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[Efficacy of various insecticides in the environmental control of Tunga penetrans (L., 1758)].

In this study the variation of infection prevalence before and after control procedures was utilized as an evaluation tool. The pyrethroids Cypermethrine (Cymperator 25EC), deltamethrine (K-Othrine 25EC and 5OSC) were tested. Apart from the effects, the results evaluation has also been based on the cost per area and cost benefit, which are relevant items in Public Health campaigns. We believe all these aspects will help us to evaluate these results and serve as basis for future better insecticide choices.

Animals↗

High exposure to Tunga penetrans (Linnaeus, 1758) correlates with intensity of infestation.

Tungiasis is a parasitic skin disease widespread in resource-poor urban and rural communities in Brazil. Inhabitants of an urban slum in Northeast Brazil were examined for the presence of tungiasis lesions and followed-up twice a week for a period of three weeks. Each time the number, stages, and topographic localization of lesions were recorded on a documentation sheet. The infestation rate (number of newly embedded sand fleas per individual and day) remained stable during the observation period. The infestation rate was significantly related to the intensity of infestation (total number of lesions present) (rho = 0.70, p < 0.0001) and the proportion of viable lesions (rho = 0.28, p < 0.0001). The results indicate that in an endemic area the infestation intensity and the proportion of viable lesions can be used as a proxy to assess the exposure of individuals at risk for tungiasis. Persistently high infestation rates during the transmission season favour the use of prevention measures against invading sand fleas (such as a repellent) rather than a drug to kill already embedded parasites.

Adolescent↗

Tunga penetrans.

We describe a patient who acquired tungiasis while traveling in an area where the condition is endemic. The pathogenesis, diagnosis, and treatment of this tropical disease are presented.

Adolescent↗

[On a new species of sand flea from Ecuador and tungiasis, a problem of Public Health in many developing countries].

The authors recently described a new species of sand flea (genus Tunga) occurred in goat, sheep, cow, pig and man, in the Andean village of S.ta Isabel (Ecuador) and named Tunga trimamillata. Its most important morphological characteristics are: slightly larger dimensions than T. penetrans, both in male and female; presence on the anterior extremity of gravid female of three rounded humps surrounding head and thorax; length of the first segment of maxillary palpi which is longer than each of the other three. The importance of this parasite is due to the fact that it can cause the same damages as T. penetrans both in humans and domestic animals, with conseguent walking difficulties and local or generalized infections. For breeders, economic losses can be remarkable. Tungiasis is a serious problem of Public Health in many countries of Latin America and Subsaharian Africa, and it can be considered in these localities as an indicator of underdevelopment and poor hygiene conditions.

Animals↗

Molecular phylogeny of isolates of Ctenocephalides felis and related species based on analysis of ITS1, ITS2 and mitochondrial 16S rDNA sequences and random binding primers.

The phylogenetic relationships among 31 different flea isolates representing seven different species were studied by nucleotide sequence comparison of the internal transcribed spacer 1 (ITS1), internal transcribed spacer 2 (ITS2) and/or mitochondrial 16S ribosomal RNA gene (mt16S-rDNA) to examine the patterns of variation. Results show that all regions are useful in discriminating among flea species. In Ctenocephalides felis and Tunga penetrans, some differences in these gene regions occurred among different isolates within the same species. In the latter case, the differences are in the mt16S-rDNA region, with one isolate showing 48% divergence in nucleotide sequence. The taxonomic implications of this result are unclear at present. The gene regions revealed differences between C. felis isolates only after DNA sequencing the PCR products. Further differentiation among C. felis isolates was obtained using four different random binding primers (decamers) and primers for mammalian aldolase to amplify narrow differences in the genome. Using these primers we were able to discriminate between different C. felis isolates and determine that some of the genetic variation coincided with minor differences in response to the control agent imidacloprid. However, overall findings do not support the existence of subspecies of C. felis.

Animals↗

Morbidity assessment in sand flea disease (tungiasis).

Tungiasis, caused by the sand flea Tunga penetrans, is a health problem in many impoverished communities in Latin America, the Caribbean, and sub-Saharan Africa. Sand flea disease is associated with a broad spectrum of clinical and histological pathology. The factors determining the disease burden in endemic communities are not well understood, and severity of clinical pathology has never been assessed quantitatively. Thus, two severity scores were developed: one for acute disease and one for chronic sequels. These scores were evaluated in a cohort of 70 severely infested patients living in a shantytown in Fortaleza, a capital city in Northeast Brazil. Patients were examined during a period of 25 days and followed-up after a twice daily application of a plant-based repellent to prevent reinfestation. The severity score for acute disease symptoms significantly correlated with the infestation rate and the number of embedded fleas. It turned zero when reinfestation was prevented. The score for chronic disease also significantly correlated with the infestation rate. Tungiasis is associated with considerable acute and chronic morbidity. The degree of acute morbidity is directly related to the number of embedded sand fleas. When transmission is interrupted, the chronic morbidity reflects the infestation rates individuals have experienced in the past.

Adolescent↗

Tungiasis in rural Haiti: a community-based response.

Tungiasis is a disease endemic to poor communities in Latin America, the Caribbean and Africa. It is caused by the female flea, Tunga penetrans, which burrows into the skin of its host to feed while producing and extruding eggs. Consequent lesions may be painful and even crippling with damage ranging from mild erythema and swelling to necrosis. Superinfection of lesions can be serious and may result in auto-amputation or death from tetanus. We describe an outbreak of tungiasis in rural Haiti and a community-based intervention used to address it. Of 177 patients assessed, 132 (47 female, 85 male, 23 children) had tungiasis lesions. Forty-four patients had clinical signs of superinfection; 15 had ectopic lesions. Community health workers cleaned and disinfected patients' feet and any parts of the body with ectopic lesions, and then extracted fleas from existing lesions. Patients with superinfections were treated with appropriate antibiotics. Over 1000 pairs of shoes were distributed in the villages. Over 400 adults were given tetanus vaccinations during follow-up visits. Patients who had been treated reported feeling better and those who had received shoes indicated they had not developed new lesions. All superinfections were resolved. We concluded that community-based care can treat tungiasis effectively.

Adolescent↗

High prevalence of tungiasis in a poor neighbourhood in Fortaleza, Northeast Brazil.

Tungiasis has been reported to occur in many Latin American, Caribbean and African countries. However, epidemiological data are still very scanty and do not exist at all for Brazil. To fill this gap, a cross-sectional study has been undertaken in a shantytown (favela) in Fortaleza, Ceará State, northeast Brazil. All 327 households of a circumscribed sub-area were visited, and 1185 out of the 1460 household members were thoroughly examined for the presence of tungiasis. Thirty-four% (95% CI: 30.9-36.4) were found to be infected with Tunga penetrans with a significant preponderance of the male sex (p<0.0001). In the children five to nine years old, the age group most heavily affected, the prevalence rate was 65.4% (95% CI: 54.0-75.7) in boys and in 48.3% (95% CI: 37.4-59.2) in girls. The data show that tungiasis is hyper-endemic in the study area. As the favela is typical for the many poor communities in northeast Brazil, it can be assumed that tungiasis is a frequent infection in the underprivileged in this part of the country.

Adolescent↗

Tungiasis: report of one case and review of the 14 reported cases in the United States.

Tungiasis is a cutaneous parasitic infestation by the fertilized female sand flea Tunga penetrans. It is prevalent in tropical Africa and in Central and South America. Despite increasing air travel to and from these countries, surprisingly the disease is rarely reported in the United States. This report describes another case of tungiasis and reviews the 14 previously reported cases in the United States. Clinical features, differential diagnosis, treatment, and prophylaxis of tungiasis are discussed.

Adult↗

Tungiasis: a neglected health problem of poor communities.

Tungiasis is caused by the flea Tunga penetrans. Growing urbanization, improved housing and use of appropriate footwear presumably have led to an overall reduction of the occurrence of this ectoparasitosis within the last decades. However, it is still highly prevalent where people live in extreme poverty, occurring in many Latin American and African countries. Although the infection has long been known, data on the ectoparasite's biology and the epidemiology of the disease are scant. Methods for treatment, prevention and control have never been evaluated in a scientific manner. Tungiasis remains an important public health problem for the very poor, a problem neglected by those who are affected, by the medical profession and by the scientific community.

Animals↗

Bacterial superinfection in human tungiasis.

Tungiasis is caused by penetration of the female sand flea Tunga penetrans into the epidermis of its host. It is endemic in many countries in Latin America, the Caribbean and sub-Saharan Africa. Although superinfection is a common clinical observation, the frequency and the pattern of bacterial pathogens associated with tungiasis have never been investigated systematically. We conducted a prospective clinico-bacteriological study with patients living in a shantytown in Fortaleza, capital of Ceará State (Northeast Brazil), where tungiasis is hyperendemic. Swabs were taken from 78 patients with multiple lesions after surgical extraction of the parasite, and the specimens were cultured for aerobic and anaerobic microorganisms. Ninety-nine specimens were investigated for aerobic bacteria, from which 146 pathogens were identified. The most common species were Staphyloccous aureus (35.5%) and various enterobacteriaceae (29.5%). Bacillus sp., Enteroccous faecalis, Streptococcus pyogenes and Pseudomonas sp. were also isolated. Eighty-four anaerobic cultures yielded 20 pathogens: in eight cases we detected Peptostreptococcus sp., in seven cases Clostridium sp., and in five cases non-identifiable gram-negative bacilli. These results show that secondary infection is very common in tungiasis, and caused by a variety of highly pathogenic microorganisms. It is proposed that T. penetrans acts as a foreign body facilitating biofilm formation within the epidermis. To prevent spreading of pathogens to the surrounding tissue and/or the systemic circulation, sand fleas should be surgically extracted immediately after penetration.

Adolescent↗