Efficacy of a mixture of neem seed oil (Azadirachta indica) and coconut oil (Cocos nucifera) for topical treatment of tungiasis. A randomized controlled, proof-of-principle study

Background

Tungiasis is a neglected tropical skin disease caused by the female sand flea (Tunga penetrans), which burrows into the skin causing intense pain, itching and debilitation. People in endemic countries do not have access to an effective and safe home treatment. The aim of this study was to determine the efficacy of a traditionally used and readily available mixture of neem and coconut oil for treatment of tungiasis in coastal Kenya.

Methodology

Ninety-six children aged 6–14 years with at least one embedded viable flea were randomized to be treated with either a mixture of 20% neem (Azadirachta indica) seed oil in coconut oil (NC), or with a 0.05% potassium permanganate (KMnO₄) foot bath. Up to two viable fleas were selected for each participant and monitored for 6 days after first treatment using a digital microscope for signs of viability and abnormal development. Acute pathology was assessed on all areas of the feet using a previously established score. Children reported pain levels and itching on a visual scale.

Results

The NC was not more effective in killing embedded sand fleas within 7 days than the current standard with KMnO₄, killing on average 40% of the embedded sand fleas six days after the initial treatment. However, the NC was superior with respect to the secondary outcomes of abnormal development and reduced pathology. There was a higher odds that fleas rapidly aged in response to NC compared to KMnO₄ (OR 3.4, 95% CI: 1.22–9.49, p = 0.019). NC also reduced acute pathology (p<0.005), and there was a higher odds of children being pain free (OR 3.5, p = 0.001) when treated with NC.

Conclusions

Whilst NC did not kill more fleas than KMnO₄ within 7 days, secondary outcomes were better and suggest that a higher impact might have been observed at a longer observation period. Further trials are warranted to assess optimal mixtures and dosages.

Trial registration

The study was approved by the Kenya Medical Research Institute (KEMRI) Scientific and Ethical Review Unit (SERU), Nairobi (Non-SSC Protocol No. 514, 1st April 2016) and approved by and registered with the Pharmacy and Poisons Board’s Expert Committee on Clinical Trials PPB/ECCT/16/05/03/2016(94), the authority mandated, by Cap 244 Laws of Kenya, to regulate clinical trials in the country. The trial was also registered with the Pan African Clinical Trial Registry (PACTR201901905832601).

Tungiasis is a disease caused by the female sand flea which burrows into the skin of the feet and causes intense pain and itching. People in endemic tropical areas do not have access to a simple, effective and safe method for treatment at home. The most common treatment used during clinical outreach activities is a foot bath in a disinfectant. Here we report on a clinical trial testing the effectiveness of a mixture of neem and coconut oils to kill the embedded fleas and reduce inflammation, pain and itching. We found the oil mixture reduced the proportion of fleas alive in the foot after 6 days in a similar way as the footbath in disinfectant, which is unavailable to households. However, unlike the footbath, the neem oil treatment caused most of the fleas to rapidly age in the foot and decreased the inflammation, leaving more children pain-free after one week. We conclude the neem and coconut oil mixture could be a promising approach for the treatment of tungiasis but its activity on the fleas might be slower. We need to follow up with longer observation time and test different dosages and application times.

Lesson of the month 2: Chronic erythematous painless plaque on the eyelid co-presenting with multiple ulcerated nodules on the extremities

Cutaneous leishmaniasis is a parasitic disease caused by the Leishmania species, transmitted by the bite of an infected sandfly. The typical cutaneous lesion is a painless ulcer with a raised, indurated margin and often covered with an adherent crust. The lesions are mostly located on exposed sites such as the face and the extremities. Eyelid involvement is rare, making up only 2-5% of cases with facial cutaneous leishmaniasis. Herein, we report a 50-year-old male who presented with an erythematous plaque on the upper eyelid and multiple ulcerated nodules located on the extremities. Following microscopic examination of the lesional smear, a diagnosis of cutaneous leishmaniasis was made, and the patient was successfully treated with intramuscular meglumine antimonate therapy.

Effectiveness of synthetic versus natural human volatiles as attractants for Anopheles gambiae (Diptera: Culicidae) sensu stricto

Females of the African malaria vector, Anopheles gambiae Giles sensu stricto, use human volatiles to find their blood-host. Previous work has shown that ammonia, lactic acid, and aliphatic carboxylic acids significantly affect host orientation and attraction of this species. In the current study, these compounds were tested for their attractiveness relative to human emanations in vivo and in vitro. Emanations from a human hand, incubated sweat, and foot skin residues on a nylon sock were significantly attractive when tested against clean air. In a dual-choice test, foot skin residues were significantly more attractive than emanations from a human hand in vivo. Ammonia alone attracted more mosquitoes than fresh or incubated sweat. However, the odor of a human hand or of foot skin residues were more attractive than ammonia. A known attractive blend of ammonia with lactic acid and carboxylic acids was less effective than natural foot odorants. The results demonstrate that the synthetic blend based on skin odor is attractive for An. gambiae, but that in a choice situation in vitro natural skin odors are still preferred by the mosquito. Differences in volatile organic compound abundances between a worn sock and the synthetic blend may have resulted in stronger attraction to the sock. This suggests that candidate attractants should be evaluated with consideration of the strength of natural odorant sources. The data furthermore suggest that additional unidentified compounds from the human foot are involved in the host-seeking behavior of this mosquito species.

Sand flea (Tunga spp.) infections in humans and domestic animals: state of the art

Tungiasis is a parasitic disease of humans and animals caused by fleas (Siphonaptera) belonging to the genus Tunga. Two species, Tunga penetrans (L.) and Tunga trimamillata, out of 10 described to date, are known to affect man or domestic animals; the other eight are exclusive to a few species of wild mammals. Tunga penetrans and T. trimamillata originated from Latin America, although the first species is also found in sub-Saharan Africa (between 20 degrees N and 25 degrees S). Hundreds of millions of people are at risk of infection in more than 70 nations, mostly in developing countries. The second species has been reported only in Ecuador and Peru. Males and non-fertilized females of Tunga are haematophagous ectoparasites; pregnant females penetrate the skin where, following dilatation of the abdomen, they increase enormously in size (neosomy) and cause inflammatory and ulcerative processes of varying severity. The importance of Tunga infection in humans concerns its frequent localization in the foot, which sometimes causes very serious difficulty in walking, thereby reducing the subject's ability to work and necessitating medical and surgical intervention. Tungiasis in domestic animals can be responsible for economic losses resulting from flea-induced lesions and secondary infections. Because tungiasis represents a serious problem for tropical public health and because of the recent description of a new species (Tunga trimamillata), it seems appropriate to review current knowledge of the morphology, molecular taxonomy, epidemiology, pathology, treatment and control of sand fleas of the genus Tunga.

Footbath acaricide treatment to control cattle infestation by the tick Amblyomma variegatum

Previous studies have shown that about 90% of adult Amblyomma variegatum Fabricius (Acari: Ixodidae) picked up daily by grazing cattle are still attached to the interdigital areas in the evening, when the animals return from pasture. It was therefore postulated that a targeted treatment, designed to kill the ticks attached to the feet, would limit infestation of the predilection sites. Footbaths filled with various pyrethroid formulations were used over 3 years, at the beginning of the rainy season (from mid-May to the end of July), to assess the efficacy of such a control method. It proved efficient in preventing the ticks from attaching to the predilection sites. Although five to 12 A. variegatum adults attached to each treated animal daily, and although the tick burden of the predilection sites of control cattle increased each day by four to 10 ticks, the average infestation of the predilection sites of treated cattle that were initially highly infested (over 100 ticks/animal) continuously decreased to reach a level of about 10-30 ticks/animal after 6-8 weeks of treatment. In herds with a lower initial tick burden (40-70 ticks/animal) this level was obtained within 2-3 weeks and the mean infestation subsequently remained consistently low. Footbath treatment carried out every other day during the adult peak infestation period should therefore greatly limit losses due to ticks. This method was appreciated by traditional livestock farmers, essentially because it is not time-consuming and because it requires only c. 200 mL aqueous formulation per animal at each passage. The cost of the acaricide needed to treat one animal during the peak infestation period was assessed at c. euro 0.20. This control method might also have an impact on some species of tsetse flies and mosquitoes, thereby contributing to trypanosomiasis and malaria control.

Leishmania-derived murine monocyte chemoattractant protein 1 enhances the recruitment of a restrictive population of CC chemokine receptor 2-positive macrophages

Transgenic Leishmania parasites that encode the murine chemokine monocyte chemoattractant protein 1 (MCP-1) were generated. These parasites transcribed MCP-1 mRNA and secreted MCP-1 protein. Infection of BALB/c, C57BL/6, or MCP-1 knockout (KO) mice with these parasites resulted in minimal lesion development with fewer parasites in the infected foot, lymph node, and spleen compared to wild-type-infected mice. In contrast, transgenic parasites caused substantial lesions with relatively high numbers of parasites in CC chemokine receptor 2 (CCR2) KO mice, indicating that the parasites are viable and healthy and that the lack of lesion development is CCR2 dependent. Prior infection of mice with transgenic parasites offered no protection to subsequent wild-type L. major challenge, suggesting that the transgenic parasites are controlled by an early innate immune response. Consistent with innate immunity, flow cytometry of cells from the ears of mice infected with transgenic parasites revealed an increase in the number of CCR2-positive macrophages by day 7 postinfection. The enumeration of transgenic parasites in ear lesions demonstrated a significant reduction in parasite numbers, which coincided with the increased CCR2-positive macrophage migration. CCR2-positive macrophages isolated from ears of mice infected with transgenic parasites contained virtually no parasites. In vitro studies revealed that optimal parasite killing required the recruitment of CCR2-positive macrophages, followed by stimulation with a combination of both MCP-1 and gamma interferon (IFN-gamma). This work suggests that the parasite-derived MCP-1 can recruit a restrictive population of CCR2-positive macrophages into lesions that can be optimally stimulated by MCP-1 and IFN-gamma to efficiently kill Leishmania parasites.

Expression of hypoxia-inducible factor-1alpha in the cutaneous lesions of BALB/c mice infected with Leishmania amazonensis

The hypoxia-inducible factor-1alpha (HIF-1alpha) is expressed in response to hypoxia and has been recently demonstrated in a variety of cells such as tumor cells and tumor-associated macrophages. Several characteristics of leishmanial lesions in humans and in animal models, such as microcirculation impairment, metabolic demand for leukocyte infiltration into infected tissue, parasite proliferation, and secondary bacterial infection, are strong indications of a hypoxic microenvironment in the lesions. We evaluated HIF-1alpha expression in the cutaneous lesions of BALB/c mice during Leishmania amazonensis infection. Immunohistochemical analyses of the lesions demonstrated, only in the later stages of infection when the lesion size is maximal and parasite burden is enormous and massive numbers of recruited macrophages and ulcers are observed, positive HIF-1alpha-infected cells throughout the lesions. HIF-1alpha is expressed mainly in the cytoplasm and around parasites inside the parasitophorous vacuoles of macrophages. This is the first evidence that macrophages in the microenvironment of lesions caused by a parasite produce a hypoxia-inducible factor.

Feline leishmaniasis due to Leishmania (Leishmania) amazonensis in Mato Grosso do Sul State, Brazil

A case of leishmaniasis in a domestic cat (Felis domesticus) is described. The animal showed a single, nodular lesion on the nose and many nodules of different size on the ears and digital regions of all the paws. Diagnosis was made by microscopic detection of amastigotes in Giemsa-stained smears from the lesions. By monoclonal antibodies the aetiological agent was identified as Leishmania (Leishmania) amazonensis, one of the seven species implicated in human leishmaniasis in Brazil. The clinical signs in feline leishmaniasis are unspecific and similar to those observed in other diseases such as cryptococcosis and in sporotrichosis, commonly found in cats. Leishmaniasis should therefore, be added to the differential diagnosis by feline veterinary practitioners and adequate investigations should carried out for dermal leishmaniasis in the area where the feline infection is detected.

Chemokine gene expression in toll-like receptor-competent and -deficient mice infected with Leishmania major

We studied the expression of a subset of chemokines, including RANTES/CCL5, MIP-1alpha/CCL3, IP-10/CXCL10, and MCP-1/CCL2, in Toll-like receptor (TLR)-competent and -deficient mice after infection with Leishmania major. Chemokine expression at the site of infection (the footpad), in the draining lymph nodes and in the spleens of infected animals was determined by using two different methods of analysis. The results indicate that L. major infection causes overall upregulation of RANTES/CCL5, MIP-1alpha/CCL3, IP-10/CXCL10, and MCP-1/CCL2 in the footpads and lymph nodes, while expression of these chemokines is constitutive in the spleens of TLR4-competent mice (C57BL/10ScSn) and TLR4-deficient mice (C57BL10/ScN). Different patterns of expression were detected depending on the time postinfection, but there was little variation in the expression of these four chemokines in the presence or absence of TLR4.

Biological behavior of Leishmania (L.) amazonensis isolated from a human diffuse cutaneous leishmaniasis in inbred strains of mice

After a subcutaneous injection of 100000 purified amastigotes of an isolate from a diffuse case of cutaneous leishmaniasis caused by the MHOM/BR/76/Ma-5 strain of Leishmania amazonensis, three inbred mouse strains developed a progressive nodular lesion, which evolved to an ulcerated lesion. Based on these data, mice of BALB/c, C57BL/6 or C57BL/10 could be classified as susceptible. The majority of mice developed metastases in the footpads, ear, tail, nose and oral mucosa. Amputation of the members related to the primary lesion was frequent. Experiments using the limiting dilution analysis showed that there was no correlation between lesion and parasite load. It has been demonstrated that these mouse strains could be considered excellent models for mucocutaneous leishmaniasis when infected with L. amazonensis. Metastatic lesions caused destruction of the nasal region with many parasitized macrophages under the epithelial surface of the nasal mucosa. Bone destruction occurred with an extensive inflammatory reaction presenting macrophages heavily parasitized by amastigotes. The parasites also spread to the periodontal ligament and other structures of the oral cavity, which could induce a severe inflammatory process. This study indicates that both nasal and oral lesions in mice infected by L. amazonensis were characterized by an inflammatory reaction with the presence of a high parasite load within macrophages.

Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil: I. Natural history of tungiasis in man

Tungiasis is an important health problem in poor communities in Brazil and is associated with severe morbidity, particularly in children. The causative agent, the female flea Tunga penetrans, burrows into the skin of its host, where it develops, produces eggs and eventually dies. From the beginning of the penetration to the elimination of the carcass of the ectoparasite by skin repair mechanisms, the whole process takes 4-6 weeks. The present study is based on specimens from 86 patients, for some of whom the exact time of penetration was known. Lesions were photographed, described in detail and biopsied. Biopsies were examined histologically and by means of scanning electron microscopy (SEM). Based on clinical, SEM and histological findings, the "Fortaleza classification" was elaborated. This allows the natural history of tungiasis to be divided into five stages: (1) the penetration phase, (2) the phase of beginning hypertrophy, (3) the white halo phase, (4) the involution phase and (5) residues in the host's skin. Based on morphological and functional criteria, stages 3 and 4 are divided into further substages. The proposed Fortaleza classification can be used for clinical and epidemiological purposes. It allows a more precise diagnosis, enables the assessment of chemotherapeutic approaches and helps to evaluate control measures at the community level.

Ectopic localization of tungiasis

Tungiasis is caused by the penetration of the female sand flea Tunga penetrans into the epidermis. It is generally assumed that lesions are confined to the feet. To determine to what degree tungiasis occurs at other topographic sites, 1,184 inhabitants of a poor neighborhood in northeastern Brazil were examined; 33.6% were found to have tungiasis (95% confidence interval = 30.9-36.4%). Six percent presented lesions at locations other than the feet, with the hands being the most common ectopic site (5.5%). Other sites were the elbows, thighs, and gluteal region. Ectopic tungiasis was significantly associated with the total number of lesions (P < 0.001) and an age less than 15 years old (P = 0.02). In 86 patients actively recruited with lesions on their feet, ectopic localizations were observed in 25.6%. Since untreated sand flea lesions are prone to become superinfected, clinicians should be aware of not missing any ectopic localization of tungiasis.

Mechanism of transforming growth factor beta-induced inhibition of T helper type 1 differentiation

Regulation by transforming growth factor (TGF)-beta plays an important role in immune homeostasis. TGF-beta inhibits T cell functions by blocking both proliferation and differentiation. Here we show that TGF-beta blocks Th1 differentiation by inhibiting the expression of T-bet, the apparent masterregulator of T helper (Th)1 differentiation. Restoration of T-bet expression through retroviral transduction of T-bet into developing Th1 cells abrogated the inhibitory effect of TGF-beta. In addition, we show that, contrary to prior suggestions, downregulation of interleukin 12 receptor beta2 chain is not key to the TGF-beta-mediated effect. Furthermore, we show that the direct inhibitory effect of TGF-beta on T cells is responsible, at least in part, for the inability of BALB/c mice to mount a Leishmania-specific Th1 response and to clear Leishmanial infection.

Parasitic load and histopathology of cutaneous lesions, lymph node, spleen, and liver from BALB/c and C57BL/6 mice infected with Leishmania mexicana

The course of infection, parasitic loads, and histopathology of cutaneous lesions, draining lymph node, spleen, and liver were compared in BALB/c and C57BL/6 mice over a period of 34 weeks after inoculation in footpad with promastigotes of a Leishmania mexicana reference strain. The results show that the primary footpad lesions first present a 12-week phase that develops similarly in both strains of mice. Thereafter, a cutaneous and visceral dissemination of L. mexicana parasites occurs in BALB/c mice; the latter experience an extensive breakdown of the lymphoid organ microarchitecture, whereas C57BL/6 mice succeed in eliminating the parasite infection from the lymph nodes but not from the primary cutaneous lesion, which does not heal. These results highlight marked differences between responses of key anatomical compartments controlling L. mexicana infection in BALB/c and C57BL/6 mice.

Distribution and abundance of the tick Ixodes uriae in a diverse subantarctic seabird community

At Bird Island, South Georgia, we surveyed the distribution and abundance of ticks on the vertebrate fauna and found only 1 species Ixodes uriae. We classified all seabird species into 3 groups: (1) seabirds nesting on the surface of the ground solitarily, in dispersed groups of a few nests, or in colonies with well-spaced nests; (2) seabirds nesting on the surface of the ground in dense colonies; and (3) seabirds nesting in dense colonies in burrows or rock crevices. We detected I. uriae only on 3 species of the second group that nested in large, dense, persistent colonies, i.e., black-browed albatross (Diomedea melanophrys), gray-headed albatross (Diomedea chrysostoma), and macaroni penguin (Eudyptes chrysolophus). Ticks were found on the undersides of the feet on albatrosses but not on the undersides of the feet on penguins. We hypothesize that the coarse pebble nests of penguins, combined with the fact that their young walk around more than albatross young, make the environment on the underside of penguin feet more harsh and hostile for ticks than the underside of albatross feet. Despite the great abundance of Antarctic fur seals (Arctocephalus gazella) on the island, we found no ticks on them.

The role of polymorphonuclear leukocytes in the resistance to cutaneous Leishmaniasis

The massive infiltration by polymorphonuclear leukocytes (PMN) soon after skin infection with Leishmania major suggests that PMN could participate in reducing parasite load and controlling the spreading of leishmanial infection. Yet, direct evidence for the participation of PMN in host defense against L. major was lacking. We investigated L. major infection in susceptible and resistant mice treated with the monoclonal (mAb) antibody RB6-8C5 that depletes the population of mature neutrophils and eosinophils. Both BALB/c and C57BL/6 mice depleted of PMN show accelerated parasite spreading and more severe footpad swelling than similarly infected untreated mice. In addition, significant higher parasite numbers were found in the lesion draining lymph nodes from PMN-depleted C57BL/6 mice. Histopathological analysis of the paw confirmed neutrophils containing ingested parasites as the dominant cell type in the infiltrate of the first days after infection and the nearly absolute neutrophil depletion in mAb-treated mice. Our data show the importance of PMN in early control of parasite load and parasitism spreading in cutaneous leishmaniasis.

The seasonal pattern of sheep blowfly strike in England and Wales

Information on 4049 cases of sheep blowfly strike on 495 farms in England and Wales was gathered in a longitudinal survey conducted in 1991. The breech was the most commonly infested area, accounting for 70.9% of all strikes recorded. Body strikes accounted for 19.7% and foot strikes 11.4% of all strikes. Early in the season the incidences of both breech and body strikes were higher in ewes than in lambs, but from June to October lamb strikes predominated. The incidence of foot strike was greater in ewes than lambs throughout the year, with a peak incidence in September. Regional differences in strike incidence were evident; the highest overall incidences were recorded in the southern regions of England where peak incidence occurred earlier in the year. The highest monthly incidence risk was recorded in August in the south-east of England where there were 14.2 strikes per 1000 lambs and 4.0 strikes per 1000 ewes at risk. The importance of faecal soiling and ambient temperature are discussed.

Rodents are not a source of endogenously-produced, fecally-transmitted Caryospora bigenetica oocysts

Fifteen Swiss-Webster mice (Mus musculus) and eight cotton rats (Sigmodon hispidus) were inoculated orally with Caryospora bigenetica oocysts. Feces from these animals were collected from 0 to 180 days postinoculation (DPI) and examined for endogenously-produced oocysts using Nomarski microscopy. Oocysts were recovered from mouse feces at 0, 1, 2, 3, 5, 7, 8, 10, and 14 DPI, and from cotton rat feces at 1, 2, and 9 DPI. The recovered oocysts were determined to be from the original inocula due to the presence of thick walls, polar granules, and Stieda and substieda bodies. All animals exhibited clinical signs at 8 DPI. Developmental stages of C. bigenetica were identified in various tissues of seven cotton rats found dead at 9, 10, 11, 12, and 13 DPI. Caryocysts were found in muzzle, tongue, footpad, scrotum, and rectum of mice and cotton rats at 30 DPI. Fecal samples collected from mice on 0, 8, 10, 12, 14, 16, and 18 DPI, and from cotton rats on 0, 9, 11, 13, 15, and 17 DPI were injected subcutaneously into 13 mice. Of the 13 mice, a Caryospora infection was observed only in the mouse inoculated with 0 DPI mouse feces. We propose that endogenously-produced C. bigenetica oocysts are not fecally-transmitted by Swiss-Webster mice or cotton rats.

Epidemiology of sheep myiases in São Paulo State, Brazil

A survey of Diptera species causing cutaneous myiases on sheep in Botucatu, São Paulo, Brazil was made to determine seasonal incidence, predilection sites and the factors predisposing to infestation. Sheep were checked daily for myiases for one year. At two week intervals larvae from wounds were collected for identification. Only larvae of Dermatobia hominis and Cochliomyia hominivorax were found. Myiases due to C. hominivorax were observed during the whole year with high incidence from January to April. The feet, vulva, tail and scrotum were most frequently infested. Wounds were the commonest predisposing factor.

Cytokine control of Leishmania infection in the BALB/c mouse: enhancement and inhibition of parasite growth by local administration of IL-2 or IL-4 is species and time dependent

The therapeutic potential of locally injected interleukin-2 (IL-2) or interleukin-4 (IL-4) was studied in the footpads of Leishmania mexicana or Leishmania major infected BALB/c mice. The disease state was measured both pathologically, by measuring lesion size, and parasitologically, by counting total parasite numbers from infected footpads. IL-2 (0.5 microgram/dose) or IL-4 (0.1 microgram/dose) was administered either early, 1 day and/or 15 days after infection, or late, after palpable lesions had developed. Results differed markedly depending on which Leishmania species was used and at what time during the course of disease that therapy commenced. Both L. major and L. mexicana infections, as measured by footpad thickness and parasite number, were exacerbated if IL-4 was injected into the infected footpads early, during the first two weeks of infection. Paradoxically, late intralesional injection (i.e. after measurable lesions had developed) of IL-4 markedly inhibited both lesion size and parasite growth in L. major, though not L. mexicana, infected mice. IL-2 had no measurable effect on the course of L. major infections no matter when or how often, the infected footpads of mice were treated. However, early administration of IL-2 did exacerbate L. mexicana lesion and parasite growth while late treatment had no effect. Generally, but not always, increases in footpad size correlated with increases in parasite number.

Experimental infection routes of Angiostrongylus cantonensis in mice

Stomach intubation is the most common method used in the experimental infection of animals with Angiostrongylus cantonensis. In order to compare the effectiveness of other possible transmission methods, groups of BALB/c mice were given infective third-stage larvae of A. cantonensis by different routes including intraperitoneal or subcutaneous injections, and penetration of anal mucosa, vaginal mucosa, conjunctival mucosa, lacerated skin, unabraded skin, foot pad and tail skin, while stomach intubation was used as control. Recovery of fifth-stage larvae was higher in mice inoculated with third-stage larvae subcutaneously. Successful infections were established through all experimental transmission routes except tail skin penetration. This study suggests that oral infection may not be the only route for the transmission of human angiostrongyliasis, and subcutaneous infection may be a better method for experimental infection.

Effects of route of inoculation on the site of development of Caryospora bigenetica (Apicomplexa: Eimeriidae)

The sites of infection by Caryospora bigenetica in Swiss-Webster mice (Mus musculus) were demonstrated after 7 routes of inoculation: oral, intraperitoneal, intravenous, intramuscular, subcutaneous, dermal, and intraocular. All mice exhibited clinical signs of dermal coccidiosis 9 days after inoculation regardless of the inoculation route. Signs included swelling of the facial tissue, footpads, and scrota (male mice). Developmental stages of the parasite were found in the muzzle, tongue, footpad, lumbar subcutaneous tissue, biceps femoris muscle, conjunctiva, and eye; the latter 3 sites represent new sites of development. The site of development of the parasite in the host tissue was independent of experimental inoculation route.

The pathogenesis of Leishmania aethiopica infection in BALB/c mice

A mouse model for L. aethiopica infection is described. BALB/c mice were unable to clear an infection with 1 x 10(7) promastigotes injected into the hind footpad. However, there was no ulceration of the lesion and no development of overt clinical symptoms after 203 days of infection. Spread of viable organisms was evident in the draining lymph node but not in the spleen or liver. The control of the infection was associated with the development of classical delayed hypersensitivity responses to phenolized promastigotes and appeared as a localized granulomtaous infiltration. The infiltration had features of classical tuberculoid granulomas, but superimposed on it was a strong eosinophilic infiltration. The relevance of such cells though unclear is discussed.

Two new species of ticks from southern Africa whose adults parasitize the feet of ungulates: Rhipicephalus lounsburyi n. sp. and Rhipicephalus neumanni n. sp. (Ixodoidea, Ixodidae)

Theiler & Robinson (1953) described, as Rhipicephalus follis Dönitz, 1910, a tick species originating from Dordrecht, Eastern Cape Province. A comparison of this tick with the syntypes of R. follis has now shown, though, that these 2 entities are different and it is therefore redescribed below as Rhipicephalus lounsburyi n. sp. Its adults parasitize sheep and various wild ungulates, attaching primarily on their feet. The hosts of the immature stages are still unknown. It has now been recorded from several places in the Eastern Cape; once in Natal, at Impendle, and in the Western Cape near Swellendam and between Clanwilliam and Graafwater. A second species, which has in the past been confused with the dassie parasite, Rhipicephalus distinctus Bedford, 1932, is described as Rhipicephalus neumanni n. sp. Its adults also attach on the feet of sheep and goats. The hosts of the immature stages are unknown. It has been widely recorded in the Bethanien and Keetmanshoop Districts of Namibia and, in South Africa, from scattered localities in the Karoo.

Zoonotic Onchocerca in a Japanese child

A female Onchocerca was found in histopathological sections of a nodule removed from the foot of a 2-year-old girl in southern Japan. As in previously reported cases in Switzerland, Crimea, Canada, and the USA, evident morphological features of the worm resembled those of Onchocerca gutturosa and O. cervicalis, which are known to exist in cervical ligaments of cattle and horses, respectively, in Japan and elsewhere.

Endemic non-filarial elephantiasis in Iringa District, Tanzania: a study of 30 patients

Endemic non-filarial elephantiasis has not yet been described in the central tableland of Tanzania. We report the results of a clinical study in Tosamaganga Hospital, located in the middle of Tanzania (Iringa District). 30 patients with elephantiasis of the lower limbs were studied parasitologically (by blood smears) and clinically. Inguinal lymph nodes were removed from 10 patients and histologically examined. The mineral content of soil samples collected from 4 different areas of the region was assayed by X-ray fluorescence. The clinical, histological, parasitological and epidemiological data prompted us to conclude that in these patients elephantiasis was not of the filarial type, and that endemic non-filarial elephantiasis is present in the Central District of Tanzania.

[Three new species of Onchocerca from duikers in Gabon (author's transl)]

The duikers from Makokou (Gabon) are parasitized by many species of Onchocerca but the adults are very often occult and can only be discovered by a systematical search. Three new species are described: O. sonini n.sp. in the feet-tendons, and O. lerouxi n.sp. in the muscular aponevrosis of the trunk of C. nigrifrons; O. beaveri n.sp. in the ligaments of the atlas-occipital articulation of C. monticola. Although their external appearance differs, these three species belong to a single group, which, from an evolutionary point of view, is intermediate between the more primitive Onchocerca of Equiids and those more evolved from other animals.