1. Direct Effects of Arthropods

2. Prevent Disease, Disability and Premature Death Recall the direct medical effects of selected arthropods on humans. Objective هدف

3. Prevent Disease, Disability and Premature Death Terminology Effect on Humans Medical Condition Overview مرور

4. Prevent Disease, Disability and Premature Death Entomophobia The irrational fear of arthropods or what they might do. Often results in exaggerated fear of places where the feared arthropods may be found Often results behavior that is not appropriate to the actual threat (i.e. evacuate your home if you find a spider) May lead to “refusal to go” if ordered to deploy to that place.

5. Prevent Disease, Disability and Premature Death Entomophobia Where do we derive or fears? Television Newspapers Magazines “Armchair Experts”

6. Prevent Disease, Disability and Premature Death Delusory Parasitosis The persistent, sincere, but mistaken belief that arthropods are living on the person. May present clinically as complaints that “bugs” are all over & can't be removed. May continually wipe exposed skin with tissues or show other unusual behavior. Examination may show mild to severe irritation from scratching or itching, but no insects.

7. Prevent Disease, Disability and Premature Death Nuisance Effects A group of somewhat related conditions caused by insects are lumped together under the general heading of "nuisances." Although some can be carriers of diseases, they are generally referred to as “nuisance pests.”

8. Prevent Disease, Disability and Premature Death Nuisance Effects Four general categories: Annoyance: flies buzzing around the head Accidental injury: gnat gets stuck in your eye Dermatosis: itchy skin after a mosquito bite Allergic reactions: hay fever-like symptoms after breathing in dust mites

9. Prevent Disease, Disability and Premature Death Flies -- How many are too many?

10. Prevent Disease, Disability and Premature Death Annoyance: Mild/General annoyance – flies circling your food while you’re trying to eat Severe annoyance -- biting bugs so numerous they stop normal activities by: Discouraging activity due to their presence. Distracting people so they cannot effectively perform their duties (flightline) Extreme annoyance -- bugs so numerous their feeding causes mild anemia through blood loss. Nuisance Effects

11. Prevent Disease, Disability and Premature Death Accidental Injury Physical contact of an insect with a sensory organ can cause mild discomfort to severe pain. Nuisance Effects Photo: Corneal laceration of motorcyclist from high-speed impact with a beetle.

12. Prevent Disease, Disability and Premature Death Dermatoses Reddening & mild swelling of skin, accompanied by itching or pain Skin lesions and/or skin irritation (For our purposes, skin lesions caused by contact with insects & their saliva or venoms.) Nuisance Effects

13. Prevent Disease, Disability and Premature Death Dermatoses – Skin irritation caused by: Bites & stings (can last from a few minutes to a few days) Skin invasion by arthropods (infestation) Photo: Dermatoses caused by bed bug bites. Nuisance Effects

14. Prevent Disease, Disability and Premature Death Dermatoses Terms: Infestation: A condition where arthopods actually live on or in the skin, or in clothing in direct contact with skin for extended periods of time. Pediculosis is specific infestation by lice, of any species Nuisance Effects

15. Prevent Disease, Disability and Premature Death Infestation of the skin by the scabies mite (Sarcoptes scabei) Dermatoses Nuisance Effects

16. Prevent Disease, Disability and Premature Death Pediculosis via Infestation of pubic lice (Pthirus pubis) Dermatoses Nuisance Effects

17. Prevent Disease, Disability and Premature Death Allergic Reactions The over-reaction of the body’s natural defenses that present clinically as exaggerated or atypical signs/symptoms. Two primary types Dermal allergic reactions Respiratory allergic reactions Nuisance Effects

18. Prevent Disease, Disability and Premature Death Dermal Allergic Reactions An extreme dermal reaction to mosquito bites, developing a blister at each bite site, scabs where scratched off, probably secondary infection. Nuisance Effects

19. Prevent Disease, Disability and Premature Death Respiratory Allergic Reactions Many caterpillars (gypsy moth & tussock moth) release body hairs when they molt, causing seasonal "epidemics" of hay-fever-like illnesses in people allergic to them. Nuisance Effects

20. Prevent Disease, Disability and Premature Death Respiratory Allergic Reactions Allergy to the house dust mite might produce hay- fever-like symptoms. Nuisance Effects

21. Prevent Disease, Disability and Premature Death Respiratory Allergic Reactions Many people are allergic to cockroaches’ body parts (castings) & feces (frass) -- normally present as mild to severe hay fever, but can be severe. Nuisance Effects

22. Prevent Disease, Disability and Premature Death Defined: Myiasis is the invasion (or infestation) of organs or tissues by larvae of certain fly species. Fly larvae are commonly known as “maggots.” Myiasis

23. Prevent Disease, Disability and Premature Death Larvae may be found singularly like those of the human botfly, Dermatobia hominis); or Tumbu fly (pictured). A very painful nuisance. Myiasis

24. Prevent Disease, Disability and Premature Death Larvae may be found in large groups like those of the screwworm fly, Cochliomyia hominivorax (pictured). These cause massive tissue destruction & have caused fatalities. Myiasis

25. Prevent Disease, Disability and Premature Death Direct Effects of Arthropods Part I Interim Summary Entomophobia & Delusory Parasitosis Nuisance Effects Annoyance Accidental Injury Dermatosis Allergic Reactions Myiasis Envenomization (Next 2-hours)

26. Prevent Disease, Disability and Premature Death Break

27. Prevent Disease, Disability and Premature Death Direct Effects of Arthropods Part II Overview Entomophobia & Delusory Parasitosis Nuisance Effects Annoyance Accidental Injury Dermatosis Allergic Reactions MyiasisEnvenomization

28. Prevent Disease, Disability and Premature Death Envenomization Defined: Poisoning caused when venom (the poison) is transmitted by a bite, sting, or other mechanism by an organism into or on another organism.

29. Prevent Disease, Disability and Premature Death Envenomization The most important type of direct effect of arthropods. Of the millions of people envenomated by arthropods each year, about 25,000 have severe reactions. It is important to be able to recognize venomous arthropods & understand how they can affect health.

30. Prevent Disease, Disability and Premature Death Envenomization 5 Human Envenomization Reactions Local Reactions Systemic Reactions Necrotic Reactions Neurotoxic Reactions Anaphylactic Shock

31. Prevent Disease, Disability and Premature Death Envenomization: Local Reactions Defined: Reactions restricted to pain, itching, swelling & reddening or other changes at the envenomization site or on the involved limb. Examples : those caused by: Some bees, wasps, & ants Non-neurotoxic scorpions. Most spiders. Urticating caterpillars & blister beetles.

32. Prevent Disease, Disability and Premature Death Envenomization: Systemic Reactions Defined : Reactions such as nausea, fever, vomiting, stomach cramps, or headaches that take place away from the site of envenomization or involved limb. Examples: those caused by: Some bees, wasps, & ants Kissing bugs Puss caterpillars Widow spiders

33. Prevent Disease, Disability and Premature Death Envenomization: Neurotoxic Reactions Defined : Venom attacks the nervous system causing paralysis, and in severe cases, death. Examples: those caused by: Black Widow Spiders Neurotoxic Scorpions Ticks Black Widow

34. Prevent Disease, Disability and Premature Death Envenomization: Anaphylactic Shock Defined : Hypersensitivity to a foreign substance (i.e., insect venom), after an initial exposure -- may result in death if the victim does not receive immediate medical treatment. Examples:- those caused by: Hymenoptera -- bees, wasps, & ants Hemiptera -- true bugs THIS IS A MEDICAL EMERGENCY!!!

35. Prevent Disease, Disability and Premature Death Methods of Envenomization An easy way to sort out the venomous arthropods is to categorize them by their method of envenomization. There are 4 methods of envenomization: Biting or piercing StingingUrticatingVesicating

36. Prevent Disease, Disability and Premature Death Methods of Envenomization: Biting/Piercing Delivers venom through hollow mouthparts or legs modified for: Piercing then chewing (e.g., centipedes) Piercing & sucking (e.g., true bugs, spiders)

37. Prevent Disease, Disability and Premature Death Centipedes Large centipedes are capable of causing extremely painful bites with their "poison claws" which are actually modified legs (first pair). Methods of Envenomization: Biting/Piercing

38. Prevent Disease, Disability and Premature Death Spiders All use their venom to kill their prey. Many larger ones are able to break human skin & can inflict a painful bite. In Afghanistan, the Widow spiders are notably dangerous. Methods of Envenomization: Biting/Piercing

39. Prevent Disease, Disability and Premature Death Black Widow Spider Venom is neurotoxic -- approx. 15 times as toxic as rattlesnake. Mortality rate 4-5% -- most victims very young or very old without medical care. Antivenin (if required) must be given within 3 hours after bite to be effective. Bite is extremely painful, dramatic cramping & abdominal muscle rigidity is common. Methods of Envenomization: Biting/Piercing

40. Prevent Disease, Disability and Premature Death Other Widow Spiders The brown widow, red widow, & northern widow spiders are about as dangerous as the black widow but not as widely distributed & occur in much smaller populations in the areas where they are found. Methods of Envenomization: Biting/Piercing

41. Prevent Disease, Disability and Premature Death Tarantula Tarantula bites are painful because of the large size of the mouthparts, but the venom is not dangerous to humans & tarantula bites are usually not causes for concern. Methods of Envenomization: Biting/Piercing

42. Prevent Disease, Disability and Premature Death Kissing Bug Bite is not normally painful, but sometimes very painful. This “true bug” is a blood feeder. Local reaction -- anaphylactic shock may occur. Methods of Envenomization: Biting/Piercing

43. Prevent Disease, Disability and Premature Death TicksEctoparasites.Bloodfeeders. Bites can get swollen & red around bite site, especially if not found & removed soon after biting. Can cause tick paralysis, but rarely. Methods of Envenomization: Biting/Piercing

44. Prevent Disease, Disability and Premature Death Stingers, which are modified reproductive organs, are used by hymenoptera & scorpions to deliver their venom. There are four groups of stinging organisms worthy of individual discussion: ants, bees, wasps, & Centruroides scorpions. Methods of Envenomization: Stinging

45. Prevent Disease, Disability and Premature Death Direct Effects of Arthropods Part II Interim Summary Entomophobia & Delusory Parasitosis Nuisance Effects Annoyance Accidental Injury Dermatosis Allergic Reactions MyiasisEnvenomization

46. Prevent Disease, Disability and Premature Death Break

47. Prevent Disease, Disability and Premature Death Direct Effects of Arthropods Part III Overview Entomophobia & Delusory Parasitosis Nuisance Effects Annoyance Accidental Injury Dermatosis Allergic Reactions MyiasisEnvenomization

48. Prevent Disease, Disability and Premature Death Wasps/Hornets There are several potentially dangerous wasps Most are predators & scavengers, but their hunting & nesting habits bring them close to people. Normally, they only cause local reactions, but anaphylactic shock & deaths have occurred. Methods of Envenomization: Stinging

49. Prevent Disease, Disability and Premature Death Scorpions Most are non-neurotoxic, but three have the capability of causing human fatalities. Methods of Envenomization: Stinging

50. Prevent Disease, Disability and Premature Death Scorpions—Non-Neurotoxic Species Sting is initially sharp & severe, will cause localized intense pain, discoloration, & swelling -- similar to a wasp sting. First aid is ice on the sting & analgesics for pain. Methods of Envenomization: Stinging

51. Prevent Disease, Disability and Premature Death Scorpions—Neurotoxic Species Three most dangerous in Afghanistan: Hemiscorpius lepturus Hottentotta alticola Androctonus amoreuxi Sting is painful initially like that of non-neurotoxic species, but there is little swelling or discoloration. Have caused deaths & should be considered very dangerous. Methods of Envenomization: Stinging

52. Prevent Disease, Disability and Premature DeathSummaryTerminology Effect on Humans Medical Condition

53. Prevent Disease, Disability and Premature Death Questions?سوالات