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Tungiasis is an infestation of the skin caused by the flea Tunga penetrans. It is not rare in western Europe because of tourism to tropical and subtropical countries. However, tungiasis has been very rarely reported in children. We describe a case of tungiasis in a 3-year-old child. The infestation was localized to the second toe of the left foot and was characterized by an atypical clinical presentation.
Tungiasis is a cutaneous infestation caused by the gravid female sand flea, Tunga penetrans. We describe 2 cases of tungiasis that occurred in siblings who recently emigrated as international adoptees from Liberia to the United States. Both patients had infectious complications as a result of the infestation with T penetrans.
The prevalences of Tunga penetrans Linn. within the five townships of Granville, Fullerton, Icacos, Coromandel and Cedros in south-western Trinidad, West Indies, as determined by physical examination of all inhabitants present during the survey, were 17.0% (38/223 subjects), 15.7% (36/237), 31.4% (102/325), 17.4% (42/242) and 17.9% (50/280), respectively. The rate in Icacos was significantly higher than in the other four sites (P < 0.001). Not only were males more likely to be infected than females in all five study sites (P < 0.0007) but chigoe-flea burdens were also higher in males than in females (P < 0.012), with mean (S.D.) burdens of 5.44 (2.54) fleas/male infected subject and 2.38 (2.00) fleas/female infected subject. Feet were significantly more infected than other areas of the body (P < 0.001). Analysis of variance revealed that the interactions between prevalence of chigoe-flea infection and geographical location (P = 0.0058) and between sex of infected subject and site of infection (P = 0.0109) were highly significant but that between geographical location and sex of infected subject was not significant (P > 0.30). At least seven species of bacteria, with varying sensitivities to antibiotics, were isolated from 16 patients with sepsis associated with their T. penetrans infections: Streptococcus pyogenes, beta-haemolytic Streptococcus (not group A), Klebsiella aerogenes, Enterobacter agglomerans, Staphylococcus aureus, Escherichia coli and a Bacillus species. Closteridium tetani was not isolated.
Human cases of tungiasis were recorded in Mexico until 1948. Here we report 3 new cases of infection by chigoe, Tunga penetrans (L.), with 2 from Hidalgo State and the 3rd, although acquired in Mexico City, was associated with the other 2 cases. This is the 1st record of this species in Hidalgo State and indicates a reappearance of this parasite in Mexico.
A case of a 39 year old patient in whom infection by the sand flea Tunga penetrans was diagnosed by histological examination is described. Clinical findings included small red lesions on the lower extremities, containing a pyodermic component and a central black dot resembling tattoo. A tropical parasitic disease was considered as the signs developed following the patient's return from Tanzania.
A case is described of Tunga penetrans infection in the feet of a tourist returning from South America to Scotland. The condition had initially mimicked verrucae vulgaris, but microscopic examination of the lesions together with the travel history allowed the diagnosis of tungiasis to be made. This is the first case reported in Scotland.
Tungiasis is caused by the penetration of the female sand flea Tunga penetrans into the epidermis of its host. Human infestation with this ectoparasite is hyper-endemic in many resource-poor communities in sub-Saharan Africa, the Caribbean and South America and is associated with considerable morbidity. Currently, there is no effective drug available to treat tungiasis (or at least none for which a parasiticidal effect has been clearly demonstrated). In an attempt to fill this gap, the effects of treatment with topical ivermectin (lotion), thiabendazole (ointment and lotion), metrifonate (lotion) or placebo lotion were compared in a randomized trial. A total of 108 subjects with 169 tungiasis-infested feet participated in the study. The results show that topical ivermectin, metrifonate or thiabendazole can each significantly reduce the number of lesions caused by embedded sand fleas. Further studies are needed to optimise the doses and administration of these compounds.
The parasitic skin disease tungiasis occurs in many resource-poor communities in Latin America, the Caribbean and sub-Saharan Africa. The sand flea, Tunga penetrans, most commonly penetrates into the skin of the feet. Many individuals harbor a large number of embedded parasites and show significant morbidity. Standard treatment consists of surgical extraction of the flea and application of a topical antibiotic. There are no drugs available with proven effectiveness. Clinical trials performed in the last few years did not show very promising results. Thus, surgical extraction still remains the treatment of choice in patients with a low parasite load, such as tourists returning from endemic areas. Probably the best approach to reduce tungiasis-associated morbidity in heavily affected individuals is the application of a repellent to prevent the penetration of sand fleas. In the future, we should see new exciting data on the biology, epidemiology, therapy and control of tungiasis.
Tungiasis is a neglected parasitic skin disease caused by the permanent penetration of the female sand flea (also called jigger flea) Tunga penetrans into the skin of its host. After penetration, most commonly on the feet, the flea undergoes an impressing hypertrophy, and some days later the abdominal segments of the flea have enlarged up to the size of about 1 cm. The flea infestation is associated with poverty and occurs in many resource-poor communities in the Caribbean, South America and Africa. In this review, a historical overview on tungiasis is given. The natural history, pathology, epidemiology, diagnosis, therapy and control of the parasitic skin disease are discussed. It is concluded that tungiasis is an important parasitosis causing considerable morbidity in affected populations. Future studies are needed to increase the knowledge on the biology, pathophysiology, epidemiology, therapy and control of the ectoparasite.
This paper describes patterns of infestation with Tunga penetrans (L., 1758) within the poor community of Araruama municipality, State of Rio de Janeiro, Brazil, assessed by the number of persons and domestic animals parasitized. The overall prevalence of infestation was 49.2% (211 parasitized hosts) of the 429 examined. Humans (p < 0.01) and dogs (p < 0.01) were the most important hosts with 62.6% and 35.6% respectively. Dogs were considered as the potential infestation source to humans. Considering sex and age groups, both measures showed a significant difference (p < 0.01): female (62.2% infested of 143 examined) and male (43.9% infested of 98 examined). All age classes were found infested with significant difference (G = 42.5; p < 0.01) and most of the infestation occurred in children in the 0-9-year old category (27.3%). In contrast and based on mean of chigoe burden per person, the parasitic intensity was significantly higher on male than on female in all age categories, except for the 50+ (H = 27.1; p < 0.01) and decreasing with the increase of age (chi2 = 69.7, A = -124.6, p < 0.01). Growing urbanization, improved housing and sewage systems, use of appropriate footwear, examination of the feet principally in young children, antitetanus prophylaxis and reduction of stray dogs population are the major prophylactic methods recommended.
Evaluating tetanus immune status is not yet the usual clinical practice regarding patients with chronic ulcers or myasis. However, of 858 tetanus patients at Hospital Couto Maia (Salvador, Bahia, Brazil) aged 1 year or above, 2 had pressure ulcers and 17 had chronic ulceration of the lower limbs where these skin lesions were the ports of entry for Clostridium tetani. In these 19 cases, the following predisposing factors were described: venous insufficiency (n=6), sickle cell anemia (n=2), Hansen s disease (n=1), malnutrition (n=1), diabetes mellitus (n=1), trauma (n=1) and unknown factors (n=7). In 6 other cases, in addition to the Hansen s disease patient, the port of entry for tetanus was the site of extraction of Tunga penetrans larvae. In these 25 cases, the majority of patients (68%) were over 40 years old (17/25) and all of these patients stated that they had either not followed a tetanus toxoid vaccination regimen (19/25), or had partially completed such a regimen, or did not give precise information (6/25). Among the same series studied, over half (52%) of the patients died (13/25). We conclude that tetanus prevention must be included in the treatment of chronic skin ulcer patients, vaccination coverage should be increased among older people, and strategies aimed at improving coverage for all age groups must be reviewed.
Tungiasis is caused by the penetration of the female sand flea Tunga penetrans into the epidermis, and subsequent hypertrophy of the parasite. In most cases lesions are confined to the feet. During a cross-sectional study, an unusual case of ectopic tungiasis in the inguinal area was detected. Histological examination of tissue samples showed a remarkable pseudoepitheliomatous aspect of the epidermis. Clinical features and differential diagnoses are discussed.
Tungiasis is caused by infestation with the sand flea (Tunga penetrans). This ectoparasitosis is endemic in economically depressed communities in South American and African countries. Tungiasis is usually considered an entomologic nuisance and does not receive much attention from healthcare professionals. During a study on tungiasis-related disease in an economically depressed area in Fortaleza, northeast Brazil, we identified 16 persons infested with an extremely high number of parasites. These patients had >50 lesions each and showed signs of intense acute and chronic inflammation. Superinfection of the lesions had led to pustule formation, suppuration, and ulceration. Debilitating sequelae, such as loss of nails and difficulty in walking, were constant. In economically depressed urban neighborhoods characterized by a high transmission potential, poor housing conditions, social neglect, and inadequate healthcare behavior, tungiasis may develop into severe disease.
Tungiasis is caused by the penetration of the female sand flea Tunga penetrans into the epidermis. It is generally assumed that lesions are confined to the feet. To determine to what degree tungiasis occurs at other topographic sites, 1,184 inhabitants of a poor neighborhood in northeastern Brazil were examined; 33.6% were found to have tungiasis (95% confidence interval = 30.9-36.4%). Six percent presented lesions at locations other than the feet, with the hands being the most common ectopic site (5.5%). Other sites were the elbows, thighs, and gluteal region. Ectopic tungiasis was significantly associated with the total number of lesions (P < 0.001) and an age less than 15 years old (P = 0.02). In 86 patients actively recruited with lesions on their feet, ectopic localizations were observed in 25.6%. Since untreated sand flea lesions are prone to become superinfected, clinicians should be aware of not missing any ectopic localization of tungiasis.
Commensal and field rodents and wild small carnivores were live-trapped in five villages of Karatu district and one settlement in the Ngorongoro Conservation Area in Ngorongoro district in Tanzania. Blood samples were taken and serologically tested for plague, using the Blocking ELISA technique. Some domestic dogs and cats in the Karatu villages were aseptically bled and similarly tested for plague. Fleas were collected from the examined animals and from randomly selected residential houses. A total of 241 rodents, 1 Crocidura spp, 43 dogs, 12 cats and 4 slender mongooses were involved in the survey. Of the rodents, 14.5% were infested with fleas, which comprised of Xenopsylla brasiliensis (45.8%) and Dinopsyllus lypusus (54.2%), with an overall population density of 0.2 fleas/animal. Thirty one (72.1%) of the dogs were infested with fleas, all of which were Ctenocephalides spp. Thirty five (63.3%) houses were infested with fleas whose population was composed of Ctenocephalides spp, Pulex irritans, Tunga penetrans and Echinophaga gallinacea. Infected rodents were found in all the villages while the infected dog was found at Rhotia-Kati. Nineteen (11%) of the rodents and one (2%) dog harboured specific plague antibodies. It was broadly concluded that sylvatic plague was endemic in Karatu district and Ngorongoro Conservation Area and that outbreaks of the disease can occur in the area any time if and when relevant conditions become favourable. Prompt application of appropriate preventive and control measures and survey for substantiating the status in the Lake Manyara National Park, which is adjacent to some of the infected villages, are recommended.
A case of importation of the sandflea Tunga penetrans is reported. If this species were to become established in Australia, there could be medical and socioeconomic repercussions.
More people than ever before are traversing continents, either for business purposes or on holiday. Because 3-10 percent of these travelers experience skin, hair, or nail disorders related to these trips there is an increasing likelihood that Western physicians will be expected to treat exotic conditions imported from different countries. Tungiasis and furunculoid myiasis are two typical disorders of intertropical regions. They represent nuisances induced by the presence of arthropod larvae or eggs in the skin. We describe a case of tungiasis, caused by the sand flea Tunga penetrans (TP), and a case of myiasis, caused by Dermatobia hominis (DH), and briefly discuss the epidemiology, biologic life cycles, vectors, reservoirs, and clinical presentations of these parasites.
A 22 year old Chilean male presented with necrotic lesions of the 5 toes of the right foot and the heal of the left foot. He had spent 7 months traveling in the Amazona region of Brazil. Surgery was performed to clean the areas where eggs of Tunga penetrans were identified.