transfusion. fn babesiosis, howev-er. the invasion of the red blood cells will eventually lead to hemolytic anemin. Babesia microti is biologically transmitted through the bite of hard-bodied ticks call. ed lxodcsscapularis, which usually feeclon white-tailed deer. The tick also feet. ls on smaller mammals like lhe white-footed mouse which is the major reservoi.-host of Babesia spp. Incident·ally the tick is also the v(.-ctor of Lyme disease cause<l by a spirochaete named Borrelia burgdorfer i. In endemic places, ii is common t Jmt an individual is simultaneously infected with both Lyme disease and babesiosis. Diagnosi s of babesiosis is established when Giemsa-stained blood films reveal the presence of the parasites. The ring forms of Babesiaspp are very difficult to differentiate from the ring fonns of Plasmodium falciparurn. The tetrads called the Maltese cross are however diagnostic, while Polymerase Chain Reaction (PCR) is very useful in low parasitemia. Detection of antibodies by serology is a Jso useful. Clindamycin is an effective antibiotic against babesiosis. Use of protective clothing like the wearing of long pants and sleeves arc also recommend ed. Clothing can even be impregnated with insecticide. Wucherer/a boncroft; and Brugia malayi These parasites cause lymphatic filariasis and are transmitted by female mosquitoes. Wuchere ria bancroft is transmitted by mosquitoes falling under genera Aedes, Anopheles and Calex. ln the Philippines, however, the parasite is transmitted by Aedes poeci Jus whkb breeds pretty well in the axils of the abaca and bana. na plants. In some areas, Anopheles mjnimus is the mosquito vector identified in the Mountain province. Culex mosquitoes have been incriminated but they are more important vectors in other countries. On the other band, Mansonia mosquitoes are responsible for the transmission of Brugia malayi. Adults of Lhe above parasites habitate the lymph vessels and/ or lymph nodes. The progeny called mkrofilariaeare found in the peripheral circulation. The presence of the microfilnriae in the circulation exhibits a rhythmica l pattern called periodicity. Wbeo the mosquitoes lake a blood meal and they pick up the microfilariae, the microfilariae will develop into first (LI), second (L2) and third (L3) stage larvae in the muscles of the mosquitoes. When the mosquitoes bite a susceptib le bosl, the 3rd stage larvae are deposited oo the skin and the larvae actively enter the skin through the site of the bite. They will eventually reach the lymphati c system and the worms 1/2ill develop into the adu Jt filarial worms (See mus. 15. 13 and lllus. 15. 14). In the early stage of trmphatic fi Jariasis, the infected individua J suffers from fever with inflammati on of the lymph gland. 'I. There is recurren t retrograde lymphangiti s with localiu.-d swelling and redness of tbe arms and legs. This is believed to coincide with the release of microfilariae by the female worms. When the adult worms die, there will be an immunological reaction resulting in lymphatic obstn1ctioo which in tum can lead to elephantiasis or hydrocoele. Jt is worth mentioning that there are microfilariae positive individuals who are asymptomatic. A few. however, manifests the characteristic tropical pulmonary eosinophilia where patients do not manifest microfilaremia because the microfilariae are in the tissues. They have hypereosinophilia and usually suffer from pulmonary symptoms like paroxysmal coughing. 380 