Tungiasis

Tungiasis is a skin infestation of the Tunga penetrans flea (also known as chigoe flea, jigger, nigua or sand flea), found in the tropical parts of Africa, Caribbean, Central and South America, and India. This disease is endemic in Nigeria and Trinidad and Tobago where in the 1980s the prevalance of tungiasis among children approached 40%. It is rarely found outside these areas. more...

The parasitic flea lives in soil and sand, and feeds intermittently on warm-blooded hosts such as humans, cattle, sheep, dogs, mice, and other animals. In order to reproduce, the female flea burrows head-first into the hosts' skin, often leaving the caudal tip of its abdomen visible through an orifice in a skin lesion. This orifice allows the chigoe flea to breathe while feeding on blood vessels in the cutaneous and subcutaneous dermal layer. In the next two weeks, the flea releases about 100 eggs through the orifice, which fall to the ground. The flea then dies and is sloughed by the host's skin. Within the next three to four days, the eggs hatch and mature into adult fleas within three to four weeks.

History

The first reported case of tungiasis was noted in the 1500s by Gonzalez Fernandez De Oviedo y Valdes, when sailors from the Santa Maria who sailed with Christopher Columbus were shipwrecked on Haiti and became infected. Tungiasis also infected many of the soldiers of the Spanish conquistadores, who also reported that an entire village in Colombia was abandoned because of this disease. The first clinical account of tungiasis was provided by the Portuguese doctor Aleixo de Abreu.

Symptoms

The symptoms of this disease include:

• Severe pruritus
• Pain
• Inflammation and swelling
• Lesions and ulcerations, with black dots in the center

Left untreated, secondary infections such as bacteremia, tetanus, and gangrene can occur.

Prevention

Because of their limited jumping ability, the most common sites of infection are the soles of the feet, the toe web and toenails. Preventing infection by chigoe flea is easily achieved by wearing shoes when traveling in endemic regions and spraying insecticides on infested soil. Walking barefoot, especially in children, remains the most common reason why tungiasis remains prevalent in poor, illiterate, rural populations.

Treatment

Treatment for tungiasis include physical removal of the flea by use of forceps or needles, application of topical anti-parasitic medicine, and surgery to completely remove the nodules.

Other successful reported treatment include applying a thick wax, nail polish, or petroleum solution to suffocate the flea and locally freezing the lesion by using liquid nitrogen. Local application of formaldehyde, chloroform and DDT have also been reported although their use is discouraged due to potential side effects.

Even without treatment, the burrowed fleas will die within two weeks and are naturally sloughed off as the skin sheds.

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