also become attached to the cocoon when the larva pupates, and later to the adult moth.Hairs readily become airborne. If inhaled, detached caterpillar hairs can cause laboredbreathing; if ingested, they can cause mouth irritation. The hairs of some species retaintheir urticating properties long after being shed. Hairs and setae may drop into swimmingpools and irritate swimmers. Acute urticarial lesions usually respond to topicalcorticosteroid lotions and creams, which reduce the inflammatory reaction. Oralhistamines help relieve itching and burning sensations.Contact dermatitis from moth hairs is a limited public health problem in the <strong>Middle</strong> <strong>East</strong>.Thaumetopea wilkinsoni, introduced from Cyprus, has caused outbreaks of dermatitis inIsrael. Six hundred of 3,000 Israeli soldiers camped in a pine tree grove developed rashand skin irritation after exposure to hairs of this species.9. Meloidae (blister beetles) and Staphylinidae (rove beetles). Blister beetles aremoderate-sized (10 to 25 mm in length), soft-bodied insects that produce cantharidin intheir body fluids. Cantharidin is a strong vesicant that readily penetrates the skin.Handling or crushing the beetles causes blistering within a few hours of skin contact.Blisters are generally not serious and normally clear within 7 to 10 days. If blister beetlesare ingested, cantharidin can cause nausea, diarrhea, vomiting, and abdominal cramps.Blisters that occur on the feet where they will be rubbed may need to be drained andtreated with antiseptics. Cantharidin was once regarded as an aphrodisiac, and a Europeanspecies of blister beetle was popularly known as Spanish-fly. Troops should be warnedagainst using blister beetles for this purpose.The Staphylinidae, commonly called rove beetles, is another family that produces a strongvesicating substance that causes blistering. Rove beetles are active insects that run or flyrapidly. When running, they frequently raise the tip of the abdomen, much as scorpionsdo. They vary in size, but the largest are about 25 mm in length. Some of the larger rovebeetles can inflict a painful bite when handled. Many species are small (
scorpions frequently rest in shoes or clothing.There is a broad array of scorpions in the <strong>Middle</strong> <strong>East</strong>. The two most widely distributedspecies of medical importance are the yellow scorpion, Leiurus quinquestriatus, and theblack scorpion, Androctonus crassicauda. A list of species reported from the <strong>Middle</strong> <strong>East</strong>is provided in Appendix A.5.Most stings are inflicted on the lower extremities or the arms and hands. During thePersian Gulf War, most stings occurred during the daytime, when scorpions were resting.However, among indigenous populations, stings are more often inflicted at night,especially between the hours of 2100 and 0100, when scorpions are most actively huntingfor prey. In Iran, the most dangerous scorpion, Hemioscorpion lepturus, is more oftenencountered in winter. However, in Jordan, most scorpion stings occur in the hot season,peaking in August.Scorpions can sting multiple times, and when trapped, as with a person in a sleeping bag,will readily do so, as long as the victim is active. Common places where stings areencountered by military personnel include the boots and under or around piled clothing.Scorpion stings broadly affect nearly all body tissues, and they present a mixture ofhemolytic, neurotoxic or cardiotoxic effects. All stings should be considered potentiallydangerous. The severity of scorpion stings can be categorized as follows: 1) patients withpain but no systemic findings; 2) those who in addition to pain have one or two mildsystemic manifestations, such as local muscle spasm, dry mouth, increased salivation, orrunny nose; 3) those who have more severe systemic manifestations but no centralnervous system manifestation or general paralysis; and 4) those who have severe systemicreactions, including CNS involvement, such as confusion, convulsions, and coma, with orwithout general paralysis. Victims also develop uncoordinated eye movements, penileswelling, or cyanosis. The most severe manifestations occur in children, who are moresusceptible to the effects of venom because of their small body mass. Those with type 1,2, or 3 manifestations can be managed by attempting to slow the spread of the venom byapplying ice and supporting the patient with fluids and antihistamines. However, thosewith type 4 manifestations require intensive medical treatment, especially during the first24 hours following the sting. Antivenin therapy is important for severe cases. For thistreatment to be effective, the stinging scorpion must be captured so it can be properlyidentified.To prevent scorpion stings, military personnel should be instructed to empty boots beforeattempting to put them on, carefully inspect clothing left on the ground before dressing,and keep sleeping bags tightly rolled when not in use.11. Simuliidae (black flies, buffalo gnats, turkey gnats). Black flies are small (3 to 5mm), usually dark, stout-bodied, hump-backed flies with short wings. Despite theirappearance, black flies are strong flyers that are capable of dispersing many km from theirbreeding sites. Only females suck blood. They can emerge in large numbers and beserious pests of both livestock and humans. Black flies bite during the day and in theopen. Simulium damnosum tends to have a bimodal pattern of activity, with peaks ofactivity around 0900 h in the morning and 1700 h in the afternoon, but in shaded areasbiting is more evenly distributed throughout the day. The arms, legs and face are common140
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1. Table of ContentsI. Preface.....
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IX.Selected ReferencesA. Military P
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and spills have polluted sea- and l
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Sand fly fever is the most widespre
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VENOMOUS ANIMALSThere are 31 specie
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Middle East11
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leptospires, various bacteria and i
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Bandar Abbas (elevation 10 m)Mean D
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a wide variety of human pathogens.
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The Jordan Valley area is part of t
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still numerous sites where waste di
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highlands (445 m elevation) are sim
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ocky central plateau, the Nejd, whi
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MONTH J F M A M J J A S O N DMaximu
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known as the Liwa, form an arc alon
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___________________________________
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Table 1. Drug-Resistant Falciparum
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Saudi Arabia: Malaria occurs in the
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General Bionomics. Female anophelin
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host with the body nearly perpendic
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crevices, leaf litter, or moist tre
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All dengue serotypes are now endemi
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period immediately following it (19
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Military Impact and Historical Pers
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on camels, pigs, dogs, donkeys, hum
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CCHF virus loses infectivity shortl
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Published Reports of Insecticide Re
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Turkey.Calgar, S.S. 1991. An invest
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Appendix ESelected List of Identifi
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MammaliaHarrison, D.L. and P.J.J. B
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Appendix F: Personal Protective Mea
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Appendix GBioscience and State Depa
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8. Kuwait9. Lebanon10. Oman11. Qata
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Appendix H: Glossaryacaricide - a c
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zoonosis - An infectious disease of
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flies.11. Information on ticks and
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APPENDIX J METRIC CONVERSION TABLEM