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Chagas disease is a vector-borne and potentially fatal parasitic disease that is transmitted by the triatomine bug, a nocturnal feeding, flying arthropod, often referred to by its colloquial name, the "kissing bug." Vector-borne transmission is considered the most important means of spreading Chagas disease in endemic and nonendemic areas. Corrugated cardboard boxes may accelerate the spread of these insect vectors to nonendemic areas through their ability to harbor and transport small terrestrial arthropods such as silverfish, termites, and cockroaches. We report the case of a patient living in northern California who presented to a community clinic 6 weeks after being bitten by a positively identified triatomine bug. A local pest control company identified a total of eight adult Triatoma protracta, nine nymphs, and two eggs; all within the patient's bedding. No bugs were found outside of the patient's bedroom. The Centers for Disease Control and Prevention confirmed one adult female was positive for Trypanosoma cruzi via polymerase chain reaction. The patient's bedroom doubled as an office and regularly received and stored corrugated cardboard shipping boxes. Corrugated cardboard boxes have been used to trap and study the triatomine bug. This is the first documented case that provides circumstantial evidence that corrugated cardboard boxes may be an inadvertent and unrecognized factor in the spread of Chagas disease., (© The American Society of Tropical Medicine and Hygiene.)

An important variable in determining the vectorial capacity of malaria mosquito species is the degree of mosquito-human contact. This parameter can be affected by community sleeping behavior and the host-feeding habits of vectors. A cross-sectional study of 775 randomly selected inhabitants, including 385 Baluchi residents and 390 Afghani refugees, was conducted in a malarious area in Sabaz District, Sistan-Baluchestan Province, southeastern Iran. In addition, monitoring of human landing periodicity of main malaria vectors was carried out during an entire transmission season. Afghanis and Baluchis showed diversity in sleeping behavior. Most (79.6%) respondents were familiar with symptoms of malaria and also aware of an association between mosquitoes and malaria. Despite this familiarity, 94.6% of Afghan refugees, 74.8% of Baluch residents, and 87.2% of study participants did not use self-protection preventive measures. Overall, only 8.8% of participants reported using bed nets regularly. Surveyed persons used bed nets mainly during second quarter of night. Three major species of malaria vectors (Anopheles culicifacies, An. fluviatilis, and An. stephensi) started biting by sunset and continued throughout the night. The results of present study indicated that synchronization of encounters between inhabitants and mosquito vectors was caused by poor self-protection and sleeping behavior of inhabitants. In addition, diversity in culture and behavior of the two communities may cause the prevalence of malaria to be different between them. Therefore, promoting awareness of self-protection against mosquito bites could promote community participation in malaria elimination program in this malaria-endemic region.

Controlled human malaria infection by blood stage parasite (BSP) inoculation is an alternative to the well-established model of infection with Plasmodium falciparum sporozoites delivered by mosquito bites. The BSP model has been utilized less frequently, but its use is increasing. Advantages of BSP challenge include greater ease of administration, better standardization of the infecting dose per volunteer, and good inter-study reproducibility of in vivo parasite dynamics. Recently, a surprising reduction in clinical symptoms at microscopic patency in the BSP model has been identified, which has an undefined and intriguing pathophysiologic basis, but may make this approach more acceptable to volunteers. We summarize clinical, parasitologic, and immunologic data from all BSP challenges to date, explore differences between the BSP and sporozoite models, and propose future applications for BSP challenge.

Transmission of Plasmodium falciparum is hyperendemic in southern Zambia. However, no data on the entomologic aspects of malaria transmission have been published from Zambia in more than 25 years. We evaluated seasonal malaria transmission by Anopheles arabiensis and An. funestus s.s. and characterized the blood feeding behavior of An. arabiensis in two village areas. Transmission during the 2004-2005 rainy season was nearly zero because of widespread drought. During 2005-2006, the estimated entomologic inoculation rate values were 1.6 and 18.3 infective bites per person per transmission season in each of the two village areas, respectively. Finally, with a human blood index of 0.923, An. arabiensis was substantially more anthropophilic in our study area than comparable samples of indoor-resting An. arabiensis throughout Africa and was the primary vector responsible for transmission of P. falciparum.

Malaria-infected mosquitoes feeding on a mammalian host inject sporozoites into the skin to induce a malaria infection. The numbers of sporozoites ultimately able to reach the liver may be important determinants of the characteristics of the ensuing blood infection. Because feeding mosquitoes not only inject sporozoites into the host but concomitantly ingest blood to obtain their bloodmeal, some sporozoites are re-ingested by the feeding mosquito. We studied transmission of fluorescent Plasmodium berghei sporozoites injected into mice by Anopheles stephensi mosquitoes and found that the numbers of sporozoites re-ingested by mosquitoes are comparable to numbers previously reported to be delivered directly into mice. Thus, re-ingestion of sporozoites likely plays a significant role in transmission dynamics of malaria by mosquitoes, and may account for the failure of some sporozoite-infected mosquitoes to induce a blood infection.

Historically, in vivo experiments of Plasmodium gallinaceum in chickens have caused high mortality. Perhaps because of this high mortality, it remains to be demonstrated whether recovered birds will resist a second episode of illness when re-exposed to infected mosquitoes. In the current study, groups of 10 chicks were infected with P. gallinaceum via mosquito bite. Parasitemia and anemia were followed by recovery in all birds, although they had persisting, low levels of parasitized erythrocytes (0.007 +/- 0.019%). Twenty-three days after the initial exposure, 10 recovered chicks were rechallenged with P. gallinaceum via mosquito bite; none of them developed clinical or hematological evidence of malaria, in contrast to matched control birds, which all became diseased (P < 0.001). Unlike previous studies, the current experiment had no mortality in chickens infected with P. gallinaceum by mosquito bite. Recovered birds resisted disease from re-exposure to the same organism. The duration and nature of immunity or premunition remain to be determined.

The probability of Trypanosoma cruzi transmission to opossums by independent events of predation and fecal contamination during feeding ("biting") with positive Triatoma infestans was estimated. Negative female opossums were challenged for 23 hr with 10 infected third and fourth instars of T. infestans, and tests for positivity for T. cruzi by xenodiagnosis were performed at 30, 60, and 90 days. From these data, seven probability parameters were estimated by maximum likelihood, and likelihood ratio statistics confidence intervals were calculated. Simultaneous estimation of p1 (probability that a "bite" will infect an opossum), p3 (probability that a bug that has been eaten by an opossum will infect it), and p6 (probability that the opossum will become infected if faced with an infected triatomine), resulted in p1 = 0.06, p3 = 0.075, and p6 = 0.059. On average, each opossum should be exposed to an average of 700 encounters with bugs during its life, resulting in about eight potentially infective contacts, to produce the 35% opossum prevalence found in the field.

Studies in the southern peninsula of Haiti showed that the biting midge, Culicoides barbosai, was capable of supporting the development of Mansonella ozzardi to the infective stage. The known vector, Culicoides furens, also was encountered. Both species showed distinct biting site preferences, i.e., 98% of the midges that engorged on the arms and head were C. barbosai whereas C. furens was collected mostly from the lower legs. Nine days after engorgement, 19 infective larvae were recovered from 13 C. barbosai versus six larvae from four C. furens. It was judged that C. barbosai may be as importantly involved in the natural transmission cycle as C. furens in this community.

The annual transmission potential of Wuchereria bancrofti was calculated from the number of infective larvae found in the number of Culex quinquefasciatus expected to bite an individual exposed 24 hr a day for a year in Calcutta and in a rural (Memari) area. In Calcutta, an average of 151 mosquitoes/night/person were collected; it was calculated that 55,028 mosquitoes could bite a person per year, including an average of 177 infective mosquitoes containing 319 infective larvae of W. bancrofti. At Memari, an average of 284 mosquitoes/night/person were collected; here with the resulting calculation was that 103,718 mosquitoes could bite a person per year, including an average of 137 infective mosquitoes containing 223 infective larvae. The annual transmission potential was higher in the urban area than that in the rural area. Annual transmission potential is useful knowledge in the epidemiological assessment of transmission dynamics for the formulation of control strategies.

To attempt rodent-sand fly-rodent transmission of Leishmania major, laboratory-reared Phlebotomus doboscqi were fed on L. major-infected mice and then refed on uninfected mice 21 days later. Flies which refed either probed 1-2 times and took a full blood meal in less than 10 min or probed 3 or more times and took little or no blood during a period of 15 min or more. When dissected, 7 of 8 flies which experienced difficulty in obtaining a blood meal had flagellates in their cibaria, an observation supporting the hypothesis that parasites in this part of the alimentary canal modify normal blood feeding behavior. None of the infected females which probed 1-2 times had similar anterior station infections. Infected sand flies transmitted L. major to uninfected mice and a single fly, transferred from 1 mouse to the next while repeatedly attempting to take blood, infected 5 mice. During a year-long survey in Baringo District, Kenya, we collected 9,182 female sand flies. Only 2 of the 278 P. duboscqi captured during this collection were infected with L. major; however, 18 of the 789 small rodents from this area were infected with L. major. Parasite interference with normal blood feeding may explain how a relatively small population of P. duboscqi, only a few of which are infected with L. major, can amplify parasite transmission thereby maintaining a disproportionately large reservoir in local rodents.

The degree to which Anopheles punctulatus complex members feed on humans in different Papua New Guinea villages has a significant effect on sporozoite rates. Among villages, the human blood index (HBI) of the members of the complex varied with the average number of persons sharing a bednet. Although dogs are the preferred hosts by the 3 malaria vector species, the number of dogs did not significantly affect the HBI. The HBI was dependent upon the human-biting rate, implying increased avoidance of anophelines by people relative to other hosts at times of greater mosquito numbers. Human-biting rates and HBIs were also influenced by the distribution of alternative hosts relative to people.