2. • The anthropozoonosis are zoonosis maintained in
nature by animals and often transmissible to humans
through a so-called vector (mosquitoes, ticks, fleas)
3. Factors favouring the increase of anthropozoonosis
• The environmental conditions in general, are the main factors involved in the
survival and development of vectors and pathogens. One of the factors most
involved in the current increase in the spread and distribution of diseases
transmitted by arthropods is the global warming with change in climatic conditions
and the creation of new habitats for the vectors of infections.
• Experimental study models have confirmed that the increase in temperature .not
only favors the biological cycle of mosquitoes and the introduction of new species in
previously unharmed areas, but also the development speed of infectious agents
within the mosquitoes themselves.
• World tourism generates 9% of world GDP (that is, about 6 trillion dollars) and 120
million direct jobs, to which add an additional 125 million in related sectors
• It is a widely demonstrated phenomenon for Aedes albopictus that commercial
exchanges can also cause diffusion in new geographic areas of carriers competent
for the transmission of infections / infestations. This species of mosquito is a species
of Asian origin, introduced in Italy with a load of used tires, coming from the USA.
• Lastly, the habit of adopting unconventional pets, like ferrets, hedgehogs, guinea
• Rabies is a fatal neurologic disease caused
by lyssavirus infection, Rhabdoviridae family.
• Reservoir: domestic and wild animals (dog, cat, red fox, bat).
• Early symptoms: fever, nervousness, irritability.
• Late symptoms: photophobia, alteration of the voice,
• Therapy: postexposure prophylaxis (PEP)
with rabies immune globulin and rabies vaccine.
Congo-Crimean haemorrhagic fever(CCHF)
• Congo-Crimean haemorrhagic fever is a viral hemorrhagic fever
caused by a virus of the Nairovirus genus of the Bunyaviridae family,
transmitted by ticks belonging to the Hyalomma genus. This virus
causes epidemics of hemorrhagic fever with a mortality rate of 30%
• Symptoms: as the illness progresses, large areas of severe bruising,
severe nosebleeds, and uncontrolled bleeding at injection sites can
be seen, beginning on about the fourth day of illness and lasting for
about two weeks.
• Therapy: ribavirin with folic acid
• Arboviruses (arthropod-borne viruses) are transmitted to
humans primarily through the bites of infected mosquitoes
(Aedes aegypti ed Aedes albopictus), ticks, sand flies, or
midges. The responsible virus of Chikungunya belongs to the
family of the togaviridae, of the alphavirus genus.
• Symptoms and clinical picture: after an incubation period of 2-
12 days, fever and pains in the joints suddenly develop, such as
to limit the movements of the patients, who therefore tend to
remain absolutely immobile and assume analgesic positions.
Other symptoms include muscle pain, headache, fatigue and
• Treatment:There are no specific antiviral treatments and
treatments focus primarily on relieving symptoms. A vaccine
against chikungunya is not currently on the market.
Eastern Equine Encephalitis (EEE)
• The Eastern equine encephalitis virus (EEEV) is a species of
positive single-stranded RNA virus, belonging to the genus
Alphavirus, Togaviridae family. It is transmitted by
hematophagous arthropods, a mosquito ( Culiseta melanura,
Aedes, Culex) to birds, which constitute its natural reservoir
• In humans, most cases of infection are asymptomatic; in
symptomatic ones there is headache, high fever, chills, and
vomiting. The illness may then progress into disorientation,
seizures, coma and often fatal encephalitis. EEE is one of the
most severe mosquito-transmitted diseases in the United States
with approximately 33% mortality and significant brain damage
in most survivors. There is no specific treatment for EEE; care
is based on symptoms. EEE is endemic in the states bordering
on the eastern coast of the United States and the Caribbean.
• Japanese encephalitis (JE) virus, a flavivirus, is closely related to West
Nile and St. Louis encephalitis viruses. JE virus is transmitted to humans
through the bite of infected Culex species mosquitoes, particularly Culex
• Less than 1% of people infected with Japanese encephalitis (JE) virus
develop clinical illness.
• Initial symptoms often include fever, headache, and vomiting. Neurologic
symptoms, weakness, and movement disorders might develop over the
next few days.
• Seizures are common, especially among children.
• JE vaccine (manufactured as IXIARO) is recommended for travelers who
plan to spend 1 month or more in endemic areas during the JE virus
West Nile Encephalitis
• West Nile virus is a flavivirus most commonly spread to people by the bite
of an infected mosquito (culex). Mosquitoes become infected when they
feed on infected birds. The disease it’s spread in Europe, the Mediterranean
basin, but especially in the USA
• Symptoms: most people (8 out of 10) do not develop any symptoms.
About 1 in 5 people develop a fever with other symptoms such as
headache, joint pains, vomiting, diarrhea, or rash. Most people with this
type of West Nile virus disease recover completely, but fatigue and
weakness can last for weeks or months. About 1 in 150 people develop a
severe illness affecting the central nervous system such as encephalitis
• Treatment: no vaccine or specific antiviral treatments for West Nile virus
infection are available. In severe cases, patients often need to be
hospitalized to receive supportive treatment, such as intravenous fluids,
pain medication, and nursing care.
• Yellow fever virus is an RNA virus that belongs to the genus Flavivirus. It is
related to West Nile, St. Louis encephalitis, and Japanese encephalitis
viruses. Yellow fever virus is transmitted to people primarily through the bite
of infected Aedes or Haemagogus species mosquitoes. The virus is present
in large areas of Africa and South America
• Symptoms: The majority of persons infected with yellow fever virus have no
illness or only mild illness. In persons who develop symptoms, the
incubation period is typically 3–6 days. The initial symptoms include sudden
onset of fever, chills, severe headache, back pain, nausea, and vomiting,
fatigue, and weakness. Most persons improve after the initial presentation.
About 15% of cases progress to develop a more severe form of the disease.
The severe form is characterized by high fever, jaundice, bleeding, and
eventually shock and failure of multiple organs.
• Yellow fever vaccine is a live-virus vaccine that has been used for several
decades. A single dose provides lifelong protection.
Saint Louis Encephalitis
• St. Louis encephalitis virus (SLEV) is a member of the family
Flaviviridae, genus Flavivirus. The diseases is maintained in a
mosquito-bird-mosquito cycle, with periodic amplification by
peridomestic birds and Culex species mosquitoes.
• In temperate areas of the United States, SLEV disease cases
occur primarily in the late summer or early fall. In the southern
states, where the climate is milder, cases can occur year round.
• Symptoms:less than 1% of infections are clinically apparent and
the vast majority of infections remain undiagnosed. Some
patients develop signs of central nervous system infections,
including stiff neck, disorientation, dizziness, tremors and
unsteadiness. Coma can develop in severe cases. No
vaccine is available.
Zika virus (ZikaV)
• Zika is spread mostly by the bite of an infected Aedes species mosquito
(Ae. aegypti and Ae. albopictus). These mosquitoes bite during the day
and night and these are the same mosquitoes that spread dengue
and chikungunya viruses.
• A small number of monkeys were reported to have Zika virus in one
study done in 2016 in an area of Brazil with high numbers of human
illness. More research is needed to better understand the potential for
monkeys to be reservoirs for Zika virus. The prevalence of Zika virus in
monkeys and other nonhuman primates is currently unknown.
• Zika can be passed from a pregnant woman to her fetus. Infection
during pregnancy can cause certain birth defects (microcefalia). Local
mosquito-borne Zika virus transmission has been reported in the
continental United States
• There is no vaccine or medicine for Zika.
17. Zika: nace bebé con microcefalia por virus en España.
Primer caso en Europa.
El Hospital Universitario Vall d'Hebron anuncia que la madre del niño se encuentra en
"condiciones estables". La mujer contrajo la enfermedad durante un viaje a Sudamérica.
Por F. Q. | 26 de julio de 2016.
Plague has a remarkable place in history and has had enormous
effects on the development of modern civilization. The collapse of the
Roman Empire may be linked to the spread of plague by roman
soldiers returning home from battle in the Persian Gulf in 165 AD.
It’s caused by a bacterium called Yersinia pestis that often infects
small rodents (like rats, mice, and squirrels) and is usually transmitted
to humans through the bite of an infected flea.
Symptoms: pneumonic plague, septicemic plague, bubonic
plague: Patients who develop this clinical form present sudden onset
of fever, headache, chills, and weakness and one or more swollen,
tender and painful lymph nodes (called buboes).
Therapy: streptomycin, gentamicin, tetracyclines or chloramphenicol
Cat Scrathc Disease
• Cat-scratch disease (CSD) is a bacterial infection spread by cats. The
disease spreads when an infected cat licks a person's open wound, or
bites or scratches a person hard enough to break the surface of the
skin. CSD is caused by a bacterium called Bartonella henselae. About
40% of cats carry B. henselae at some time in their lives, although
most cats with this infection show NO signs of illness.
• Although rare, CSD can cause people to have serious complications.
CSD can affect the brain, eyes, heart, or other internal organs. These
rare complications, which may require intensive treatment, are more
likely to occur in children younger than 5 years and people with
weakened immune systems.
• Therapy: trimethoprim-sulfamethoxazole, gentamicin, ciprofloxin,
azithromycin, doxycycline. Usually in immunocompromised patients.
• People get infected by breathing in dust that has been contaminated by infected
animal feces, urine, milk, that contain Coxiella burnetii.
• Symptoms: can be mild or severe. People who develop severe disease may
experience infection of the lungs (pneumonia) or liver (hepatitis).
• A very small percentage of people (less than 5 out of 100) who become infected
with C. burnetii bacteria develop a more serious infection called chronic Q fever
wich develops months or years following initial infection. People often develop an
infection of one or more heart valves. People with endocarditis may experience
night sweats, fatigue, shortness of breath, weight loss, or swelling of their limbs.
• Therapy: Most people who are sick with Q fever will recover without antibiotic
treatment. However, for people who develop Q fever disease, treatment with 2
weeks of doxycycline antibiotic is recommended. A life-threatening infection,
requiring several months of treatment with a combination of antibiotics including
doxycycline and hydroxychloroquine.
• Trench fever is a disease transmitted by human body lice infected by
Bartonella quintana and was initially observed primarily among the
military during the first and second world war. Symptoms consist of
an acute, febrile illness, occasionally with rash. The disease is
endemic in Mexico, Tunisia, Eritrea, Poland and in the former Soviet
Union and is reoccurring in the homeless population of the United
• Symptoms: sudden onset with fever, weakness, drowsiness, headache
(with back-eye pain), conjunctival injections, and severe pain in the
legs and back. Relapses are frequent and occur up to 10 years after
• Although healing is usually complete within 1-2 months and negligible
mortality, bacteraemia may persist for months after clinical cure, and
prolonged treatment (> 1 month) may be required with a macrolide
• Carrión's disease, formerly known as bartonellosis, is transmitted by bites from
sand flies (genus Lutzomyia verrucarum) that are infected with the Bartonella
• Carrión's disease has limited geographic distribution; transmission occurs in the
Andes Mountains at 3,000 to 10,000 ft in elevation in western South America,
including Peru, Colombia, and Ecuador. Most cases are reported in Peru.
• Symptoms: Carrión disease has 2 distinct phases: an acute phase (Oroya fever)
characterized by fever, myalgia, headache, and anemia and an eruptive phase
(verruga peruana) characterized by red-to-purple nodular skin lesions.
• Therapy: various antibiotics are effective against Bartonella infections, and
regimens including agents such as tetracyclines, fluoroquinolones, trimethoprim-
sulfamethoxazole, rifampin, and aminoglycosides have been used.
Lyme Disease (a)
• Lyme disease is caused by the bacterium Borrelia burgdorferi and
is transmitted to humans through the bite of infected blacklegged ticks (Ixodes
scapularis) and probably also from the Amblyomma and Dermacentor (the dog
ticks). The main reservoirs of infection are wild animals (rodents, deer, foxes).
• Symptoms: include fever, headache, fatigue, and a characteristic skin rash called
erythema migrans (80% cases). If left untreated, infection can spread to joints,
the heart, and the nervous system.
• Therapy: People treated with appropriate antibiotics in the early stages of Lyme
disease usually recover rapidly and completely. Antibiotics commonly used for
oral treatment include doxycycline, amoxicillin, or cefuroxime. People with
certain neurological or cardiac forms of illness may require intravenous
treatment with antibiotics such as ceftriaxone or penicillin.
• Ticks that transmit to humans include the dog tick (Dermacentor variabilis),
the wood tick (Dermacentor andersoni), and the lone star tick (Amblyomma
americanum). Domestic cats are very susceptible to tularemia and have
been known to transmit F. tularensis to humans.
• Symptom: Ulceroglandular , Glandular, Oculoglandular, Oropharyngeal,
Pneumonic. This is the most serious form of tularemia. Symptoms include
cough, chest pain, and difficulty breathing. This form results from breathing
dusts or aerosols containing the organism. It can also occur when other
forms of tularemia (e.g. ulceroglandular) are left untreated and the bacteria
spread through the bloodstream to the lungs.
• Therapy:Antibiotics used to treat tularemia include streptomycin,
gentamicin, doxycycline, and ciprofloxacin. Treatment usually lasts 10 to 21
days depending on the stage of illness.
• Anthrax is a serious infectious disease caused by gram-positive, rod-shaped
bacteria known as Bacillus anthracis. Anthrax can be found naturally in soil and
commonly affects domestic and wild animals around the world. People can get
sick with anthrax if they come in contact with infected animals or contaminated
• Domestic and wild animals such as cattle, sheep, goats, antelope, and deer can
become infected when they breathe in or ingest spores in contaminated soil,
plants, or water.
• Symptom: A painless skin sore (ulcer) with a black center that appears after the
small blisters or bumps. General symptoms can include: fever and chills, chest
discomfort, shortness of breath, confusion or dizziness, cough, diarrhea or bloody
• Therapy: associated bactericidal (penicillin, fluoroquinolones) and protein
synthesis inhibitors (chloramphenicol, clindamycin ) is the best therapy.
• Bioterrorism: Bacillus anthracis, is one of the most likely agents to be used in a
Rocky Mountain Spotted Fever (RMSF)
• Rocky Mountain spotted fever is a serious tickborne illness which can be
deadly if not treated early. R. rickettsi is spread by several species of ticks in
the United States, including the American dog tick (Dermacentor variabilis).
• Symptoms: Early signs are not specific to RMSF (including fever, headache,
rash, muscle pain). However, the disease can rapidly progress to a serious and
• Long-term Health Problems:
• Some patients who recover from severe RMSF may be left with permanent
damage, including amputation of arms, legs, fingers, or toes (from damage to
blood vessels in these areas); hearing loss; paralysis; or mental disability.
• Therapy: doxycycline is the recommended antibiotic treatment for RMSF in
adults and children of all ages.
Human Granulocytic Anaplasmosis
• Anaplasma phagocytophilum is an obligate, intracellular bacterium that is found
predominantly within granulocytes and induces a systemic inflammatory
response, which is thought to be the mechanism for tissue damage in
anaplasmosis. Altered host neutrophil function could result in host neutrophils
being ineffective at regulating inflammation or microbicidal activity.
Anaplasmosis is transmited to humans by tick bites primarily from the black-
legged tick (Ixodes scapularis)and the western black-legged tick (Ixodes pacificus
• Symptoms: typically appear 5–14 days after the bite of an infected tick and
usually include fever, myalgia and shaking chills. Rash is present in <10% of
patients. In most cases, anaplasmosis is a self-limiting illness, however, ARDS,
peripheral neuropathies, DIC-like coagulopathies, hemorrhagic manifestations,
rhabdomyolysis, pancreatitis, and acute renal failure have been reported.
• Therapy: Doxycycline is the drug of choice for treatment of all tickborne
Mediterranean spotted fever
• Also known as Boutonneuse fever, is present in southern Europe, Asia
Africa, India. It’s the most widespread rickettsiosis in the Mediterranean
area. The R. conori i is mainly transmitted by Rhipicephalus sanguineus, a
habitual parasite of dogs and other domestic and wild animals (rabbits,
hares, sheep, goats).
• Symptom: The onset of the disease is sudden, with symptoms similar to
those of influenza (fever accompanied by chills, asthenia, headache,
general illness). From the third to the fifth day of incubation the disease
manifests itself with an exanthem which also affects the soles of the feet
and the palms of the hands.
• Therapy: doxycycline is the drug of first choice. R.conorii is also sensitive
32. 16° International Congress of Chemotherapy
June 1989, Jerusalem – Israel
A short course of Pefloxacin in the treatment of Conorii Rickettsiosis
• C. D’AMATO, C. PAPPALARDO, F.SPINAZZOLA, C.STRUGLIA , G.TOCCI and G.VISCO
• Hospital for Infectious Diseases «L. Spallanzani» Rome – Italy
• Summary: to evaluate clinical efficacy and safety of pefloxacin in patients affected by uncomplicated conorii
rickettsiosis (CR), we have treated 12 patients with a short course of Pefloxacin 800 mg/die.
• All subjets were cured without side effects . P seems as active as other drugs (i.e. doxicycline). It’s well
tolerated and therefore is a good alternative drug in the treatment of conorii richettsiosis.
• Epidemic typhus, also called louse-borne typhus, is an uncommon disease
caused by a bacteria called Rickettsia prowazekii. Epidemic typhus is spread
to people through contact with infected body lice. Though epidemic typhus
was responsible for millions of deaths in previous centuries, it is now
considered a rare disease. Some people can remain infected, without
symptoms, for years after they first get sick. These individuals can have a
relapse in disease, called Brill-Zinsser disease, months or years following
their first illness.
• Symptoms of epidemic typhus begin within 2 weeks after contact with
infected body lice. Signs and symptoms may include: fever and chills,
headache, rapid breathing, body and muscle aches, rash, cough, nausea,
• Therapy: Epidemic typhus should be treated with the antibiotic
Murine Typhus Xenopsilla cheopis
• Murine typhus, also called endemic typhus or flea-borne typhus, is a disease
caused by a bacteria called Rickettsia typhi. Murine typhus is spread to people
through contact with infected fleas. People get sick with murine typhus when
infected flea feces are rubbed into cuts or scrapes in the skin. In most areas of
the world, rats are the main animal host for fleas infected with murine typhus.
Murine typhus occurs in tropical and subtropical climates around the world
where rats and their fleas live.
• Symptoms of murine typhus are similar to epidemic typhus.
• Therapy: the drug of first choice is doxycycline, but also the chloramphenicol is
• Scrub typhus, also known as bush typhus, is a disease caused by a
bacteria called Orientia tsutsugamushi. Scrub typhus is spread to
people through bites of infected chiggers (larval mites).
• The most common symptoms of scrub typhus include fever,
headache, body aches, and sometimes rash. Most cases of scrub
typhus occur in rural areas of Southeast Asia, Indonesia, China, Japan,
India, and northern Australia
• Therapy: people who are treated early with doxycycline usually
• Human ehrlichiosis is a disease caused by at least three different ehrlichial
species in the United States: Ehrlichia chaffeensis, Ehrlichia ewingii, and a
third Ehrlichia species provisionally called Ehrlichia muris-like (EML).
Ehrlichiae are transmitted to humans by the bite of an infected tick. The
lone star tick (Amblyomma americanum) is the primary vector of
both Ehrlichia chaffeensis and Ehrlichia ewingii
• Symptoms: include: fever, headache, fatigue, and muscle aches. Usually,
these symptoms occur within 1-2 weeks following a tick bite.
• Therapy: doxycycline is the first line treatment for adults and children of all
ages: adults: 100 mg every 12 hours, children under 45 kg : 2.2 mg/kg body
weight given twice a day
• Malaria is the most important parasitosis and the second infectious disease in the
world for morbidity and mortality after tuberculosis. In 2016 an estimated 216
million cases of malaria occurred worldwide and 445,000 people died, mostly
children in the African Region. It’s transmitted among humans by female
mosquitoes of the genus Anopheles . People with malaria often experience fever,
chills, and flu-like illness. Left untreated, they may develop severe complications
• Five kinds of plasmodia are known: p. vivax ,p. ovale, (“hypnozoites”)p. malariae,
p.falciparum, and p.knowlesi (South East Asia) (p. cynomolgi?)
• Symptoms: elevated temperatures, weakness, enlarged spleen, mild jaundice,
enlargement of the liver, increased respiratory rate.
• Severe malaria include cerebral malaria, anemia, ARDS, impairment of
consciousness, seizures, coma, or other neurologic abnormalities
Malaria Drug chemoprophylaxis (2)
• No prophylactic regimen may offer complete protection.
• Chloroquine has been the corner-stone of anti-malarial drugs up to the 80s,
thanks to its efficacy, tolerability and safety in pregnancy and childhood. It is a
rapid blood schizonticide . It can be used in combination with proguanil, in
areas where P. falciparum is still sensitive to chloroquine, such as Central
America and Middle Eastern countries.
• Atovaquone-Proguanil regimen consists of 250/100 mg (1 adult tablet)
atovaquone/proguanil/day starting 1-2 days before the trip until 7 days after
• Mefloquine it’s a methanol-quinoline drug. As a blood schizonticide, it is very
effective against P. falciparum and others plasmodial infections in malarial
endemic areas, with the exception of some focal areas of South East Asia and
Malaria Drug chemoprophylaxis (3)
• Primaquine: used for reclamation of the intrahepatic forms
(hypnozoites) of P.vivax and P. ovale, to prevent recurrences.
• Doxycycline: it’s used in combination with quinine for the treatment
of malaria and alone for chemoprophylaxis in P. falciparum
chloroquine-resistant areas, even if cases of prophylactic failures are
• Clindamycin and doxycycline to be used only in combination with
quinine in areas of emerging quinine resistance.
• Drugs used only for therapy: quinine, sulfadoxine-pyrimethamine,
halofantrin, artemisina and its derivatives.
• Leishmaniasis is a parasitic disease that is found in parts of the tropics,
subtropics, and southern Europe. Infected animals (such as rodents or dogs),
along with sand flies, maintain the cycle.The most common forms are cutaneous
leishmaniasis, which causes skin sores, and visceral leishmaniasis, which affects
several internal organs (usually spleen, liver, and bone marrow). The sand flies
that transmit the parasite (Phlebotomus papatasi) are only about one third the
size of typical mosquitoes or even smaller.
• Therapy: the skin sores of cutaneous leishmaniasis usually heal on their own,
even without treatment.
• Visceral leishmaniasis may benefit from: Pentavalent antimonial (SbV)
compounds—the traditional mainstays for treating leishmaniasis since the 1940s,
liposomal amphotericin B (AmBisome®), amphotericin B deoxycholate,
pentamidine, ketoconazole, itraconazole, and fluconazole, miltefosine.
• Toxoplasmosis is caused by the protozoan parasite Toxoplasma gondii. People
typically become infected by three principal routes of transmission: foodborne,
animal-to-human (zoonotic), mother-to-child (congenital).
• Cats play an important role in the spread of toxoplasmosis. They become infected
by eating infected rodents, birds, or other small animals. The parasite is then
passed in the cat's feces in an oocyst form, which is microscopic.
• Symptoms: Healthy people who become infected with Toxoplasma gondii often
do not have symptoms. When illness occurs, it is usually mild with "flu-like"
symptoms, but the parasite remains in their body in an inactive state. It can
become reactivated if the person becomes immunosuppressed.
• Therapy: immune compromised persons can be treated with a combination of
drugs such as pyrimethamine and sulfadiazine, plus folinic acid.
(African) Trypanosomiasis (1)
• African Trypanosomiasis, also known as "sleeping sickness," is caused by
microscopic parasites of the species Trypanosoma brucei. It is transmitted by the
tsetse fly (Glossina species), which is found only in rural Africa. Currently, about
10,000 new cases each year are reported to the World Health organization.
Sleeping sickness is curable with medication, but is fatal if left untreated. There
are two subspecies of the parasite: T. b. rhodesiense (East Africa) and T. b.
gambiense (West Africa).
• Symptom: T. b. rhodesiense infection progresses rapidly. Some people develop a
rash. After a few weeks of infection, the parasite invades the central nervous
system and eventually causes mental & neurologic problems. Death ensues
usually within months. T. b. gambiense infection progresses more slowly: usually,
after 1-2 years, there is evidence of central nervous system and often kills in
about 3 years.
• Therapy: Pentamidine, melarsoprol, eflornithine, but relapse may occur.
(American) Trypanosomiasis (2)
• Trypanosoma cruzi, causes Chagas disease, a zoonotic disease that
can be transmitted to humans by blood-sucking triatomine bugs.
Chronic Chagas disease is a major health problem in many Latin
American countries: southern Argentina. rural areas of Mexico,
Central America, and South America.
• Symptoms: include fever, anorexia, lymphadenopathy, mild
hepatosplenomegaly and myocarditis. The symptomatic chronic form
may not occur for years after initial infection, but Chronic Chagas
disease and its complications can be fatal.
• Therapy: The two drugs used to treat infection with Trypanosoma
cruzi are nifurtimox and benznidazole. Nifurtimox is not currently
FDA approved. Both drugs are currently available under
investigational protocols from CDC.
• Many species of Cryptosporidium exist that infect humans and a wide range
of animals. Cryptosporidium parvum and Cryptosporidium hominis are the
most prevalent species causing disease in humans.
• Symptoms: watery diarrhea, stomach cramps or pain, dehydration, nausea,
vomiting, fever, weight loss. Symptoms usually last about 1 to 2 weeks (with
a range of a few days to 4 or more weeks) in persons with healthy immune
• Therapy: most people who have healthy immune systems will recover
without treatment. Diarrhea can be managed by drinking plenty of fluids to
prevent dehydration. People who are in poor health or who have weakened
immune systems are at higher risk for more severe and prolonged illness.
• Babesiosis is caused by parasites of the genus, Babesia. While more than 100
species have been reported, only a few have been identified as causing
human infections, including B. microti, B. divergens, B. duncani, and a
currently un-named strain designated MO-1. The Babesia microti life cycle
involves two hosts, which includes a rodent, primarily the white-footed
mouse, Peromyscus leucopus, and a tick in the genus, Ixodes. Humans enter
the cycle when bitten by infected ticks.
• Symptoms: Most infections are asymptomatic. Manifestations of disease
include fever, chills, sweating, myalgias, fatigue, hepatosplenomegaly, and
hemolytic anemia. Symptoms typically occur after an incubation period of 1
to 4 weeks, and can last several weeks.
• Therapy: For ill patients, babesiosis usually is treated for at least 7-10 days
with a combination of two medications: atovaquone + azithromycin or
clindamycin + quinine.
• Taeniasis in humans is a parasitic infection caused by the tapeworm
species Taenia saginata (beef), Taenia solium (pork), and Taenia asiatica (Asian
tapeworm). Humans can become infected by eating raw or undercooked beef
or pork. People with taeniasis may not know they have an infection because
symptoms are usually mild or nonexistent.
• Symptoms: patients with T. saginata taeniasis often experience more
symptoms that those with T. solium because the T. saginata is larger in size (up
to 10 meters) than T. solium (usually 3 m). Tapeworms can cause digestive
problems including abdominal pain, loss of appetite, weight loss, and upset
stomach. In rare cases, tapeworm segments become lodged in the appendix,
or the bile and pancreatic ducts.
• Therapy: praziquantel or niclosamide per os.
• Schistosomiasis, also known as bilharzia, is a disease caused by parasitic worms. More
than 200 million people are infected worldwide. In terms of impact this disease is
second only to malaria as the most devastating parasitic disease. Most human
infections are caused by Schistosoma mansoni, S. haematobium, or S. japonicum. The
parasites that cause schistosomiasis live in certain types of freshwater snails. The
infectious form of the parasite, known as cercariae, emerge from the snail, hence
contaminating water. You can become infected when your skin comes in contact with
• Symptoms: Within 1-2 months of infection, symptoms may develop including fever,
chills, cough, and muscle aches. Without treatment, schistosomiasis can persist for
years. Signs and symptoms of chronic schistosomiasis include: abdominal pain, enlarged
liver, blood in the stool or blood in the urine, and problems passing urine. Chronic
infection can also lead to increased risk of bladder cancer.
• Therapy: Praziquantel is taken for 1-2 days to treat infections caused by
all Schistosoma species.
• Cystic echinocccosis (CE), also known as hydatid disease, is caused by infection
with the larval stage of Echinococcus granulosus, a 2-7 millimeter long, found in
dogs (definitive host) and sheep, cattle, goats, and pigs (intermediate hosts).
Although most infections in humans are asymptomatic, CE causes slowly
enlarging cysts in the liver, lungs, and other organs that often grow unnoticed and
neglected for years. Alveolar echinococcosis (AE) is caused by infection with the
larval stage of Echinococcus multilocularis, 1-4 millimeter long, found in foxes,
coyotes, and dogs (definitive hosts). Small rodents are intermediate hosts
and human cases are rare. AE poses a much greater health threat to people than
CE, causing parasitic tumors that can form in the liver, lungs, brain, and other
organs. If left untreated, AE can be fatal.
• Symptoms: The cysts are mainly found in the liver and lungs but can also appear
in the spleen, kidneys, heart, bone, and central nervous system, including the
brain and eyes.
• Cyst rupture is most frequently caused by trauma and may cause mild to severe
anaphylactic reactions, even death, as a result of the release of cystic fluid.
Alveolar echinococcosis (AE) is characterized by parasitic tumors in the liver and
may spread to other organs including the lungs and brain. In humans, the larval
forms of E. multilocularis do not fully mature into cysts but cause vesicles that
invade and destroy surrounding tissues and cause discomfort or pain, weight loss,
and malaise. AE can cause liver failure and death because of the spread into
nearby tissues and, rarely, the brain. AE is a dangerous disease resulting in a
mortality rate between 50% and 75%, especially because most affected people
live in remote locations and have poor health care.
• Therapy: In the past, surgery was the only treatment for cystic echinococcal cysts.
Chemotherapy, cyst puncture, and PAIR (Percutaneous Aspiration, Injection of
chemicals and Reaspiration) have been used to replace surgery as effective
treatments for cystic echinococcosis. However, surgery remains the most
effective treatment to remove the cyst and can lead to a complete cure.
• Fascioliasis is caused by Fasciola hepatica and less often by F. gigantica, which are
flat worms classified as trematodes.
• Symptoms: Human fascioliasis is usually recognized as an infection of the bile
ducts and liver, but infection in other parts of the body can occur. In the early
(acute) phase, symptoms can include gastrointestinal problems such as nausea,
vomiting, and abdominal pain. Fever, rash, and difficulty breathing may occur.
During the chronic phase (after the parasite settles in the bile ducts), the clinical
manifestations may be similar or more discrete, reflecting inflammation and
blockage of bile ducts, which can be intermittent. Inflammation of the liver,
gallbladder, and pancreas also can occur.
• Therapy: The drug of choice is triclabendazole. In the United States, this drug is
available through CDC, under a special (investigational) protocol. The drug is
given by mouth, usually in one or two doses.
• Anisakiasis is a parasitic disease caused by anisakid nematodes that
can invade the stomach wall or intestine of humans. The transmission
of this disease occurs when infective larvae are ingested from fish or
squid that humans eat raw or undercooked. In some cases, this
infection is treated by removal of the larvae via endoscopy or surgery.
• Symptoms: abdominal pain, nausea, vomiting, diarrhea, blood and
mucus in the feces, fever.
• Therapy: Successful treatment of anisakiasis with albendazole* 400
mg orally twice daily for 6 to 21 days has been reported in cases with
presumptive (highly suggestive) or serology diagnoses.
• Trichinellosis (trichinosis) is caused by nematodes (roundworms) of the
• Symptoms: light infections may be asymptomatic. Intestinal invasion can be
accompanied by gastrointestinal symptoms (diarrhea, abdominal pain,
vomiting). Larval migration into muscle tissues (one week after infection) can
cause periorbital and facial edema, conjunctivitis, fever, myalgias, splinter
hemorrhages, rashes, and peripheral eosinophilia. Occasional life-threatening
manifestations include myocarditis, central nervous system involvement, and
pneumonitis. Larval encystment in the muscles causes myalgia and weakness.
• Therapy: Treatment with either mebendazole or albendazole is recommended
Prompt treatment with antiparasitic drugs can help prevent the progression of
trichinellosis by killing the adult worms and so preventing further release of
• Lymphatic filariasis, is a parasitic disease caused by microscopic, thread-like
worms (Wuchereria bancrofti ).The adult worms only live in the human lymph
system. In Asia, the disease can also be caused by Brugia malayi and Brugia
timori. A wide range of mosquitoes can transmit the parasite, depending on
the geographic area. In Africa, the most common vector is Anopheles and in
the Americas, it is Culex quinquefasciatus. Aedes and Mansonia can transmit
the infection in the Pacific and in Asia.
• Symptoms: Although the parasite damages the lymph system, most infected
people have no symptoms and will never develop clinical symptoms. A small
percentage of persons will develop lymphedema that mostly affects the legs,
but can also occur in the arms, breasts, and genitalia.
• Therapy: Diethylcarbamazine (DEC) is the drug of choice.
• Loiasis, called African eye worm by most people, is caused by the parasitic worm Loa
loa. It is passed on to humans through the repeated bites of deerflies (also known as
mango flies or mangrove flies) of the genus Chrysops. The people most at risk for loiasis
are those who live in the certain rain forests in West and Central Africa. The deerflies
that pass the parasite to humans usually bite during the day and are more common
during the rainy season.
• Symptoms: . People who get infected while visiting areas with loiasis are more likely to
have symptoms. The most common manifestations of the disease are Calabar swellings
and eye worm: calabar swellings are localized, non-tender swellings usually found on
the arms and legs and near joints. Eye worm can cause eye congestion, itching, pain,
and light sensitivity. Although eye worm can be scary, it lasts less than one week and
usually causes very little damage to the eye.
• Therapy: The treatment of choice is diethylcarbamazine (DEC), which kills the
microfilariae and adult worms. Albendazole is sometimes used in patients who are not
cured with multiple DEC treatments.
• The causal agent is the trematode Dicrocoelium dendriticum. Ruminants are
the usual definitive hosts, although other herbivorous animals, carnivores,
and humans can serve as definitive hosts. Many species of snail may serve as
the first intermediate host, including Zebrina spp. and Cionella spp. Many
ants may serve as the second intermediate host, especially members of the
• Symptom: Most infections are light and asymptomatic. In heavier infections,
symptoms may include diarrhea, cholecystitis, liver abscesses and upper
• Therapy: Praziquantel as a single dose (25 mg/kg or less) is the current
treatment of choice, but is not approved for treatment of children less than 4
years old. Niclosamide is used in such instances.
• Liver fluke infections occur mostly in people living in some areas where
the parasites are found. O. viverrini is found mainly in northeast Thailand,
Laos, Cambodia, and central and southern Vietnam. O. felineus is found
mainly in Italy, Germany, Belarus, Russia, Kazakhstan, and Ukraine. People
become infected by eating raw or undercooked freshwater fish containing
the larvae. After ingestion, the liver flukes grow to adult worms that live
inside the human bile duct system.
• Symptoms: cholangitis, which can lead to periductal fibrosis, cholecystitis
and cholelithiasis, obstructive jaundice. Infection may cause
• Therapy: Praziquantel or albendazole are the drugs of choice to
treat Opisthorchis infection.
• Clonorchiasis is caused by the trematode Clonorchis sinensis (Chinese or
oriental liver fluke). Endemic areas are in Asia including Korea, China, Taiwan,
and northern Vietnam. Infection of humans occurs by ingestion of
undercooked, salted, pickled, or smoked freshwater fish.
• Symptoms: most pathologic manifestations result from inflammation and
intermittent obstruction of the biliary ducts. In mild cases, manifestations
include dyspepsia, abdominal pain, diarrhea or constipation. With infections
of longer duration, the symptoms can be more severe, and hepatomegaly and
malnutrition may be present. In rare cases, cholangitis, cholecystitis, and
chlolangiocarcinoma may develop.
• Therapy: praziquantel, adults, 75mg/kg/day orally, three doses per day for 2
days; the pediatric dosage is the same. Albendazole is an alternative drug; the
dosage for adults is 10mg/kg/day for 7 days. The pediatric dosage is the
• Dipylidium caninum mainly infects dogs and cats, but is occasionally
found in humans. The dog is the principal definitive host. Humans
acquire infection by ingesting the cysticercoid contaminated flea. This
can be promulgated by close contact between children and their
infected pets. Human infections have been reported in Europe, the
Philippines, China, Japan, Argentina, and the United States.
• Symptoms: most infections with Dipylidium caninum are
asymptomatic. Mild gastrointestinal disturbances may occur.
• Therapy: consists of a single oral dose administration of 5-10 mg / kg
• Infected dogs and cats shed Toxocara eggs in their feces into the environment. Humans
or other animals can be infected by accidentally ingesting Toxocara eggs. For example,
humans can become infected if they work with dirt and accidentally ingest dirt
containing Toxocara eggs. Most people infected with Toxocara do not have any
symptoms. There are two major forms of toxocariasis, visceral toxocariasis (VT), also
called visceral larva migrans (VLM), and ocular toxocariasis (OT), also called ocular larva
• Symptoms: in visceral toxocariasis (VT) the larvae can travel through parts of the body
such as the liver, lungs, or central nervous system and cause symptoms such as fever,
coughing, enlarged liver or pneumonia. Ocular toxocariasis occurs when a
microscopic Toxocara larva enters the eye and causes inflammation and scarring on the
retina. OT typically occurs only in one eye and can cause irreversible vision loss.
• Therapy: VT can be treated with drugs such as albendazole or mebendazole. Treatment
of OT is more difficult and usually consists of measures to prevent progressive damage
to the eye.
78. Message to take home
• The involvement of the dog, in
previous described diseases, could
give rise to negative considerations
and ultimately to think that it may be
dangerous to keep a dog at home.
Nothing more wrong. If the dog is well
kept, controlled and - above all -
subjected to vaccination, it is
absolutely no danger. And he tells you
who kept at home for eighteen a
beautiful little dachshund called Bea ...