TOT headerISSN-1059-6518 Volume 27 Number 1

Makonde for “that which bends up”


Chikungunya is NEW to the Caribbean Islands

By Frank Hubbell, DO

Haiti: A 19-year old female presents at a rural clinic with a high fever, 104F, a fine, erythematous rash on her feet and lower legs that does not blanch with pressure, and body aches and pains, that have been quite painful for the past 4 days.

The remainder of her physical exam is normal.

Living in a rural community, she does not have screens on her windows, and she does not sleep under mosquito netting. As a result, she is commonly bitten by mosquitos.

 Recently, there has been an outbreak of both dengue and chikungunya in the area.


 A single-stranded RNA virus of the Genus Alphavirus, Family Togaviridae,

 the virus targets the cells that make up blood vessels. It is the destruction of these cells that causes the bleeding into the skin and the non-blanching hemorrhagic rash, thus the name hemorrhagic fever.

 The reservoir in nature is primarily humans.MarchApri08lWMN copy-18.1

 The vector that spreads the virus from infected human to human is the Aedes mosquito; A. aegypti and A. albopictus.

 The Aedes mosquito can also spread:


            Dengue – infects blood vessels- hemorrhagic


            Eastern Equine Encephalitis – infects the brain- encephalopatic


            West Nile Virus – infects the brain- encephalopatic


Yellow Fever Virus – infects blood vessels- a lethal hemorrhagic illness

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By Frank Hubbell, DO

Illustrations by T.B.R. Walsh

This is a short article to compare and contrast Centipedes and Millipedes. Centipedes are venomous and can cause a painful bite, while Millipedes have no venom and pose no danger to humans.

Centipedes:    Millipedes:

KINGDOM                Animalia        Animalia

PHYLUM                  Arthropoda    Arthropoda

SUBPHYLUM          Myriapoda      Myriapoda

CLASS                      Chilipoda         Diplopoda


These are not Arachnids; they are Chilipoda.

They are predatory – eat insects, worms, and millipedes.

They have a pair of legs for each segment, 20 to over 300 pairs.

They have a pair of venom claws on the front segment, and they do produce venom used to killed and subdue their prey.

Size: 4mm (1/4”) to 30cm (12”).

8000 species of centipedes.

They have a venomous sting that is painful but not dangerous.

The only danger is the risk of an allergic reaction or anaphylaxis.

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 Dangerous to Humans

By Frank Hubbell, DO

Illustrations by T.B.R. Walsh

KINGDOM – Animalia

PHYLUM – Arthropoda

SUBPHYLUM – Chelicerada

CLASS – Arachnida


They are joint-legged invertebrate animals.

They have eight legs, the front two may be modified into fangs or jaws.

There are over 100,000 named species.

There are 11 Orders of Arachnida:

Potentially dangerous to humans:

Araneae – spiders

Scorpiones – scorpions

Acari – ticks and mites

Harmless to humans:

Scolifugae – camel spiders, wind scorpions, sun spiders, solifuges

Opiliones – harvestmen (daddy longlegs)

Amblypygi – tailless whipscorpions and whip spiders

Palpigradi – micro whipscorpions

Pseudoscorpion – pseudoscorpion, bookscorpion, or false scorpion

Ricinulei – ricinuleids or hooded tick spiders

Schizomida – schizomids or shorttailled whipscorpion

Thelyphonida – whiptailed scorpion, vinegaroons, uropygids

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Japanese Encephalitis

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Travel Immunizations

Japanese Encephalitis

By Frank Hubbell, DO

Japanese Encephalitis (JE) is more correctly known as Japanese B Encephalitis.

It is a virus in the family Flaviviridae.

The reservoirs in nature that harbor the JE virus are pigs and herons.

The vector for JE is the mosquito – Culex tritaeniorhynchus & C. vishnui.

JE is not contagious, in that it cannot be transferred from human-to-human. It has to be spread by the Culex mosquito vector.

The incubation period from mosquito bite to symptoms is 5  – 15 days.

The vast majority of those infected are asymptomatic.

Only 1 in 250 cases develops into encephalitis.

Still JE is the leading cause of encephalitis in Asia with 30,000 – 50,000 cases per year.

One in four patients that develop JE encephalitis will die. There is a 25% fatality rate caused by brain damage.

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