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Tungiasis


Key Points

  • The female adult flea ( Tunga penetrans ) burrows into epidermis, mostly of the feet, and grows by 2000-fold within 3–7 days.

  • The embedded sand flea causes intense inflammation with pain and itching, resulting in acute and chronic clinical pathology, sleep disturbance and impaired mobility.

  • Off-host stages (eggs, larvae, pupae, and adult males) develop in dry, sandy soils and floors with cracked surfaces.

  • Tungiasis is a zoonosis, with domestic and sylvatic animals acting as reservoirs.

  • Hitherto, treatment consists of sterile surgical extraction, taking care not to disrupt the flea. Recently, a two-component dimeticone (NYDA) was shown to be highly effective when applied topically on the lesions.

  • Prevention includes wearing of closed shoes, use of insect repellents, sealing of floors, and treatment of infected animals.

  • Morbidity prevention is possible by regular inspection of the feet and early treatment with dimeticone.

Synonyms

  • Sand fleas, Jiggers (East Africa), chigoe flea, funza (swahili), nigua (Venezuela, Columbia), pique (Paraguay), bicho de pe (Brazil), pulga de areia (Brazil), sand flea disease

Introduction

Tungiasis is a zoonotic, parasitic skin disease caused by Tunga penetrans (sand flea, Order Siphonoptera). The adult female flea penetrates the skin, normally around the toenails and other areas of the feet, but can be found anywhere on the body, especially on the fingers of people with reduced mobility. It predominantly affects economically and socially marginalized populations of Central and South America, the Caribbean, and sub-Saharan Africa. Within these populations it is children under 15 years old, the elderly, and the disabled who bear the highest disease burden. Domestic animals such as pigs, dogs, cats, sheep, and goats can act as reservoirs. There is an increasing number of travelers who become infected in endemic areas.

History

The first written records of tungiasis date from soon after the arrival of Columbus in South America in 1492. However, earthen pottery has been identified from archaeological sites in present-day Peru and Ecuador that clearly depicts pre-Incan people with tungiasis. These cases indicate that tungiasis has been an endemic disease in Peru for at least 14 centuries. In 1872, the parasite is thought to have been introduced into the African continent by a ship arriving from Brazil carrying sand ballast. Reports from military physicians in West and East Africa in the late 19th and the beginning of the 20th century indicated that tungiasis rapidly spread throughout sub-Saharan Africa and caused severe disease among local military personnel and inhabitants of the hinterland.

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