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UNIT 8: Introduction to Parasitology Parasitology is a study of the phenomenon of parasites and parasitism. Parasite is defined as “an animal/ organism or a plant which lives in or upon another animal/ organism (technically called the ‘host’) and draws its nutrition directly from it”. Animal Association/ relationship In a broader sense any interaction between two organisms is considered as symbiosis (living together). And so, the science of parasitology seems largely a study of symbiosis. Depending on the degree and type of interdependence of the symbionts, symbiosis can be divided into different categories as: 1. COMMENSALISM: (Com mensa lat. - sharing table): it is an association where an organism, the COMMENSAL, derives benefit (nourishment) from another (host) without harming the benefactor (Host). E.g., Entamoeba gingivalis in mouth 2. MUTUALISM: it’s an association of two partners where both are benefited by each other. E.g., Ciliates in ruminants 3. PHORESIS ("traveling together" or "to carry"): it is a temporary relationship with no metabolic dependence. A smaller organism, termed the PHORONT, is carried mechanically by a HOST. For instance, bacteria, fungus, cysts, or eggs on insect legs or even passively within an arthropod gut. 4. PREDATION: it is usually a short term relation between the two individuals in which member, the PREDATOR, is benefited and the other, the PREY, is harmed; usually killed. E.g., cats and mice 5. PARASITISM: it is a relation in which an organism (the parasite) lives in or on the host and is metabolically dependent on another organism, the HOST. Types of parasites Endoparasites: Endoparasite is one which lives inside the organ/tissues/ body cavity or body fluids of a host. Examples: all helminth and protozoa parasites of mammals and birds, larva of some insects. Ectoparasites: Ectoparasite is one which lives on the surface of the host. Example: most insects and arachnids Obligatory parasite: Obligatory parasite is one which must spend at least a part of its life as parasite with its host to survive and complete it life cycle. Example: most of the helminthes and protozoa. Facultative parasite: facultative parasite is one which is not normally parasitic but can become so, at least for a time, when it is accidentally ingested or enter the body orifice or a wound on the body of the host. Example: when the flesh fly Sarcophaga dux lays its larva in wound on the skin of a man. Accidental/incidental parasite: it is one which enters or attaches to the body of a species of host which is different from its normal host. Example: ingestion of infective eggs of Toxocara canis by man leading to viscera larva migrans. Permanent parasite: permanent parasite is one which lives its entire life within or on its host. Example: Trichinella spiralis, Sheep ked (Melophagus ovinus) Temporary or intermittent parasite: It is one which only visits its host to feed on it and then leaves. Example: mosquitoes, bed bugs Hyperparasites: it is one which parasitizes. It’s a parasite within a parasite. Example: malaria in mosquitoes; tapeworm larvae in fleas. ‘ Zoonotic parasite: Zoonotic parasites are those parasites which are transmissible from animals to man (anthropozoonoses) or from man to animals (zooanthroponoses) or both ways (amphixenoses). Types of hosts 1. DEFINITIVE OR FINAL HOST- A host in which a parasite reaches sexual maturity and reproduces. Example: Cattle, buffaloes, sheep and goats are definitive hosts for Fasciola hepatica. 2. INTERMEDIATE HOST – it is one in which early develop of parasite occurs to produce usually infective stages of it without reaching to maturity. Example: snails in the life cycle of Fasciola hepatica. 3. PARATENIC OR TRANSPORT HOST – it is one which picks up the infective stage of a parasite either from the intermediate host or directly from the atmosphere without any development of the parasite; but parasite continues to live and is infective to next host. Example: A mouse is the paratenic host for Toxocara canis, T. cati or Toxascaris leonina. 4. VECTORS – vector is usually a blood-sucking arthropod which transmits the parasite from the infected vertebrate animal to another susceptible vertebrate animal. a. BIOLOGICAL VECTOR- biological vector is one which transmits the parasite after some biological development of the parasite to make it infective for a susceptible host. Example: Mosquitoes involved in the transmission of various filarial roundworms and malarial parasites. b. MECHANICAL VECTOR – it is one which transmits the parasite in a short time as such without undergoing any developmental or biological change. Example: Tabanid flies transmit Trypanosoma evansi. 5. CARRIER HOST- it is a vertebrate animal which had suffered from an infection and in later stage carries the infective organisms in its body without showing any clinical signs. 6. RESERVOIR HOST – it is a vertebrate animal which may or may not be the natural host of a parasite and possess parasitic infection without any clinical manifestation that serves as sources of infection to other susceptible hosts. Types of life cycle Direct life cycle: direct life cycle of a parasite does not involve any intermediate host between parasite and its host. Example: Strongylid nematodes Indirect life cycle: indirect life cycle of a parasite involves necessarily one or more intermediate hosts or vector(s) to complete its life cycle. Example: Fasciola hepatica. Simple life cycle: it is the one where a parasite simply multiplies by binary fission both in its vertebrate host and its insect vector for its propagation. Example: Trypanosoma spp. Complex life cycle: it is one where there is an alteration of both asexual and sexual processes of reproduction in the life cycle of a parasite. Example: all helminth parasites A. Helminth Parasites “Helmins or helminthes (Grk): a Worm. Helminth means a worm and usually applied to parasitic and non-parasitic species belonging to the following three phyla: 1. Phylum: Platyhelminthes 2. Phylum:Nematohelminthes 3. Phylum: AAcanthocephala Phylum: Platyhelminthes The worms are usually bilaterally symmetrical; dorso-ventrallly flattened and commonly called flatworms. These are either leaf-like or oval/globular (fluke parasites) grouped under a Class- Trematoda, or a very long elongate tape-like (tapeworms) grouped under two classes- Eucestoda (true tapeworms) and Cotyloda (fish tapeworms). All flatworms are hermaphrodite and most of the species are parasitic. a. Class: Trematoda: has only one sub-classDigenea of veterinary importance which contains species of flukes of variety shape and sizes (0.16 mm to 5.7 cm long). Most fluke parasites are hermaphrodite but blood flukes, classified under the family Schistosomatidae, are unisexual and elongate. All types of flukes possesss a powerful oral sucker surrounding the mouth. Besides, some flukes have a ventral sucker near middle or in upper half of the body, while others have a muscular sucker towards the posterior end. Life cycle of all trematodes is indirect involving one or more intermediate hosts. In all cases, the first or the only one intermesdiate host is a species of snail. The second intermediate host, if any, may be an ant, grasshopper, fish, dragon fly, snail, frog or some crustaceans. Trematodes lay usually operculated eggs, while a few others lay spinosed eggs (blood flukes) or with a long filament at either ends. The different early developmental stages inside the snail are: i. Miracidium: enter the snail soon after hatching out from an egg. ii. Sporocysts iii. Redia and iv. Cercaria The cercaria stage comes out of the snsail and encysts either on vegetation or inside a second intermediate host. Thus, the infective stage so developed is called metacercaria. Mode of infection of an animal with most flukes occur either through ingestion of metacercaria stage encysted on the vegetation or by eating second intermediate host harbouring metacercarial stages, or through skin penetration by cercariae in case of blood flukes. Life Cycle The life cycle of Fasciola hepatica is typical of the order. Fasciola hepatica can infect a wide variety of mammalian hosts, particularly sheep and cattle. It requires snails of the genus Lymnaea as intermediate hosts. The most common is L. truncatula, an amphibious snail with a world-wide distribution. Mature adults live in the bile ducts of livers in their mammalian hosts. Eggs are laid in the bile ducts, pass to the small intestine then out in the feces of the host. The first stage, a miracidium (A), develops within each egg, which hatches and releases the mature, motile, ciliated miracidium. Hatching of eggs takes less than two weeks at optimal temperatures between 220C and 260C. Development is negligible below 100C. Hatched miracidia are short-lived because they do not feed. They must find a suitable snail intermediate host within 24 hours of hatching or they die. Miracidia swim, using their cilia, and seek out snails by chemotaxis. They adhere to snails and penetrate their soft tissues using an enzyme and a cone-shaped papilla at the anterior end. The miracidium loses its cilia and continues to develop into the sporocyst stage (B), which is a sac containing germinal cells. Each germinal cell grows and divides eventually becoming a redia (C). These first generation rediae burst through the wall of the sporocyst and migrate to the hepato-pancreas of the snail. A second generation of "daughter" rediae may develop from germinal cells in the first, parent generation. Germinal cells in these daughter rediae develop into the final cercarial stages (D). Cercariae are, in fact, immature flukes with tails used for swimming. They attach to plants such as grass blades, lose their tails and encyst as metacercariae (E), the infective stages for their final mammalian hosts. ( ) Following ingestion of metacercariae by the final host, they excyst in the small intestine (F), migrate through the gut wall, cross the peritoneum and penetrate the liver capsule (G). The immature flukes tunnel through the liver parenchyma for 6 to 8 weeks, then enter the small bile ducts, then migrate to the larger ducts and occasionally the gall bladder. ( ) Eggs laid by adult flukes pass down the bile ducts through the gastrointestinal tract and exit the host in feces, completing the cycle. The prepatent period is 10 to 12 weeks, and the minimal period for completion of one entire life cycle of Fasciola hepatica is 17 to 18 weeks CLASS: TREMATODA: common trematodes in animals Family: Dicrocoelidae e.g., Dicrocoelium dendriticum in liver of ruminants and other mammals Family: Heterophyidae e.g., Heterophyses heterophyses in the small intestine of dog, cat and man. Family: prosthogonimidae e.g., Prosthogonimus ovatus (Oviduct fluke) in the bursa of fabricious and oviduct of domestic fowl. Family: Opisthorchiidae e.g., Opisthorchis tenuicollis in the bile ducts of dogs and cats, Clonorchis sinensis in the liver of man Family: Fasciolidae eg., Fasciola hepatica (liver fluke) and Fasciola gigantica in the liver of sheep and cattle, Fascioloides magna in the liver of cattle and horse, Fasciolopsis buski in the small intestine of man and pigs. Family: Paragonimidae e.g., Paragonimus westerman (lung fluke) in the lungs of dogs and cats and tiger. Family: Paramphistomatidae e.g, Paramphistomum cervi and Cotylophoron cotylophoron (rumen fluke) in the rumen of cattle. Family: Schistosomatidae e.g., Schistosoma indicum, S.nasalis, Ornithobilharzia bomfordi (Blood flukes) in the blood vessels. Class: Eucestoda: the members of this class are elongate, tape-like with flat body without a body cavity. The body is divided into a scolex followed by a short unsegmented neck and in general, the remainder of the body called strobila, which consists of a number of segments called proglottids. All species of cestodes have indirect life cycle except Hymenolepis nana. The intermediate host may be orbatid mites, mollusks, ants, beetles, earthworms, houseflies, fleas or lice amongst invertebrates, or there may be a species of vertebrate host viz., cattle, buffalo, sheep, goat and other ruminants, pigs, rabbit, ungulates, rats, and sometimes man. The eggs of tapeworms develop inside an intermediate host to a variety of metacestode stages which are the infective stages viz., cysticercoid, Cysticercus, strobilacercus, coenurus, hydatid and tetrathyridium. The infection of animal occurs either by ingestionof the whole invertebrate intermediate host or by eating raw or undercooked flesh of a vertebrate intermediate host containing infective metacestodes.. Class Eucestoda has six orders of importance. Class: Cotyloda: These are primarily tapeworms of fish. The only tapeworms of interest under this class are Diphyllobothrium latum and Spirometra spp. of man, dog, cat and some fish-eating mammals. Life-cycle is indirect usually having two intermediate hosts and with larval stages developing in two different intermediate hosts. These are called procercoid and plerocercoid respectively. Infection of the final host occurs by eating raw or undercooked fish or any other second intermediate host harbouring the infective stage (plerocercoid). Life cycle of Taenia solium www.humanillnesses.com/.../T-Ty/Tapeworm.html retrieved on 15 September 2008 CLASS: EUCESTODA: common parasites ORDER: ANOPLOCEPHALIDEA Family: Anoplocephalidae e.g., Anaplocephala perfoliata, Paranaplocephala mimmillana in horse Family: Thysanosomidae e.g., Stilesia hepatica in the bile ducts of ruminants, Thysanosoma actinoides in the bile ducts and pancreatic duct of ruminants ORDER: DAVAINEIDEA Family: Davaineidae e.g., Davainea proglottina, Raillietina tetragona, and Cotugnia diagnophora in the small intestine of fowl. ORDER: DILEPIDIDEA Family: Dilepididae e.g., Amoebotaenia sphenoides in the small intestine of domestic birds Family: Dipylidiidae e.g., Dipylidium caninum in the small intestine of dogs and cats. ORDER: HYMENOLEPIDIDEA Family: Hymenolepididae e.g., Hymenolepis nana in man ORDER: TAENIIDEA Family: Taeniidae e.g., Taenia multiceps and Echinococcus granulosus in dogs CLASS: COTYLODA ORDER: DIPHYLLIDEA Family: Diphyllobothriidae e.g., Diphyllobothrium latum, Spirometra ranarum in dogs and man. Phylum: Nemathelminthes Class: Nematoda: the nematode worms are commonly called roundworms because of their cylindrical forms generally with their both endsa somewhat pointed. The body is not segmentesd and the sexes are separate. The lengths of nematodes vary from about 2 mm (Strongyloides stercoralis) to upto 400 cm (Dracunculus medinensis). The female worms are generally longer than males. Eggs are laid by gravid females either as embryonated or unembryonated. A group of nematodes called the filarial worms lay first immature larval stage called microfilaria in body fluids and tissues of the host. Thus, female laying unembryonated eggs are called oviparous, embryonated eggs as ovo-viviparous; or larvae called as viviparous. Most of the nematodes have early free living developmental stages in their life cycle viz., first stage larva (L1), second stage larva (L2) and third stage larva (L3). The last one always matures to become the infective stage. Nematodes having direct life cycle, have all the three larval stages developing outside the host in open whilein nematodes having indirect life cycle, these stages develop inside the intermediate host. Infection of the final host takes place generally by ingestion of the infective egg (Ascarid worm) or L3 stage (Strongylid worm) or through skin penetration by L3 stage (hookworms) or by transplacental and/or transcolostral route (Toxocara spp.); or htrough ingfestion of invertebrate intermediate/paratenic host. In addition to this, a group of filarial nematodes, laying microfilariae in circulating blood, lymph, subcutaneous tissues, etc are transmitted by blood sucking insect vectors viz., mosquitoes, houseflies, etc. There is one specialized nematode, Trichenella spiralis, which has no period of free existence and the transmission occurs through eating raw or underccoked flesh of infected animals harbouring encysted infective larvae. Life cycles of Nematodes AInfected DH with Adult nematode Egg L1 L2 L3 L3 Susceptible DH L4 L5 (Adult Stage) Egg CLASS: NEMATODA: Common parasites ORDER: ASCARIDIDA Family: Ascarididae E.g., Ascaris suum in pigs, Parascaris equorum in horses, Toxascaris leonina and Toxocara canis in dogs Family: Oxyuridae e.g., Oxyuris equi in horses. Family: heterakidae: Heterakis gallinarum and Ascaridia galli in small intestine of fowl. ORDER: RHABDITIDA Family: Strongyloididae e.g., Strongyloides papillosus in the small intestine of ruminants. ORDER: STROGYLIDA Family: Strongylidae e.g. Strongylus vulgarus in the mesenteric vessel of equines Family: Trichonimatidae E.g., Chabertia ovina and Oesophagostomum columbianum in abomasum of sheep Family: Stephanuridae e.g., Stephanurus dentatus (kidney worm of swine) in the kidney of pigs Family: Syngamidae e.g., Syngamus trachei in trachea of fowls Family: Ancylostomatidae e.g., Ancylostoma caninum in dogs, Bunostomum phlebotomum in cattle Family: Trichostrongylidae e.g., Trichostrongylus axei and Haemonchus contortus in abomasum of sheep Family: Dictyocaulidae e.g., Dictyocaulus filaria in bronchi of sheep, and goats ORDER: SPIRURIDA Family: Thelaziidae e.g., Spirocerca lupi in the esophagus of dogs Family: Filariidae e.g., Dirofilaria immitis in the pulmonary artery of dogs and cats Family: Onchocercidae e.g., Onchocerca armillata in the aortic walls of cattle. ORDER: ENOPLIDA Family: Trichinellidae e.g., Trichinella spiralis in small intestine of man, pigs and rats Family: Trichuridae e.g., Trichuris ovis in the caecum and upper colonof sheep, goat and cattle. Family: Dioctophymidae e.g., Dioctophyma renale renale in the kidney of dogs and other wild carnivores. Phylum: Acanthocephala The phylum contains a group of parasitic worms which are cylindrical and closely resemble to the nematodes. They are commonly called ‘thorny headed worms. The life cycle is indirect involving an intermediate host which is usually an arthropod. The larva in the egg hatches in the intermediate host and then encysts as ‘Cystacanth’ in the haemocoel of the arthropod. One to threee months are required for the cysaccanth to become infective stage. Usually, the definitive hosts become infected by ingesting the arthropods, and reaches adult stage in 5-12 weeks. The adult acanthocephalan parasites chiefly occur in aquatic vertebrates like fish and birds besides some mammals. Family: Oligacanthorhynchidae Genus: Macrocanthorhynchus Macrocanthorhynchus hirudinaceus occurs in the small intestine of domestic pigs and wild boars. The male is upto 10 cm and the female is upto 15 cm or more long. B. PROTOZOA Protozoa are thought to be very primitive (not well-organized) in nature because they are unicellular. Hence, called protozoa (proto- first, zoa- animal). But they are highly organized and very specialized within a single cell itself. Salient features of protozoa 1. unicellular 2. microscopic (10 µm to 200 µm) 3. eukaryotic Most parsitic protozoa have a distinct nucleus. There are some species which have two similar (e.g., Giardia, Hexamita) or two dissimilar nuclei (e.g., Balantidium coli). Reproduction is either asexual (simple binary fission) or by both asexual and sexual processes. Sporogony is a process of spore formation by asexual division inside the zygote/cyst or oocyst formed by gametogony. The resultant sporozoites are the infective stages in all cases. Most protozoa are free-living while a few are parasites of animals and man. Direct life cycle: a. Simple (by binary fission) e.g. flagellates b. Complex (by alternation of asexual and sexual generations) like Coccidia Indirect life cycle: a. Involvement of insect vectors e.g., mosquitoes in the life cycle of members of family Plasmodidae (malarial parasites), and involvement of arachnid vectors e.g., Ixodid ticks in the life cycle of Babesia and Theileria species. b. Involvement of mammalian host(s) in the life cycle of Sarcocystis and Toxoplasma. Life cycle stages of protozoa: The stages of parasitic protozoa that actively feed and multiply are frequently called trophozoites. Cysts are stages with a protective membrane or thickened wall. Protozoan cysts that must survive outside the host usually have more resistant walls than cysts that form in tissues. C. ARTHROPOD PARASITES Phylum: Arthropoda Arthropod (Greek: Arthros- Joint and podos- foot). The members of the phylum Arthropoda therefore have jointed–legs. Arthropods are segmented animals. The anterior group of segments forms the head, the middle group the thorax, and the posterior group the abdomen. The appendages on the body are typically paired. The sexes are separate. Arthropods of veterinary importance Class: Insecta includes all insects of which only a few are parasites of mammals and birds. Class: Arachnida includes ticks and mites as parasites of mammals and birds. Class: Pentastomida. Only Linguatula serrata is important as a parasite. ARTHROPODA INSECTA ARACHNIDA ACARI Astigmata Diptera (Flies) Prostigmata Phthiraptera (Lice) Siphonoptera (Fleas) Mesostigmata Metastigmata Some typical characteristics of parasitism 1. High reproductive potential (i.e. multiple fission in Apicomplexa; hermaphroditism of trematodes; parthenogenesis in Strongyloides spp.; i.e. strobilation of tapeworms for high ova output; and overall high ova/larval output of many worms) 2. Often unique morphological or physiological specializations, loss of structures, etc. a. loss of digestive tract of tapeworms b. loss of wings of fleas and lice c. loss of many sensory structures of nematodes d. development and refinement of a TEGUMENT; a living external layer of digeneans, cestodes and acanthocephala that allows digestion and other functions across body surface e. development of special holdfast organs, including hooks, suckers, teeth, clamps, cutting plates, spines f. production of anti-coagulants in leeches and hookworms 3. Often special site specificity 4. Usually, but not always, non-lethal to host 5. Generally more numerous than hosts 6. Generally much smaller than host (if larger, then termed a predator) 7. Often have evolved methods of evading host immune system a. Antigenic variation of trypanosomes b. Tough tegument of acanthocephalans c. Intracellular habitat of coccidia and Trichinella larvae d. Antigen acquisition of schistosomes e. Suppression of eosinophil or neutrophil migration to the site of the parasite f. Encystment g. Ability to cleave antibodies or consume complement h. Ability to trigger certain arms of the immune response, which may in turn damage host tissue enough to facilitate parasite invasion Harmful effects of parasites on their host All parasites have different types of effects on their hosts. Some are innocuous, some are mildly pathogenic, and others are moderately harmful, while a few others are highly pathogenic and fatal. Variability in the degree of harmful effects amongst various parasites is related to their number, invasive power, virulence, propensity of release of toxic products and their localization in the body of their hosts, besides many other intrinsic and extrinsic factors in their surroundings within and outside of their hosts like, general health conditions, age, breed, sex, nutritional level, concurrent infections, inclement weather, etc. Precisely, the following types of harms (pathological conditions) are caused by different types of parasites. 1. Compete with the host for food including vitamins (e.g., Ascarid roundworms, tapeworms like Diphyllobothrium latum) 2. Decrease utilization and absorption of nutrients (e.g., Haemonchus contortus in sheep). 3. Reduction in feed intake by animals. 4. Increase in the passage of food without proper digestion through the digestive tract of animals. 5. Changes or reduces the absorptive surface of the intestine. E.g., Oesophagostomum spp in sheep, Coccidia in poultry) 6. Alterations in the efflux and influx of water and ions into the bowel. 7. Removal of hosts’ body fluid including blood. E.g., Hookworms, blood sucking insects, ticks, etc. 8. Destruction of the hosts’ tissue mechanically or by pressure of the growing size of the parasite (Hydatid cysts). 9. Cause mechanical obstruction of the gut lumen, air passages, ducts, blood vessels, etc. (E.g., Ascarids, liver fluke, blood fluke). 10. Produce toxic substances causing haemolysis, histolysis, neurotoxin, anticoagulants, toxic metabolites, toxicity due to dead worms in the body of the host, etc 11. Host’s tissue reactions against parasites like inflammation, haemorrhage, necrosis, fibrosis, excess mucous production, hyperplasia, hypertrophy, paralysis, ulceration, anaemia, fever, etc. 12. Some parasites carry other pathogenic organisms (E.g., Heterakis gallinae transmits Histomonas meleagridis; Metastrongylus apri carries swine influenza virus) GENERAL PRICIPLES OF PREVENTION AND CONTROL There are some essential prerequisites on which principles of prevention and control of a parasitic infection can be formulated. Mainly, the following information is necessary before developing strategy for prevention and control of parasitic diseases. 1. Nature of infection(s), whether it is ubiquitous, endemic or sporadic. 2. Type of life cycle of disease causing parasite(s) in the area of operation, and involvement of any intermediate host/vector(s), if any, and their breeding places. 3. History of the infection in a herd/flock of animals/birds in the area. Geo- and agroclimatic data and rainfall in the area. 4. Hygienic status of livestock farms maintained in the area. 5. Nutritional level of animals and the sources of their feed and potable water. The term prevention of a disease is used when efforts are made to prevent healthy animals from infection by adopting the following methods. 1. Keeping animals in hygienic and in dry surroundings 2. Avoiding access of susceptible animals to various sources of infection including contact with diseased animals. 3. Providing balanced and clean drinking water. 4. Removing spots/places of breeding of intermediate hosts/vectors including their killing by using molluscicides/ insecticides. 5. Proper maintenance of slaughter houses and effective disposals of offals/ blood accessible to stray animals. 6. Proper investigation of new animals before introducing in the herd/flock. 7. Use of sterilized equipment for mass vaccination, artificial insemination, feeding, watering, storing, etc. 8. Frequent screening of animals to detect any latent/carrier case and its immediate treatment. 9. Formulating mass drenching schedule for prophylaxis (prevention) according to the requirement in the area against possible parasitic infection and to remove infection from sub-clinical or carrier cases, particularly at organized livestock farms. Also, immuno-prophylaxis may be adopted by vaccinating animals against infections like lungworms in sheep and theileriosis in dairy animals. 10. Frequent removal of ticks from the body of the animals and their immediate burning. 11. Newly born and young growing animals should be reared separately from the adult animals and they should not be allowed to graze on infected pastures. The term control of a parasitic disease means to minimize the intensity and to prevent further spread of an existing infection in animals by adopting the following methods. 1. Segregation of clinical cases and their proper treatment (chemotherapy). 2. All apparently healthy animas should be given preventive medication (chemoprophylaxis). 3. Immunoprophylaxis (vaccination) may be done as stated under prevention, and all other methods of prevention may be adopted.