms. They should be counseled on hand hygiene and avoidance of close contact with animals (dead or live). Organisms in category A cause anthrax, smallpox, plague, tularemia, botulism, and viral hemorrhagic fevers, including Ebola, Marburg, Lassa, Junin, and other related viruses. Category B agents are moderately easy to disseminate, cause moderate morbidity and low mortality rates, but still require enhanced diagnostic capacity and disease surveillance. Some examples of these agents include Coxiella burnetii (Q fever), Brucella species (brucellosis), Burkholderia mallei (glanders), Burkholderia pseudomallei (melioidosis), alphaviruses (Venezuelan equine, eastern equine, and western equine encephalitis), Rickettsia prowazekii (typhus), and toxins such as ricin toxin from Ricinus communis (castor beans) and Staphylococcus enterotoxin B. Additional category B agents that are foodborne or waterborne safety threats include, but are not limited to, Salmonella species, Shigella dysenteriae, Escherichia coli O157:H7, and Vibrio cholerae. Category C agents include emerging pathogens that could present a potential bioterrorism threat as scientifc information about these organisms increases. Public health assessment and prioritization of potential biological terrorism agents.

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It occurs as yellow to light-orange crystals or crystalline powder with a characteristic odor of ensilage. The circulating tretinoin levels represent only a portion of total tretinoin-associated retinoids, which would include metabolites of tretinoin and that sequestered into peripheral tissues. For hydroquinone quantifiable plasma concentrations were obtained in 18% (8 out of 44) Group I subjects. Patients were instructed to apply their study medication each night, after washing their face with a mild soapless cleanser, for 8 weeks. Instructions were given to apply a thin layer of study medication to the hyperpigmented lesion, making sure to cover the entire lesion including the outside borders extending to the normal pigmented skin. Protective clothing and avoidance of sunlight exposure to the face was recommended. Patients were evaluated for melasma severity at Baseline and at Weeks 1, 2, 4, and 8 of treatment. Primary efficacy was based on the proportion of patients who had an investigators assessment of treatment success, defined as the clearing of melasma at the end of the eight-week treatment period. The majority of patients enrolled in the two studies were white (approximately 66%) and female (approximately 98%). Assessment Scale: Cleared (melasma lesions approximately equivalent to surrounding normal skin or with minimal residual hyperpigmentation); Mild (slightly darker than the surrounding normal skin); Moderate (moderately darker than the surrounding normal skin); Severe (markedly darker than the surrounding normal skin). The remission periods appeared to shorten between progressive courses of treatment. Additionally, few patients maintained complete clearing of melasma (approximately 1 to 2%). They were to apply the study medication each night, after washing their face with a mild soapless cleanser. Excessive bleaching resulting in undesirable cosmetic effect in patients with darker skin cannot be excluded. The majority of patients developing this condition are Black, but it may also occur in Caucasians and Hispanics. Local irritation, such as skin reddening, peeling, mild burning sensation, dryness, and pruritus may be expected at the site of application. If a reaction suggests hypersensitivity or chemical irritation, the use of the medication should be discontinued. Information for Patients Exposure to sunlight, sunlamp, or ultraviolet light should be avoided. Patients who are consistently exposed to sunlight or skin irritants either through their work environment or habits should exercise particular caution. Sunscreen and protective covering (such as the use of a hat) over the treated areas should be used. Sunscreen use is an essential aspect of melasma therapy, as even minimal sunlight sustains melanocytic activity. Because of the drying effect of this medication, a moisturizer may be applied to the face in the morning after washing. If local irritation persists or becomes severe, application of the medication should be discontinued, and the health care provider consulted. Allergic contact dermatitis, blistering, crusting, and severe burning or swelling of the skin and irritation of the mucous membranes of the eyes, nose, and mouth require medical attention. If the medication is applied excessively, marked redness, peeling, or discomfort may occur. This medication is to be used as directed by the health care provider and should not be used for any disorder other than that for which it is prescribed. Patients are cautioned on concomitant use of medications that are known to be photosensitizing. Studies of hydroquinone in animals have demonstrated some evidence of carcinogenicity. This effect has been confirmed in a later study in pigmented mice, and dark pigmentation did not overcome the enhancement of photocarcinogenesis by 0. Although the significance of these studies to humans is not clear, patients should minimize exposure to sunlight or artificial ultraviolet irradiation sources. Mutagenicity studies were not conducted with this combination of active ingredients. Published studies have demonstrated that hydroquinone is a mutagen and a clastogen.

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To ease discomfort during a disease fare, select vegetables and fruits that are easier to digest, such as well cooked asparagus and potatoes, applesauce and melons. Steaming vegetables until they are very soft preserves more of the nutri ents than boiling them. Some vegetables, like broccoli, caulifower and Brussels sprouts, have a ten dency to produce gas. Vegetable stock is a good source of nutrients that can be used for making soup, or added to rice or pas ta. These grains are used to make products such as bread, pasta, oatmeal and breakfast cereal. Refned grains have been milled to remove the bran and germ, and they have a fner texture. Grains are important sources of fber, B vita mins and minerals (such as iron, magnesium and selenium). Nutritionists often recommend eating whole grain products because the pro cess of refning grains removes some of the iron and B vitamins. During a disease fare, foods containing refned grains are generally easier to digest. Most re fned grain products are enriched with B vitamins and iron, so you wont be missing these nutri ents. If you reduce your fber intake during a fare, slowly increase the amount you consume when you are feeling better. Choose the Best Sources of Protein Meat, seafood, beans, eggs, nuts and seeds are excellent sources of protein. They also provide B vitamins (niacin, thiamin, ribofavin 19 and B6), vitamin E, iron, zinc, magnesium and other nutrients. Animal proteins (fsh, beef, pork, poultry, eggs, and dairy) contain all the essential amino acids. Vegan sources of protein may not contain all amino acids but can be eaten in combination to provide all necessary protein. Eat a variety of protein sources to ensure that you consume all the required amino acids. Eat fsh, especially oily fsh that con tains omega-3 fatty acids, like tuna and salmon, and try smooth nut butters. Children ages 4 to 8 should consume 800 to 1,000 mg per day, and children ages 9 to 18 should consume 1,200 to 1,500 mg per day. To meet your calcium needs without a supple ment, aim to eat at least three to four servings of calcium-rich foods daily. Sources of calcium include milk (regular, lactose-free, calcium fortifed almond or soy), yogurt, cheese, calcium-fortifed orange juice and canned fsh. If you arent getting the recommended amount of calcium in your diet, you can add a calcium supplement. Maintain Adequate Caloric Intake Meeting the bodys calorie and protein de mands is essential to prevent tissue wasting and weight loss. Caloric needs may increase during times of stress, including infammation, fever and diar rhea. If your weight begins to drop, try adding about 250 to 500 calories more per day, and talk to your health care provider for additional strategies to maintain a healthy weight. It can also reveal whether your diet is providing an adequate supply of nutri ents. Tracking foods along with symptoms will be helpful when speaking to your physician or registered dietitian. You may not make the best food choices as you will be driven by hunger and the desire to feel full. This way, you can identify potential food prob lems and avoid feeling hurried by the server when reviewing options.

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Lambert-Eaton (myasthenic) syndrome Congenital myasthenic syndromes Diseases of Peripheral Nerve Charcot-Marie-Tooth disease mda. The combined cohort had the following characteristics: multiple episodes of visual Correspondence to loss, predominance for women, and lengthy time interval before the fellow eye is affected Dr. The visual prognosis is poor, and the majority of patients remain registered legally blind for the rest of their lives with a substantial impact on their quality of life. Funding information and disclosuresdeemedrelevant by the authors, ifany, areprovidedat the end of the article. Our aims were to 1) define the clinical pheno Standard protocol approvals, registrations, and patient type in a large cohort of patients with an over consents. One patient had bilateral visual loss at pre or nmo or white matter lesions or demyelination or harding or hardings). The search was conducted independently by 2 of the sentation, and the other 9 had sequential visual loss with authors (G. Data collection was conducted indepen intervals of up to 17 years before both eyes were affected dently by 2 of the authors (G. Five of disagreement, the relevant articles were re-reviewed to reach a con the patients had more than 2 episodes of visual loss over sensus. All 5 patients with mutations had severe and early optic nerve involvement (a subgroup containing only 209 patients from 5 studies,3,8,11213 although the lack of control groups in most of these studies makes this finding difficult to evaluate). From these 47 articles, we identified this group, there was a broad range of features, from 44 patients who met our criteria for inclusion. Based on Initial clinical presentation (n 5 46) the current population of approximately 63 million Initial presentation with visual symptoms, % (n) 73. Denominators vary for different metrics because information was not available from all How can we reconcile this conclusion with the patients for each measured characteristic. In this case, there would be interdependence, based on the above uncharacteristic features for and an interplay causing this unusual phenotype. James Overell who referred patients and the data are insufficient to offer clear guidance at for this study. Jacqueline Palace who provided additional information regarding previously published cases. A multiple sclerosis-like illness ment approaches in a prospective, objective way. The epidemiology of Leber hereditary optic of the studies needed to demonstrate a treatment effect neuropathy in the North East of England. Compston: study concept and design, data acquisition and optic neuropathy: a risk factor for multiple sclerosis. Leber hereditary the treatment of multiple sclerosis: report of the Thera optic neuropathy. The clinical profile of optic pyridine on vision in multiple sclerosis patients with optic neuritis: experience of the Optic Neuritis Treatment Trial. Preaxostyla Paratrimastix pyriformis Tritrichomonas foetus Trichomonas vaginalis Parabasalia Pentatrichomonas hominis Carpediemonas membranifera Ergobibamus cyprinoides Aduncisulcus paluster Chilomastix cuspidata Chilomastix caulleryi Kipferlia bialata Fornicata Dysnectes brevis Giardia intestinalis Spironucleus salmonicida Spironucleus barkhanus Spironucleus vortens Trepomonas sp.

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The diagnostic laparoscopy of a woman from Benin who had abdominal pain for 10 years found hundreds of calcified masses 1 to 2 cm in diameter in the abdominal cavity. Microscopy of the nodules revealed questionable remains of parasites, but the X-ray showed crescent or horseshoe-shaped calcifica tions that were attributed to Armillifer (Mulder, 1989). The Disease in Animals: Nonhuman primates are also accidental hosts of the infection. Source of Infection and Mode of Transmission: the reservoirs and definitive hosts of Armillifer spp. Man contracts the infection by consuming water or vegetables contaminated with eggs eliminated in the feces or saliva of infected snakes, by consuming raw or under cooked snake meat, or by placing hands to the mouth after handling contaminated snake meat. The other intermediate hosts also become infected by ingesting the par asite eggs. Diagnosis: Some cases can be diagnosed by radiographic examination, which reveals the calcified, half-moon-shaped larvae. In the overwhelming majority of cases, however, the encapsulated nymphs of the pentastomids are found during autopsies or laparotomies performed for other reasons. Jones and Riley (1991) iden tified a protein of Porocephalus crotali that combined with rat immune serum in the Western blot test; an enzyme-linked immunosorbent assay can thus presumably be designed for the diagnosis of pentastomiasis. Endoparasites of selected populations of cottontail rabbits (Sylvilagus floridanus) in the southeastern United States. Hepatic granuloma due to a nymph of Linguatula serrata in a woman from Michigan: A case report and review of the literature. Ocular linguatuliasis in Ecuador: Case report and morphometric study of the larva of Linguatula serrata. Man is not affected by specific ticks, but can occasionally be infested by ticks of other vertebrates that transmit various infections (Table 4). Ticks are divided into two groups: the family Argasidae, comprised of soft ticks whose bodies are covered by a coriaceous tegument, with the mouthparts located on the ventral surface, and the family Ixodidae, comprised of ticks which have an enlargement of the shield-shaped cuticle on their backs, and mouthparts on the anterior end. That shield covers the entire back in the males, but just the anterior half of the back in females, to permit their bodies to engorge while feeding. Ornithodoros, which transmit the relapsing fevers in man caused by strains of Borrelia recurrentis, and several species of Argas, in particular those of chickens, pigeons, and other birds that attack man when they cannot find their natural host. The species of Ornithodoros that infest man live hidden in the ground, in tools and equipment, and in the cracks of shack or cabin walls, and emerge at night to suck blood from people or chickens that take shelter there. The nymphs that go through four stages molt into adult males; those that go through five stages molt into adult females. Also, more than half of the females can survive between 9 and 56 months without feed ing. The cycle of Argas is similar to that of Ornithodoros,but the larvae feed by day as well as by night and can remain attached to the hosts skin, sucking blood, for several days. Among the hard ticks, the species of the genera Amblyomma, Boophilus, Dermacentor, Haemaphysalis, Hyalomma, Ixodes, and Rhipicephalus are important in human medicine. The life cycle of all these ticks is similar, with small variations among the genera. The female produces several thousand eggs at a time for a few days, and then dies. Hexapodal larvae emerge from the eggs; they measure about 1 mm in length, feed on blood for a few days, and molt into nymphs a few days there after. These differences are important in the spread of disease and the design of tick control plans. Geographic Distribution and Occurrence: the transmission areas of tick-borne infections are shown in Table 4.

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J Clin Microbiol 1978;3:51 good model for assessing the severity of disease in 61. Line and Western blot im populations residing in areas where the disease is munoassays for diagnosis of Mediterranean spotted endemic. Prevalence of rickettsia-like organisms and spotted this investigation was supported in part by the Naval fever group rickettsiae in ticks (Acari: Ixodidae) form Medical Research and Development Command, Research Zimbabwe. African tick-bite fever: a new spotted fever group rickettsiosis under an old name. Serologic of antibodies to Coxiella burnetii, Rickettsia conorii, and typing of rickettsiae of the spotted fever group by Rickettsia typhi in seven African countries. Two ad is crossed by the trans-African highway, which con ditional sites in the capital city, Bangui, were nects West and Central Africa with East Africa included to perform testing for laborers and univer (Figure 1). However, except in small studies to the National Public Health Laboratory in Bangui. Public Health Service guidelines for con rican Republic have not been characterized. This is confirmed by the wide variety of study, the extremely wide pattern of serologic reac genotypes (subtypes) found in the republic in the past (1), and suggests that in certain populations, Table. Bambari Since the quantity of specimens collected in this Prenatal clinic women 20 (13. Until 1991 when it in amebae simulates the mechanism of infection in was described and given the name Sarcobium humans (9,10). The ability of Legionella lyticum (5), it was simply referred to as an obligate pneumophila to infect epithelial cells in vitro is also intracellular bacterial parasite of free-living ame enhanced by prior cultivation of the bacteria in ame bae (6, 7). Clinical samples from the patient were culture and serologi cally negative for L. However, incubation of the sputum sample with Acanthamoeba polyphaga resulted in numerous bacteria-infected amebae. The patient demonstrated a fourfold rise in antibody titer to the bacteria from the infected amebae. Transmission electron micrograph of further serologic evidence for the involvement of Sarcobium lyticum within Acanthamoeba castellanii. Each strain was sequenced at least 3 times to ascertain accuracy of obtained results. Ambiguous and hypervariable regions were removed before phylogenetic analysis, which was carried out on 53 strains for 1303 nucleotides by the neighbor-joining method from the Phylogeny Inference Package (Phylip) (33), version 3. Multiple datasets (X100) were analyzed, and different distance models were compared to ensure reliability. It is also possible that these strains single well-defined clade, most closely related represent more than five species because, even (>96. The gas liquid influencing growth are yet to be determined, but chromatography fatty acid profiles obtained, how sodium selenate and alanine may not necessarily ever, appeared to be distinct from those of other be required for growth. All colonies had the characteristic cut 12 Legionella-like amebal pathogens be included in glass appearance associated with legionellae. Preliminary report on the pathogenicity appropriate for the strain formerly classified as S. Current views on the relationship Manual of Determinative Bacteriology as follows: between amoebae, legionellae and man. Isolation of Legionella pneumophila from clinical specimens via amoebae, and the interaction There is no known soil or animal source. Comparison of guinea lular parasites of amebae that exhibit little or no pig and protozoan models for determining virulence of growth on current laboratory media. Retrospective study of Gen-Probe Rapid Diagnostic current status and emerging perspectives. Proceedings of the 35th Interscience Conference on Proceedings of the 96th Annual General Meeting of the Antimicrobial Agents and Chemotherapy. J Clin Microbiol respiratory tract infections in adults: incidence, etiology, 1980;12:32-4.

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After successful establishment on the mucosa the bacteria produce endotoxins which pass into systemic circulation and initiate bronchoconstriction, pulmonary hypertension and pulmonary oedema. The bacterial fimbriae attach on the receptor sites on the villous epithelial cells and the bacteria multiply and colonise the villous surface. The colonisation of the villi and production of enterotoxins disrupt the absorptive mechanisms on the intestinal surface resulting in the secretion of fluids and 53 electrolytes from the systemic circulation into the intestinal lumen. This leads to electrolyte imbalance, dehydration, acidosis, hyperkalemia, circulatory failure and death. Clinical and pathological features Septicaemic colibacillosis is common in lambs and kids. Lambs and kids of 1-2 days and 3-8 weeks old have been found to be the most susceptible groups. The syndrome may be peracute in which case sudden death occurs without any premonitory signs. The acute disease is characterised by stiff gait or recumbency, depression, fever, hyperaesthesia and tetanic convulsions. No gross pathological lesions are observed in peracute septicaemic colibacillosis because of sudden death. In the acute form there are widespread subserosal and submucosal petechial haemorrhages. Enteric colibacillosis is manifested mainly by a haemorrhagic or mucoid diarrhoea various degrees of diarrhoea and slight fever. Other enteropathogens such as rotaviruses, salmonellae and Campylobacter spp may also be involved and complicate the clinical picture. Pathologically there are widespread haemorrhages in the intestinal mucosa and large numbers of the bacteria can be demonstrated in smears from the intestinal mucosa. Diagnosis the epidemiology, clinical signs, pathological features and, response to treatment may support a presumptive diagnosis of colibacillosis. Bacterial culture alone is of limited use because of the presence of non-pathogenic strains of E. In the peracute form of the disease the organisms may be isolated from abdominal viscera and heart blood. The differential diagnosis of colisepticaemia include clostridial enterotoxaemia and salmonellosis. These conditions can be confirmed by isolation and identification of the causative bacteria. The differential diagnosis of enteric colibacillosis include dietetic diarrhoea, coccidiosis and campylobacteriosis. Dietetic diarrhoea is manifested by passage of voluminous and pasty or gelatinous faeces and the animals are usually bright or alert although they may be inappetent. Other enteritides can be differentiated by isolation and identification of their aetiologic agents 54 Treatment and Control In view of the diversity of strains of E. Trimethoprim-sulphonamide combination (15-25 mg/kg) and kanamycin (20 mg/kg) given parenterally and colistin administered at a rate of 1-2 g/kg in drinking water have been found to be effective in the treatment of the disease. Other antibiotics such as oxytetracycline, neomycin, chloramphenicol and sulphadimidine are also used. Vaccination of dams 2-4 weeks before parturition to stimulate production of specific antibodies is recommended in order to provide passive protection bf neonatal lambs and kids through colostral immunoglobulins. Ewes have to be vaccinated twice in their first year of lambing, first at 8-10 weeks and then at 2-4 weeks before lambing. In subsequent years, one vaccination 2-4 weeks before parturition has been found to be satisfactory. Maintenance of good hygiene in the animal environment can reduce transmission and incidence of the disease. Provision of adequate colostrum to newly born kids and lambs will help to protect them from colisepticaemia.

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Biological factors of relevance to hum an health behavioural and developmental characteristics, both are largely similar in appearance and their differences have little significance for the purposes of this chapter. The establishment of rodents and lagomorphs in urban environments depends on a variety of factors, especially those that affect the availability of key food resources and Like rodents, rabbits and hares have high reproductive potential, becoming mature in shelter. Obviously, heavily developed areas that are almost completely devoid of vegeta about 3 months and having multiple litters per year. Gestation periods are about 40 days tion, water sources or other essential environmental factors will have few non-commen in the genus Lepus, but closer to 30 days in other genera. On the other hand, at least a few non-commensal rodents are likely to be offspring, typically being larger in Sylvilagus spp. M any rodents and lagomorphs will invade sites that offer food or shelter, including those near urban areas (M acDonald, the European rabbit was originally found in central Europe and the Carpathians, but is 1984). Usually these movements simply allow a particular species to take advantage of now widespread in western and central Europe, although its numbers have been redu valuable but transient resources. If favourable conditions persist, however, these animals ced by myxoma virus infections. These rabbits occur on sandy and light clay soils in are likely to remain in the area, perhaps breeding successfully and establishing more or woods, particularly those dominated by conifers. The ability of rodents to invade and quickly exploit newly these rabbits are not found in high mountains. When present in high numbers, they can available habitats is favoured not only by their behavioural adaptability, but also is favou be significant agricultural pests. Another important species is the European (or brown) hare (Lepus europaeus), which is found not only in Europe, but is also found as introduced populations in some areas of the temporary invasion of normally marginal habitats by either rodents or lagomorphs, North America. In Europe, it occurs in flat country (often near cultivated fields), deci or the favourable alteration by humans of habitats otherwise unsuitable for these ani duous woods, moors and dune areas, and it will occupy sites higher in mountains than mals, can have significant implications for human health. Like the European rabbit, the European hare commonly enters these animals and people, the risk that people will be exposed to rodent-related disease areas inhabited by people and can cause agricultural damage. For example, in 1993, a previously unrecognized hanta turnal but also can be active during daylight hours. This outbreak occur red in the wake of an El Nino event that resulted in enhanced food sources and tremen the North American rabbit and hare species of greatest importance to people are the dous population increases of deer mice, which were found to be the primary reservoir of various cottontail rabbits (Sylvilagus spp. As deer mouse populations increased to extraordinary levels, the mice frequently jackrabbit (Lepus californicus) and the white-tailed jackrabbit (Lepus townsendii). In gene ral, these rabbits prefer brushy sites or shrub-filled forest clearings, but they also can be Also, as mouse populations decreased dramatically in the drier years that followed this common in cultivated areas, parks and well-vegetated home sites. Jackrabbits are resi El Nino event, so did the risk of people being exposed to hantavirus. In this instance, peo dents of the more wide open landscapes of western North America and are less likely to ple were exposed when individual mice from the expanding mouse populations entered occur in close proximity to people, although some claim they cause agricultural damage. The most important cottontail rabbits are the eastern cottontail (Sylvilagus floridanus), desert cottontail (Sylvilagus audubonii), and mountain cottontail (Sylvilagus nuttalli). Eastern cottontails occur throughout the eastern half of the continent and northern South America (Chapman, Hockman & Ojeda, 1980). Desert cottontails and mountain cotton tails are found in the western half of the continent, with the former species occurring at 432 433 Non-commensal rodents and lagomorphs Public Health Significance of Urban Pests 13. Non-commensal rodents and lagomorphs also can affect the risk of human disease by providing the blood-meals that vectors need to successfully develop and reproduce. In the transmission of disease agents from non-commensal rodents or lagomorphs to peo most instances, a positive correlation exists between the density of rodent or lagomorph ple can occur through many routes. People are believed to become infected with various hosts and the abundance of the arthropod vectors that feed on these animals. The risk to hantaviral agents through inhalation or direct contact with rodent excreta. Human expo people of exposure to rodent or lagomorph-related disease agents transmitted by vec sures to Puumala virus, a hantaviral agent found in voles, probably result from people tors can be expected to increase as vector populations also increase, particularly when the handling or inhaling virus particles aerosolized from hay, woodpiles or other materials vector populations undergoing expansion occur in areas heavily utilized by people. The small fox tape infested spaces (or otherwise disturbing infectious rodent excreta), especially when such worm (Echinococcus multilocularis), which causes the emerging disease alveolar echino disturbances take place in spaces that have remained enclosed and darkened for long per coccosis, uses non-commensal rodents as intermediate hosts for its immature stages. People become infected not through contact with the rodent inter 1996, 2002; M ills et al.

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Its life cycle is similar to that species, but it uses the snails Bithynia (Bulimus) leachi, B. Freshwater fish of the genera Barbus, Blicca, Leuciscus,orTinca serve as the second intermediate host. In 1981, the prevalence of human opisthorchiasis in northeastern Thailand was 35%; however, a decade after the establishment in 1988 of a national control program involving diagnosis, treatment, and education, the rate had fallen to 18. In Laos, a study conducted in the early 1990s showed that 90% of the males in the villages surveyed were infected with the adult parasite, as were 36% of the domestic or stray cats tested, while 0. There are smaller foci in eastern, southern, and central Europe, the Democratic Peoples Republic of Korea, and possibly India, Japan, and the Philippines. In some hyperen demic areas, such as Siberia, the infection rate is very high not only in the nomadic population but also among people living in some urban areas. In Kazakhstan, 100% of the specimens of some species of fish were found to have metacercariae. The snails that serve as the first intermediate host are very abun dant in certain endemic regions, and their infection rate is high. A study carried out in the Ural region between 1986 and 1991 revealed infections in 10% to 30% of the human population tested, 0. In the same parish, 3 of 100 dogs examined had parasites, whereas none of 80 swine tested had the parasite. The Disease in Man and Animals: the infection causes hepatomegaly, and in most cases, pericholangitis. These changes are restricted to the medium-sized and large bile ducts, which are the sites occupied by the parasite. The most common damage is dilation of the ducts, with hyperplasia, desquamation, proliferation, and adenomatous transformation of the epithelial cells, and infiltration of the wall with connective tissue. Dilation of the gallbladder, chronic cholecystitis, and carcinomas occur only in adults (Riganti et al. In general, when only a few parasites are present, the infection is asymptomatic, even though there may be appreciable damage to the bile capillaries. With a parasitosis of medium intensity there is fever, diarrhea, flatulence, moderate jaundice, asthenia, cephalalgia, hepatomegaly, and passive congestion of the spleen. In chronic cases with a large parasite burden, there may be mechanical obstruction and biliary stasis, as well as secondary infections with cholangitis, cholangiohepatitis, and formation of micro and macroabscesses. When the para sitosis is massive, there may also be invasion of the pancreas, producing catarrhal inflammation of the pancreatic ducts. It is thought that Opisthorchis may play a role in the development of hepatic carcinomas, especially cholangiocarcinomas. Although a close correlation has been observed between the infection and this type of cancer in the parasites endemic areas, there are also areas with high prevalence of the can cer in which the parasite is not present (Sinawat et al. In a study conducted in an endemic area, the levels of antibody to the parasite were lower in individuals who had parasite eggs in their feces than in those who were not shedding eggs. This finding was interpreted as evidence that the infection produces protective immunity (Akai et al. However, the prevalence rate, number of eggs in feces, and number of parasites in the liver become stabilized in adults (Sithithaworn et al. Source of Infection and Mode of Transmission: Man and other definitive hosts become infected by eating raw or undercooked fish containing metacercariae. Human opisthorchiasis occurs only where appropriate intermediate hosts, especially snails, are found, and where people customarily eat raw, lightly salted, or sun-dried fish. High rates of infection have been found among Thai workers in other Asian countries. In highly endemic areas, it is thought that man is primarily responsible for maintaining the cycle, since people contaminate rivers and lakes with fecal matter containing the eggs of the parasite. Fecal matter deposited by animals on riverbanks is washed into watercourses by rain. Diagnosis: Laboratory diagnosis is based on demonstrating the presence of para site eggs in feces either by sedimentation techniques or by duodenal probe.

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Another difficulty in diagnosis by microscopic examination of blood prepa rations is the low parasitemia that occurs in nonhuman primates. To get around this difficulty, inoculation of blood into susceptible monkeys is recommended. Although serologic reactions are useful as a means of confirming malarial infection, they are rarely specific enough to identify the Plasmodium species involved. Control: Malaria experts agree that malaria of nonhuman primates does not con stitute an obstacle for programs to control and eradicate human malaria. The human infection has been eradicated from some parts of Brazil, although high rates of infection in monkeys persist. Given the small number of confirmed cases of human infection by plasmodia of simian origin and the benign nature of the clinical mani festations, special control measures are not justified. To prevent the disease, nonimmune persons who must go into the jungle should use insect repellents on exposed body parts and on clothing. Regular use of chemo prophylaxis would be justified only if the nonimmune person had to live in an area where human malaria is endemic. A primate model for human cerebral malaria: Plasmodium coatneyi-infected rhesus monkeys. In: First Inter American Conference on Conservation and Utilization of American Nonhuman Primates in Biomedical Research. Studies on transmission of simian malaria and on a natural infection of man with Plasmodium simium in Brazil. Sero-epidemiological stud ies of malaria in Indian tribes of the Amazon Basin of Brazil. The evolution of primate malaria parasites based on the gene encoding cytochrome b from the linear mitochondial genome. A nonhuman primate model for human cerebral malaria: Rhesus monkeys experimentally infected with Plasmodium fragile. Plasmodium ovale: Observations on the parasite development in Saimiri monkey hepatocytes in vivo and in vitro in contrast with its inability to induce parasitemia. Hydrolytic enzymes of rhesus placenta during Plasmodium cynomolgi infection: Ultrastructural and biochemical studies. Although there are some 700 species that infect verte brates and invertebrates, the species identified to date as parasites of man are Enterocytozoon bieneusi, Encephalitozoon intestinalis (formerly Septata intesti nalis), Encephalitozoon hellem, Encephalitozoon cuniculi, and some species of the genera Nosema, Pleistophora, Trachipleistophora, and Vittaforma (Scaglia et al. Enterocytozoon causes intestinal infections almost exclusively, while Encephalitozoon may cause intestinal or systemic infections which may spread to various organs. Parasites of the genera Nosema, Pleistophora, Trachipleistophora, and Vittaforma are uncommon in man and do not affect the intestine (Field et al. Proof of the existence of isolates with genetic differences exists, at least within E. The genera Cryptosporidium, Isospora, and Cyclospora belong to a completely different phylum: Apicomplexa (formerly Esporozoa). The spores are released from the host cell and are eliminated into the external environment, where they may infect other individuals. At their anterior end, they have an extrusion apparatus, the polaroplast, which everts the polar tube or filament that is coiled around the polaroplast and sporoplasm within the spore. Infection takes place when the polar tube is extruded and penetrates the host cell, allowing the sporoplasm to pass through it and enter the host. Occurrence in Man: Microsporidiosis is one of the most frequent complications occurring in immunodeficient patients, but it is rare in immunocompetent individu als. As of 1994, more than 400 cases had been recognized, most in immunodeficient patients. The parasites were detected in 60% of patients with chronic diarrhea but in only 5. Occurrence in Animals: Microsporidiosis occurs in a great number of vertebrate and invertebrate species, but as it is not generally pathogenic for vertebrates, its dis covery is accidental, and there are thus no reliable statistics on its frequency. Although the causes of the intestinal disease are not well understood, it is presumed that it is due to loss of microvilli and enterocytes.

References:

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  • https://www.azdhs.gov/documents/director/border-health/frontiers-emergent-public-health-issues.pdf