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Multi-legged Creatures and Delusory Parasitoses on the Internet

About even/other week there is an appeal on the discus- sion groups monitored here from someone suffering from a nasty sounding medical condition, and asking for information.

(bionet.parc~sffolo W mall newsgroup) Following an earlier series of exchanges on the subject of 'worm around jugular' (FarcSitc, ?arasitol. Today 13, 92-93, 1997), Dougla~ Conner rema&...o.d that when a pel3on is diagnosed as having a 'parasitosi~', parasitologists quickly become psychiatrists, as they assume that if a parasite has not been found then it does not exist and the sufferer mu~[ be a mental case. Haybe 'in this world not everything is yet known', For example, he and his family are afflicted with an unpleasant and unci,agnosed dermatological ailment. Above the skin it is associated with 'small, fiat, reddish-brown organ- isms about the size of an eyelash (some have been larger) which also have l~le hairs or spikes equally distributed along each side from one end to the other'. Another individual ('Alpenrose' - 'a scientist, pharmacist.., level-headed, hon- est') described how after being bitten in the south of France two years ago by a swarm of what were probably Chn/sops (deer flies) his body was horribly invaded b)' unidentified worms which are still causing trouble, Thiabendazole was discontinued because of its side effects. The discussion which followec lasted for three weeks in February:

What do quolilled physicians know about paras/tes? Steve Kayes (University of South Alabama) noted that med- ical parasitolo~ is not one of the strong points of the med- ical school curriculum: students are often convinced that pan. asitology is exotic and can be ignored or forgotten as soon as possible. It was quite different, however, when he taught on a course for military physicians about to be shipped to endemic areas - they adm/t-ted they had ignoted the subject before, because they tJ~ought that they w~uid never have to us= it. He believes textbooks only give a clinical picture of a limited number of parasites and 'that pa~sites cannot read road ,naps so as to always end up where the textbook says they ought to... many of the descriptions of parasitic refec- tions (internal parasites) or infestations (external parasites) described by some participants to this newsgroup are not consistent with anything that is recognizable'. He concluded by disclosing that the American Society of Tropical Medicine and Hygiene lists a directory o f clinical physicians at http.'Jlmembers.aol.cornlastrnhweblinde~chtml, which might help some people in the USA at least. Bob Garrison (Sacramento, CA) agreed that not many 'physician parasitologists' exist outside university medical schools. As 'a veterinarian.., with a keen interest in parasites affecting people ~nd animals', he thought that veterinarians are much better educated about parasitic infections than are ph~icians, being particulady well informed about zoonotic infections transmiss- ible from animals to people. Responsible physicians should say 'I don't know' when stumped. But there is a well-documented condition of delusory parasitosis which has a psychiatric basis, patients describing ~uly strange-sounding problems (multi- legged creatures constantly crawling in/out of body orifices, etc.).., and several o f the recent posts to this group are sug- gestive of it.' It seems that parasitology is taught to physicians in America in two weeks (Gary Conboy, Atlantic Veterinary

Parasitology Today; vol. 13, no. 5, 1997

College), in 24 h of lectures w,th 16 h of practicals in France (Jean-Fran~:ois Magnaval, Toulouse), and over 90 h in Chile (Ornar Barriga, Ohio State University). Mark Siddall (University of Michigan), himself a parasitologist, described his own, private experiment when he was correctly diagnosed and =-eared by 'my primary care physidan (not a spedalist)' as suffering from Giardiasis after a visit to South Afrlc~ (Tin not crazy about metronidazole. -iastes awful[). Om~r Barfiga, wondering if Michigan had 'something to do with it', continued with a nice diatribe: thanks to excellent sanitation, parasitic diseases el: humans are rare in the USA and there is no money in it. 'A physici@, has to be a fool to spend time studying parasitic dis- eases to see a case even/other week instead of studying car- diology and seeing a case even/15 minutes. At $I00 to $200 the visit, that r,~akes quite a bit of a difference, l~ wcn't be until we, the public, demand socialized medicine t'~at all specialties will have takers,,, many poor people in the USA,,. cannot afford medical care while a few affluent people get a rout3ne CT scan for a sinus infection. One wonders if development means anything for the masses or just for a few chosen ones.' The debate ended there;

Cysticercosis LP~ Vires had observed this infa~ion in a person who had been a strict vegetarian since birth and wondered if there ~m reports of oral-faecal transmission of cysticercosis. Rick Speare (james Cook University, Australia) ~mphasized the dif- ference between c/sticercosis (transmitted b 7 faecal contami- nation, through ingestion of eggs of Taenia so!ium, which hatch in the small intestine, enter the bloodstream and form cysts in many organs) and taeniasis (acquired by eating ~ c e r c i in pig muscle which develop in the g~Jt into the aduff tapeworm). He mentioned interesting studies on cysticercosis in people who eat no po.'P.. ]~vier Ambrosio (Universidad Naci6nal Aut6noma de M~xico) quoted a paper on neurocysticemosis in an orthodox Jewish community in Ne~ York City" (P.M. Schantz e~ al. New Eng. ]. iVied. 327, 692%95, 1992) and one on seropreva!ence (A.C. Moore et el. Am. J. Trop. Med. /-/yg. 53, 439-442, 1995). VVhile it might be thought to be a dis- ease associated with poverty and bad hygiene, he pointed out that only one tapeworm cartier involved in food processing could infect a very large number of relatively afflue~ people. An individual ('earthling2') then reproduced a section on ver- mifuges from Chambers Cyclopedia (Univer~ol Knowledge for the People, Vol. 8, p. 95, published in 1888), which discussed the use of various exlracts of wormwood, worm-seed, £em- root, the 'Pomegranite tree' and pumpkin seeds for expelling intestinal worms and recommended that ~dne intense itchin~ about the lower part o f the bowel, especially in .'-_he evening and at night is best relieved by the introductuon era littt,'e mer- curial ointment within the verge of the anus, when the vi~im retires to rest'. How times have changed!

Mosqui to Discussion G r o u p Parasitologists might be described as inward Io~.~king in their outlook How-~.ver, entomologists as a species are more extrovert and :learly concerned with the grea~ wide world outside. When .:tacy, describing herself as 'a 16 year old gid living in PA' war,ring help with a research paper, asked for 'information abo~ ~. the useful purposes of mosquitoes - are there any?' respot'ses were numerous and various: she was

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that n'~ny fish and aquatic creatures depend on mosq~g~o lantae and pupae (Sonny Ramaswamy, Mississippi State Unh~ersitF). that mosquitoes provide food for birds ( D a ~ Fre~.. Multidata Inc., Minnesota), especially, said Barry Carter (Blue Mountain N~ve Forest Alliance), 'neotropical m~ato O, ~rds who summer in the sub-Arctic regions. My dad. who used to live in Alaska, says that the only way there c c ~ ~ more mosquitoes in some areas up there is if they we~ sma~er'. Robert Lowrie said they also serve as poUina- tots, 5h~,_%~. this was denied by Gary. McCallister (Colorado) w h o ~ them nectar robbers: o f 200 Aedes he had exam- ined ¢~.!y one had pollen attached to iL ~ d only one pollen grain at theft However. Roy Ellis (Prairie Pest Planagem.e~t Carman, NB Canada) stated that northern Aedes have often _~'~ coll¢~ed ;;~*~ po!!en on their 10cd~s and thair enor- mous n~r.bers in the Canadian tundra suggest they rnust be im~.~rtant pollinators "Jnere. David Frenz then revealed him-

tO be a palynolo~st with a peripheral interest in ento- mology. [Palynology, f~m the Greek: to sprinkle, was first used in 1944. f~r the ~tudy of the stnacture and dispersa! of pollen grains (Shorter Oxford English Dictionary).] He posted several references about mosqu~oes as pollina:~ors (obtained through PolpaI-L a list for those interested in pol~m) which inter alia, deal with their pollinating activities in Qu~,~ns~ald, Australia and their pollination of orchids in A~9,a. athena drew attention to the genus Toxorhynchitjs - adu~ females are not blood-sucking and the larvae feed on

m o p , t o larvae. P, anjith de Aiwis (Sri Lanka) men- tk,x~td two species, ~,: sp!en~ens and T, maximu/, which bn~d ~n ~ holes there, and can in fact be used for mos- quito con~l . Daniel Mauer (Iowa Slate University) quoted EO. Wilson as sa)mg that every spe(ies 'is a masterpiece of ~ ' . He tho-~h.t that mosquitoes have influenced the art, fot~Jore, and I~eratune of many culture.s, and are useful because ~Eey r,'~al-,. • tl'~ wod, d more interesting[ Lynn D~ose (~av-an~h, GA) submitted another point of vie~ mosquitoes, by transmittin~ malaria and a r,umber of lethal

diseases, are 'Nature's ~ l y of biocon~-ol for humans... ecology iS a ~;,~,ole new scier~ce when you are one of the test animals'. Gary McCailister a~a~-~ecl and added that since the foss~l r~cord showed they w~re here before us, we should ask instead what good ~'e we to mosquitoes? Steve S d ~ z (CorCra Costa Mosquito & Vector C.nntrol District Co~:ord, CA) admitted to nervousness wi,er~ si.~J about the 'purpose' of a living organism. In biological ~erms, the only 'purpo~_' of a i vi, ng creature is to reproduce and pass its genes on to its ofispnr,g. As it is 'a religious idea that the 5 ~ e m e ~;ng created al! thin~s for a specific purpose', maybe Stacy should consult 'a clengy person to add a differ- ent perspective'. David Frenz was roused: ' Does this mean that once my children are in college that my life has achieved its ultimate purpose? What about my contribution to the

such as r.~;=l sde,,~J~c di~o-,cdes, publishing papers, etc.? Are these largely irrelevant endeavors? If so, I would rather sit in a boat in northern Minnesota than in front of a computer semen all day long. I'II have to it,dude these reasons in my letter of resignation,..' Schutz com-

j~tife2oly, that his comment was being taken out of context - he ,had dearly specified 'in biolosical te~ms'. Finally, P~occo Mosd~*3 (Universit~ ~f Alaska) drew attention to all the ~ whose livelihomi 'depends on studyin~ control- ~ g and admiring the "~wly" mosqu¢o'. Developing new weapons in the war on mosquitoes is big business. 'In Alaska, more money is made from insect repellents, and "giant mosq~o" post cads g-an most products promoting other a~l~,s of ~ state'. Stacy must have had fun with that essay...

Plalar|a Discussion Group Although busy with queries durin~ I February, none led to any exchanges of points of view of time kind summarized above. The question as to why malana i~ t~-ansrr,~ed exclusively by' the Anopheles mosqulto was answ,=.red by Bob Sinden (Imper- ial College of Science, Technology and Medicine, U~ that it is not: all parasites of the avian and saurian species are transmit- ted by Culicines or Sandflies, and his lab i,~ actively engaged in investigating why Aedes spp. transmit Plasmodium gallinaceurn and Anopheles transmit P. berghei. Paul Horrocks (VV6rzburg University, Germany), wanting a clone of the P, falciparurn calmodulin gene, was told to try Alan Cowman at the Walter and Eliza Hall Institute, Melbourne and was offered one by John Dame (University of Florida Gainesville, FL). When Phihp Coelho (Ba!l State University. IN) asked about the anthropo- metric effects of malaria, the impact of chronic malaria of vary- ing intensity upon body dimensions, Patrick Rozmajzl (US Navy) thought it would be difficult to separate the effects of genetics, chronic disease (other than malaria), nutrition and so on, but Tom Smith (Swiss Tropical Institute, Basel) provided a number of possible references (starting with IA. McGregor, Malaria: nutritional implications, Rev. Infect. Dis. 4, 798-804, 1982). Uoyd V~_lidum (Guyana) asked if proven mefloquine r~.~istance has been reported in South Anlerica and he also v~tnted to know if the WHO classification of resistance of malaria parasites to antimalarials has been reviewed recently. Mariano Zalis (Federal University of Rio de Janeiro) replied that resistance had been encountered in two states in Brazil and Kevin Palmer (VVHO, Manila) gave some details of a document outlining changes in the classification and method of assessing drug sensitivity that will be put out by WHO in Geneva; there is a switch to measuring therapeutic efficacy and a few clini,,:al parameters have been added. Gary Martens (Fort Worth, -[~exas)..: layman asking about ~dne side effects of malaria', was told by Luiz Jacintho da Silva (State University of Campinas, Brazil) quite briskly. 'Untreated mala~a, as any other untreated disease has no side effects, it has main effects. Drugs have side effects.'

W e b Sites Microbial Geno,~e Discussion Group Mark PaUen (email: m.pallen@qmw.ac.uk) (h~p'Jlwww.qmw.ac, uk/ ~rhbm0011mpallen.html) has launched this general forum for discus- sion of bacterial, archaeal and small euk,~s-/otic genomes. To take part, send a message to mailbase@mailba~.acuk \*.:~h 'Join microbial- genomes firs'marne(s) lastname' as the onty text,, in the ~ of the message. Some specif~: mai~ing lists already exist (see httpJlwww.mail- base.ac.uldlists/parasite-genome and http']lwww.rnailbase.aculdlists/ filarial genorne).

Leishman/a Di~:usslon Group This is run from listser~bdt.on&br. To join in send a message with subscribe LEISH-L and your name in the body of the text, The Leish- Net website is at httpJlwww.bdtong,brlbdtJleishnet •

A~cen Trypanesome Genome Project The secretaries Sara MeMIle (sml60@rnole.bio.cam.ac.uk) and John Donelson (john-donelson@uiow~edu) have set up a web site at http']/pa~d.pa~.cam.acuk for those interested in the molecular biology of .1". t~ucei. Worm Health Organizmion This site is an excellent source of information about infectious dis- eases of rnanldnd: http'Jl,~v.who.chl

ParaS/re was compiled, from t~e !n~ernet, I by Janice Taverne (J. Taverne@ucl.ac.uk) I

Parasitology Todoy, vol. 13, no. 5, 1997