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Common parasites of military importance


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Common parasites of military importance

  2. 2. CONTENTS1. Introduction of Parasites a. Definition of Parasites. b. Types of Parasites. c. Classification of Parasites. d. Lifecycle of Parasites. e. Groups of Parasites.2. List of Parasites of Medical Importance.3. Common Parasites of Military Importance. a. Pathogenic Intestinal Parasites. b. Malaria Parasites. c. Blood flukes. d. Filarial Parasites e. Haemoflagelates parasites f. Arthropods of Military Importance.4. Activities to Modify Risk of Infection. 25. Conclusion.
  3. 3. DEFINITION OF PARASITES (1)1. An animal or organism – lives on or in another organism and derives it nourishments there from.2. An obligate parasite – A parasite which is completely dependent upon the host (organism which harbour parasite and is usually larger than the parasite).3. A facultative parasite – An organism which is capable of living both freely and as a parasite.(Last J.M, 4th Edition A Dictionary of Epidemiology) 3
  4. 4. DEFINITION OF PARASITES (2)1. Parasites are organism that live inside humans or other organisms, who act as hosts.2. They are dependents on their hosts – unable to produce food or energy for themselves.3. Parasites are harmful to humans or other organism because: * they consume needed food * eat away body tissue and cells * eliminate toxics waste which makes people sick. 4
  5. 5. TYPES OF PARASITES1. Endoparasites - A parasites which lives within the body of the host. Example: Plasmodium vivax, Enterobuis vermicularis, Brugia malayi.2. Ectoparasites - A parasites which lives on the outside of the host. Example: Fleas, Tsetse Flies and lice. 5
  6. 6. CLASSIFICATION OF PARASITES1. Parasites are classified according to the International Code of Zoological Nomenclature.2. Major divisions of animal kingdom – Phylum, Class, Order, Family, Genus and Species.3. Main criteria – morphology and genetic structure of parasites.4. Each parasites is designated under the binomial (two names) system, genus and species: eg: Entamoeba histolytica. 6
  7. 7. LIFECYCLE OF PARASITES1. A parasite is dependent for its survival on transmissions from host to host.2. Lifecycle patterns: simple - involving a single host. : complex - involving 2 or more intermediate hosts3. Importance of lifecycle: diagnostic stage - diagnosis : infective stage - initiates infection : control program against parasites 7
  8. 8. GROUPS OF PARASITESParasites can be categorized into:1. Protozoa. eg: Plamodium vivax, Entamoeba histolytica, Toxoplasma gondii, and Pneumocystis carinii.2. Helminths. eg: Wuchereria bancrofti, Trichuris Trichiura, Enterobius and vermicularis.3. Arthropods. Fleas, Tsetse Flies and lice. 8
  9. 9. LIST OF PARASITES OF MEDICAL IMPORTANCE1. Entamoeba histolytica 12. Taenia saginata2. Naegleria fowleri 13. Hymenolepis nana3. Acanthamoeba sp. 14. Schistosoma spp.4. Giardia lamblia 15. Trichuris trichiura5. Leishmania donovani 16. Hymenolepis nana6. Trypanosoma cruzi 17. Enterobius vermicularis7. Plasmudium falciparum 18. Brugia malayi8. Plasmodium vivax 19. Ascaris lumbricoides9. Plasmodium ovale 20. Tsetse Flies10. Plasmodium malariae 21. Lice11. Toxoplasma gondii 22. Sarcoptes scabiei 9
  10. 10. COMMON PARASITES PARASITES OF MILITARY IMPORTANCE1. Entamoeba histolytica 11. Leishmania sp.2. Giardia lamblia 12. Trypanosoma sp.3. Plasmodium falciparum 13. Soft Ticks4. Plasmodium vivax 14. Tsetse Flies5. Plasmodium ovale6. Plasmodium malariae7. Schistosoma sp. (Blood flukes)8. Wuchereria bancrofti9. Brugia malayi10. Brugia timori 10
  11. 11. PATHOGENIC INTESTINAL PARASITE – Introduction (1) Entamoeba hystolytica • Worldwide distribution with higher incidence in developing countries. • This amoeba is the human intestinal tract parasite. • Humans are primary host for this pathogen. • It is spread via the anal to oral route. • Acquired form contaminated water, or foodstuffs contaminated by untreated sewage. Entamoeba histolytica cyst Entamoeba histolytica (infective stage) trophozoites 11
  12. 12. Entamoeba hystolytica – The life cycle (2) 12
  13. 13. Entamoeba histolytica – The Source of Infection in Military (3)• In military environment - parasite usually acquired by soldiers from: drinking water contaminated with fecal material from infected person (river/lake),• Food intake, contaminated with cysts of E.histolytica.• This happen because: when soldiers are tired, not enough facility to cook, lack of knowledge about hygiene. 13
  14. 14. Entamoeba histolytica of Military Importance (4)• The most pathogenic amoeba for humans (soldiers).• Infectious diseases – can be spread(Waterborne & Food borne Ds).• Worldwide distribution – military more expose to this parasite (jungle exercise, UN mission, war).• E. histolytica causes amoebic dysentery – the trophozoites invade intestinal wall, leading to formation of amoebic ulcers: characterized by bloody stools and diarrhea accompanied by abdominal pain.• Trophozoites penetrate the intestinal wall – spread to blood streams cause liver abcesses or spread to lungs and brain - resulting in death.• 14
  15. 15. Giardia lamblia -Introduction (1)• Giardia lamblia is a flagellate of world-wide distribution.• It is the most common flagellate of the intestinal tract causing Giardiasis. Giardiasis is an infection of the upper small bowel, which may cause diarrhoea.• G. lamblia is transmitted through ingestion of cysts in contaminated water or food.• It is a major cause of waterborne intestinal disease.• Has a high rate of person to person transmission.• Groups at increased risk - food handlers, travelers to endemic areas (such as St Petersburg, Russia), hikers and campers who neglect to adequately purify their water. 15
  16. 16. Giardia lamblia – The Lifecycle (2) 16
  17. 17. Giardia lamblia – The Source of Infection in Military (3)• The source of infection is from the contaminated water with cysts of Giardia lamblia which can be ingested from the river, lake, pond or from the well in rural area.• The other sources of infection are from food or dirty hands which contaminated with the cysts of G. lamblia.• Giardiasis is the waterborne disease – military may expose to this disease because the attitude of themselves who neglect to adequately purify their water – lack of hygiene knowledge, shortage of time in the war, lack of facilities to cook their food or water .• The military are always expose to the endemic area. Going for UN mission around the world. Military traveling to other countries and get infection to this parasite - called travelers disease. 17
  18. 18. Giardia lamblia of Military Importance (4)• Why the parasites are importance?• Parasites can cause many causalities in military. Operations can’t be execute with diarrhoeal soldiers.• Humans are the only important reservoir of the infection . Parasites loves soldiers with attitude of neglect the hygiene especially in the jungle or rural area.• G. lamblia has a high rate of person to person transmission.• The main symptoms of disease are abdominal pain, flatulence, and episodic diarrhoea with malabsorptive syndrome (steatorrhea) and periodical soreness in severe cases.• The parasites can be a disaster to military in the endemic area . Many soldier get sick and can’t going for war. 18
  19. 19. Malarial Parasites -Introduction (1) • Malarial parasites are known as Plasmodium spp. which cause the important tropical disease, Malaria. MalariaCASEVAC/MEDEVAC with 1-3 million deaths per year caused by is a global problemvia air ambulance falciparum malaria. • Plasmodium sp. are sporozoan obligate intracellularExercise Planning : 2 Scenarios 1. parasites of liver Burn blood cells - blood parasites. Scenario 1: and red • Scenario 2: Appendicitis 2. 4 species which infect both humans and animals: • Plasmodium falciparum • Plasmodium vivax • Plasmodium ovale • Plasmodium malariae 19
  20. 20. Malarial Parasites – The life cycle (2)Schema of the Life Cycle of Malaria 20
  21. 21. Malarial Parasites – The source of Infection and Transmission in Military (3) • Jungle is the main source of malarial parasites infection- ¾ of Malaysia covered by jungle. • The humidity, moderate temperature and clear water in the tropical rain forestsCASEVAC/MEDEVAC can enhance the survival of the parasites.via The Anopheles • air ambulance mosquitoes is the main vector of these parasites. • Why soldiers are the easiest groupExercise Planning : 2 Scenariosacquired the infection? 1. working environment ; in the jungle - expose to mosquitoes - Scenario 1: Burn 2.bites. Scenario 2: Appendicitis - lack of facility of battling the malaria - war, jungle exercise. - lack of knowledge of anti-malaria drugs - chemoprophylaxis. • The transmission of parasites requires two hosts, a. Intermediate invertebrate host (vector): Anopheles mosquitoes. b. Definitive vertebrate host: Humans (soldiers) Female anopheline mosquito 21
  22. 22. Malarial Parasites of Military Importance (4) • The parasite cause the most important communicable disease in the field for Malaysian soldier. • Malarial parasites has resulted in large number of casualtiesCASEVAC/MEDEVACvia air ambulance in when operating endemic area. Eg; Many causalities in US Forces when deployments in Vietnam, Africa, Middle East & Korea - weaken the fighting strength.Exercise Planning : 2 Scenarios • 1. Scenario 1: Burn are resistant to anti malarial drug - Certain parasites species could be one of the enemy during war! - eg; P.falciparum is 2. Scenario 2: Appendicitis resistant to chloroquine and other antimalarial drugs. • Parasites attack still become disaster and psychological stress in most military troops – no vaccine available to cure & can cause to death. • Parasites available for research in term of prevention by military. 22
  23. 23. Blood Flukes(Schistosoma sp.) – Introduction (1) • The Schistosoma sp. are blood trematodes. • There are 5 species of Schistosoma: • S. mansoni, S. haematobium, S. japonicum, S. mekongi, S. intercalatum. All with similar life cycle involving freshwater snails. • Distribution of parasites – S. haematobium (Africa, M/East, India), S.mansoni (Africa, Brazil, Surinam, Venezuela, Caribbean islands), S.japonicum (China, Philippines), S. mekongi (Laos, Cambodia), S.intercalatum (Central Africa). • Only trematodes that live in the blood stream of warm blooded hosts. • Have two hosts definitive host (human) and intermediate (snail). • Over 200 million people are infected and over at least 75 countries with 500 million or more exposed to infection. • The disease caused is called Schistosomiasis or Bilharzia. 23
  24. 24. Schistosoma sp. – The Lifecycle (2) 24
  25. 25. Schistosoma sp. – Source of Parasites infection (3) How people acquired the parasites infection – contact with water in the endemic area 25
  26. 26. Schistosoma sp. Source of Infection in Military (4)• Source of infection from the river, lake, valley or anyplace in the jungle with swampy area where snails can befound.• Military can easily acquired this parasites infection -working environment ; always contact with waterduring exercise or in war.• In the PBB mission especially in Africa and middleEast ; endemic area – military can easily acquiredinfection.• The infective stage of parasite is cercaria canpenetrate the military body through skin – results ofcontact with water where the snails are present. 26
  27. 27. Schistosoma sp. of Military Importance (4)• The parasites has resulted many casualties when operating inendemic area.• Parasites attack can become psychological stress in mostmilitary troops.• Military more expose to the source of infection – river, lake,swampy area with present of snails.• Parasites available for research in term of prevention by military. 27
  28. 28. Filarial Parasites – Introduction (1) • It is estimated that over 140 million people are infected with one or more species of filaria. • Parasites Inhabit a range of locations within the body; lymph glands, deep connective tissue, subcutaneous tissues or mesenteries. Invasions of these tissues cause typical symptom of a human filarial infection. In some cases these result in fleshy deformities known as elephantiasis. • There are 5 commonly pathogenic species infecting man: •Wuchereria bancrofti, Brugia malayi, Brugia timori, Onchocerca volvulus and Loa loa.ns •W. bancrofti is distributed throughout the tropical regions of Asia, Africa, China, the Pacific and isolated locations in the Americas. 28 •Endemic range of Brugia malayi is confined to South and South-East Asia from India in the west to Korea in the east
  29. 29. Filarial Parasites – The Lifecycles (2)Culcicine Anopheline Aedes polynesiensis 29
  30. 30. Filarial Parasite – Wuchereria bancrofti (3)•Wuchereria bancrofti is a nematode causing lymphatic filariasisthroughout the tropics and subtropics.•Transmitted by the mosquito,Culex quinquefasciatus, Anophelesgambiae and Anopheles funestus.•Humans are the only known reservoir host of W. bancrofti.•Infection rates in some communities in East Africa exceed 30% ofadults causing revolting swellings of the legs or genital system,known as elephantiasis in man.•The adult worm occurs in tightly coiled nodular masses in the major 30lymphatic ducts.
  31. 31. Filarial Parasite – Brugia malayi (4)• Brugia malayi is a nematode causing lymphatic filariasis inSouth East Asia.• Two strain of B. malayi:• 1. Nocturnal periodic strain – Asia, microfilariae highestconcentration between hours 10pm and 2 am.• 2. Subperiodic strain – Malaysia, Indonesia and Philippines,microfilariae detected between noon and 8pm.• Nocturnally periodic Brugian filariasis – transmitted by variousAnopheles sp. and Masonia mosquitoes – bites during night.• Nocturnal sub-periodic B.malayi – transmitted exclusively byMansonia sp.Mansonoa bonneae are important vectors in Malaysia – 31breeding in swamp forest and bitting by night.
  32. 32. Filarial Parasites – The source of infection in military (5)• Military can acquired this infection from swampy tropicsand subtropics forests. These the major habitats of theparasites and the their vectors (Anopheles, Culex andMansonia mosquitoes).Eg: Mansonoa bonneae are important vectors in Malaysia –breeding in swamp forest and bitting by night.• UN and other military mission to Africa, South-east Asia,Indonesia, Philippines, Timor Timor, Vietnam are the othersources of infection that military can acquired of theseparasites. Eg: During Vietnam war, many American soldiers infected bythe parasites including filarial parasite – soldiers had beenquarantine and not allow to donate their blood.The same practice also in Malaysia - Soldiers going back frommission are quarantine. 32
  33. 33. Filarial Parasites of Military Importance (6)• The infection of these parasites can cause many causalities inmilitary. Parasites Inhabit a range of locations within the body; lymphglands, deep connective tissue, subcutaneous tissues or mesenteries. Insome cases these result in fleshy deformities known as elephantiasis.• During Viet Nam War thousands of returning US troops carried theparasites - induced disease. Nearly 54,000 soldiers returning from OperationDessert Storm carried parasites disease including this parasite!• Military are the troops on the move, especially by sending them tothe mission. This means military have great expose to this parasite’sinfection in other countries.• This parasites can be spread easily by the mosquitoes vector and cancause disaster and psychological stress to military. Patients areasymptomatic and the attack are drastic!• The parasites can be transmitted from one person infected to othersby the mosquitoes vectors. Parasites can be spread and cannot becontrolled easily!• The parasites are useful to military because it can be used asexperiment organisms for R & D by means of the prevention to parasitedisease. 33
  34. 34. Haemoflagellates parasites (Leishmania sp.) Intoduction (1)•Two genera are medical importance: Leishmania sp. andTrypanosoma sp.• Leishmania sp is endemic in many parts of Africa, Asia andSouth America. It is transmitted by Phlebotomus species,Sandfly.• 7 species infecting human: L.donovani complex, L.major, L.tropica, L. aethiopica, L. mexicana complex, L. braziliensiscomplex, L. peruviana•Leishmaniasis is a vector-borne parasitic disease endemic in parts of thetropics, subtropics, and Southern Europe. The World Health Organization 34estimates that 1.5 million cases of CL and 500,000 cases of visceralleishmaniasis (VL) occur each year.
  35. 35. Haemoflagellates parasites (Leishmania sp.) Intoduction (2)• They cause diseases collectively known as Leishmaniasis. 3 types ofLeishmaniasis : visceral, cutaneous and mucocutaneous leishmaniasis.• Visceral leishmaniasis – sometimes known as kala-azar –caused by L.donovani complex; L.donovani, L.donovani infantum and L. donovanichagasi.• Cutaneous leishmaniasis – a vector- borne parasitic disease, is a riskfor military personnel who travel to tropics, subtropics and SouthernEurope where disease is endemic. It caused by L.tropica, L.major andL. aethiopica, L.mexicana.• Mucocutaneous leishmania – L. braziliensis. 35
  36. 36. Haemoflagellates parasites (Leishmania sp) – The Lifecycles (3) 36
  37. 37. Haemoflagellates parasites (Trypanosoma sp.) Introduction (4)•3 species of haemoflagellates Trypanosoma are responsiblefor disease in humans:• T. rhodesiense & T. gambiense• Salivarian trypanosomes – parasites complete dev. in salivarysystem of vector.-disease known as Trypanosomiasis. (sleeping sickness in Africa).- Distribution of parasites – T. rhodesiense(E. Africa), T. gambiense(W. Africa).-Transmitted of trypomastigotes by bitting flies of Genus Glossina(tsetse fly). 37
  38. 38. Haemoflagellates parasites Trypanosoma sp. – Introduction (5) Trypanosoma sp. Two form of trypomastigotes of T.rhodesiense & T.gambiense The infective stage is trypomastigotes which can invade the lymphatic tissue, heart, various organs- organs enlarge. Infection of central nervous system – leading to coma and death within several years. 38
  39. 39. Haemoflagellates parasites – Introduction (6)• Trypanosoma cruzi• Stercorian trypanosomes – complete their dev. in posteriorregion of vector, infective forms appear in the insects faeces.• This the aetiological agent of South and Central America.• Cause a disease known as Chagas’ disease.•The vectors are the blood sucking bug of the genera Triatoma,Panstroglus, Rhodnius.• Multiplication of T.cruzi at site of infection can produce inflamedswelling – chagoma. Oedema of upper & lower eyelid may occuralong with conjuctivitis – Ramona’s sign.• Insect Triatominae 39 T. Cruzi in blood sample Multiplication of T. cruzi in the muscle – Kissing bug
  40. 40. Haemoflagellates parasites (Trypanosoma sp.) The Lifecycles (7)Generalised life cycle of the Trypanosoma sp. whichcause African trypnaosomiasis. 40
  41. 41. Haemoflagellates parasites -The source of infection in Military (8) 1. Military acquired the infection of these parasites fm the endemic area in many parts of Africa, Asia and South America. 2. All forms of infection starts when a female sandfly (Phlebotomus sp.) takes a blood meal from an infected host. The countries with dessert eg; (Iraq, Kuwait and Afghanistan) usually the habitat for the sandfly, is also the main source for the infection this parasites. 41
  42. 42. Haemoflagellates parasites of Military Importance (9)1. The parasites, cause many causalities to the soldiers. Eg: There are 22 cases of chronic skin lesions of CL in US military personnel deployed during 2002-2003 to Afghanistan, Iraq and Kuwait.2. Parasites are easily transmitted from one infected soldier to others by sandfly (vector-borne parasitic disease) - is a risk for military personnel who travel to the endemic area.3. The World Health Organization estimates that 1.5 million cases of CL and 500,000 cases of VL occur each year – This amount of cases also can give bad impact to military. 42
  43. 43. Arthropods as an Ectoparasites - Introduction (1)1. The 2 most important classes of Arthropods are Insecta and Arachnida.2. Insecta – mosquitoes, flies, bugs, fleas. Arachnida – ticks, mites, spiders and scorpions.3. Arthropods may transmit disease by following methods:• Mechanical transmission : diseases producing agent does not multiply in the arthropod. eg: Salmonella trasmission by the house fly.• Biological transmission – arthropod is an integral part of the life cycle of parasites; Wuchereria bancrofti and Plasmodium sp in mosquitoes. (Zaman V. and Keong A.L, 3rd Edition Handbook of Medical Parasitology) 43
  44. 44. Arthropods of Military Importance - (2)1. Soft Ticks• Class: Arachnida.• Genus: Ornithodoros.• Worldwide distribution: Europe, Africa, Asia and the Americas.• Life cycles: hemimetabolous, eggs hatching six legged larvae – moult to eight legged nymphs. Larval instars requiring a blood meal to proceed for life cycle.• Disease – the most important disease is tick borne relapsing fever. Which occurs world wide and is spread by spirochaete infected Ornithodoros. 44
  45. 45. Arthropods of Military Importance - (3)2. Mosquitoes• Class: Insecta• Order: Diptera• Genus: Anopheles, Culex, Aedes, Mansonia.• Mosquitoes are the blood feeders (ectoparasites).• Also as vector to certain disease (Vectorborne disease).• Anopheles sp – vector for malaria parasites.• Culex sp – vectors for Wuchreraria bancrofti, Japanese Encephalitis.• Aedes sp a - vectors of Bancrofti filariasis and arboviruses such as yellow fever and dengue.• Mansonia sp – Brugia malayi. 45
  46. 46. Arthropods of Military Importance - (4)3. Tsetse Flies• Class: Insecta• Order: Diptera• Genus: Glossina• Tsetse flies are the blood feeders (ectoparasites) to cows and humans.• Also as vector to certain disease (Vectorborne disease).• Tsetse flies are Vectors for African sleeping sickness (T. rhodesiense and T.gambiense). 46
  47. 47. ACTIVITIES TO MODIFY RISK OF INFECTION1. Foodborne And Water Borne Infection• Avoid undercooked food, non bottled beverage sand non pasteurized dairy products.• Avoid consuming food sold by street vendors• Avoid salads and raw seafood• Peel fruit• Used bottled water for drinking, making ice cubes and brushing teeth.• Wash hands with soap and water or alcohol and sanitizers before each meal.• Carbonated beverages are safe.• Vaccines are available for hepatitis A and typhoid. 47
  48. 48. ACTIVITIES TO MODIFY RISK OF INFECTION2. Vectorborne Infection• Wear the uniform with the pants tucked into boots, sleeves worn down and undershirt tucked into the pants.• Minimize outdoor exposure during periods of insect activity.• Use 33% extended-duration DEET.• Impregnate uniform with permethrin.• Used insect netting sprayed with permethrin• Check for ticks regularly.• Use malaria chemo prophylaxis if indicated.• Vaccines are available for Yellow fever and Japanese B encephalitis. 48
  49. 49. ACTIVITIES TO MODIFY RISK OF INFECTION3. Respiratory infection• Wash hands regularly or use alcohol hand gel.• Avoid hand contact to the face.• Do not share drinking or eating utensils.• Use appropriate control measures when dealing with infected or potentially infected individuals• Submit to pre-and post deployment tuberculin skin testing.• Vaccines are available for measles, mumps, rubella, diphtheria, pertussis,meningococcus influenza, varicella, smallpox and anthrax. 49
  50. 50. ACTIVITIES TO MODIFY RISK OF INFECTION4. Zoonotic infection• Do not pet or feed animals (especially dogs).• Avoid direct contact with animals or animal products.• Do not stray animals as pets.• Use appropriate control measures when dealing with infected or potentially infected individuals• Vaccines is available for rabbies.• Vaccines are available for measles, mumps, rubella, diphtheria, pertussis,meningococcus influenza, varicella, smallpox and anthrax. 50
  51. 51. ACTIVITIES TO MODIFY RISK OF INFECTION5. Water exposure• Avoid swimming in fresh water, especially if it is stagnant or slowly flowing• Doxycycline chemo prophylaxis available.6. Soil exposure• Water toe covered footwear.• Avoid sitting in sandy areas with uncovered skin.• Avoid ingesting soil.• Vaccine is available for tetanus. 51
  52. 52. CONCLUSION1. Parasites are the organism that derives the lives on or in another organism and derives it nourishments from their host.2. Parasites can cause many casualty in the military operation.3. Parasites have their own importance whether in medical or in military.4. The effective prevention of parasites infection can conserve the military fighting strength.5. Soldiers must practice all the time the activities to modify the risk of infection. 52