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Miller H, Ocampo J, Ayala A, Trujillo J, Feldmeier H. Very severe tungiasis in Amerindians in the Amazon lowland of Colombia: A case series. PLoS Negl Trop Dis 2019; 13:e0007068. [PMID: 30730885 PMCID: PMC6366737 DOI: 10.1371/journal.pntd.0007068] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/11/2018] [Indexed: 11/23/2022] Open
Abstract
Background Tungiasis is a parasitic skin disease caused by penetrating female sand fleas. By nature, tungiasis is a self-limiting infection. However, in endemic settings re-infection is the rule and parasite load gradually accumulates over time. Intensity of infection and degree of morbidity are closely related. Methodology/principal findings This case series describes the medical history, the clinical pathology, the socio-economic and the environmental characteristics of very severe tungiasis in five patients living in traditional Amerindian communities in the Amazon lowland of Colombia. Patients had between 400 and 1,300 penetrated sand fleas. The feet were predominantly affected, but clusters of embedded sand fleas also occurred at the ankles, the knees, the elbows, the hands, the fingers and around the anus. The patients were partially or totally immobile. Patients 1 and 3 were cachectic, patient 2 presented severe malnutrition. Patient 3 needed a blood transfusion due to severe anemia. All patients showed a characteristic pattern of pre-existing medical conditions and culture-dependent behavior facilitating continuous re-infection. In all cases intradomiciliary transmission was very likely. Conclusion/significance Although completely ignored in the literature, very severe tungiasis occurs in settings where patients do not have access to health care and are stricken in a web of pre-existing illness, poverty and neglect. If not treated, very severe tungiasis may end in a fatal disease course. Tungiasis (also called sand flea disease) is a neglected tropical disease (NTD) caused by the penetration of female sand fleas in the skin, typically at the toes, the sole or the heel. Once embedded in the upper strata of the skin, the parasite hypertrophies, enlarging its body size by a factor of 2000 within ten days. This causes intense inflammation with pain and itching, eventually leading to impaired mobility. During a period of three weeks, eggs are expelled through a tiny opening in the skin. When the last egg has been released into the environment, the parasite shrinks and eventually dies. Hence, by nature tungiasis is a self-limited infection. However, in endemic settings re-infection is the rule and parasite load gradually accumulates over time. Here we report five cases with extremely severe tungiasis in patients with 400 to 1,300 embedded sand fleas. Not only the feet were affected, but clusters of parasites also occurred at the ankles, the knees, the elbows, the hand, the fingers and around the anus. The patients were partially or totally immobile. Two patients were cachectic and one required a blood transfusion. All patients showed a characteristic pattern of pre-existing medical conditions and culture-related behaviour facilitating continuous re-infection.
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Affiliation(s)
| | - Jovana Ocampo
- Grupo SEP Línea de investigación–Interculturalidad, Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | - Alvaro Ayala
- Grupo SEP Línea de investigación–Interculturalidad, Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | - Julian Trujillo
- Department of Neglected Tropical Diseases, Ministry of Health and Social Protection, Bogotá, Colombia
| | - Hermann Feldmeier
- Institute of Microbiology and Infection Immunology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- * E-mail:
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Nazzaro G, Genovese G, Veraldi S. Clinical and histopathologic study of 39 patients with imported tungiasis. J Cutan Pathol 2019; 46:251-255. [DOI: 10.1111/cup.13410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 12/10/2018] [Accepted: 12/23/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Gianluca Nazzaro
- Department of Pathophysiology and TransplantationUniversità degli Studi di Milano, I.R.C.C.S. Foundation, Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Giovanni Genovese
- Department of Pathophysiology and TransplantationUniversità degli Studi di Milano, I.R.C.C.S. Foundation, Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Stefano Veraldi
- Department of Pathophysiology and TransplantationUniversità degli Studi di Milano, I.R.C.C.S. Foundation, Ca' Granda Ospedale Maggiore Policlinico Milan Italy
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Girma M, Astatkie A, Asnake S. Prevalence and risk factors of tungiasis among children of Wensho district, southern Ethiopia. BMC Infect Dis 2018; 18:456. [PMID: 30200882 PMCID: PMC6131746 DOI: 10.1186/s12879-018-3373-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 09/02/2018] [Indexed: 12/21/2022] Open
Abstract
Background Tungiasis is an ectoparasitic infestation, which still has public health importance in deprived populations of developing countries. Data on the prevalence and risk factors of tungiasis is rare in Ethiopia. Hence, this study was designed to determine the prevalence and risk factors of tungiasis among children in Wensho district, southern Ethiopia. Methods From February to May 2016, we conducted a community-based cross-sectional study on 366 children 5–14 years old. Data about the presence and severity of tungiasis were obtained through inspection and data on risk factors were collected through interviews of parents/guardians of the children using structured questionnaire and through observation of the housing environment using structured checklist. Results Two hundred fifteen (58.7%, 95% confidence interval [CI]: 53.7%, 63.8%) of the 366 children were infested with Tunga penetrans. Most lesions were localized in the feet and the distribution of the disease by sex was similar (57.4% among males and 60.3% among females). Children of illiterate mothers (adjusted odds ratio [AOR]: 3.62, 95% CI: 1.35, 9.73) and children whose mothers have attended only primary education (AOR: 2.72, 95% CI: 1.06, 6.97), children from cat owning households (AOR: 4.95, 95% CI: 1.19, 20.60) and children who occasionally use footwear (AOR: 7.42, 95% CI: 4.29, 12.83) and those who never use footwear (AOR: 12.55, 95% CI: 3.38, 46.58) had a significantly higher odds of tungiasis infestation. Conclusion Tungiasis is an important public health problem with considerable morbidity among children in Wensho. Hence, implementation of tungiasis prevention strategies such as promoting shoes wearing, provision of health education, fumigating the residential houses and applying insecticides on pets are recommended.
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Affiliation(s)
- Mekonnen Girma
- School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Ayalew Astatkie
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Solomon Asnake
- School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Abstract
A variety of arthropods, protozoa, and helminths infect the skin and subcutaneous tissues and may be identified by anatomic pathologists in standard cytology and histology preparations. The specific organisms seen vary greatly with the patient's exposure history, including travel to or residence in endemic countries. Arthropods are the most commonly encountered parasites in the skin and subcutaneous tissues and include Sarcoptes scabei, Demodex species, Tunga penetrans, and myiasis-causing fly larvae. Protozoal parasites such as Leishmania may also be common in some settings. Helminths are less often seen, and include round worms (eg, Dirofilaria spp.), tapeworms (eg, Taenia solium, Spirometra spp.), and flukes (eg, Schistosoma spp.). This review covers the epidemiologic and histopathologic features of common parasitic infections of the skin and subcutaneous tissues.
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Wiese S, Elson L, Feldmeier H. Tungiasis-related life quality impairment in children living in rural Kenya. PLoS Negl Trop Dis 2018; 12:e0005939. [PMID: 29309411 PMCID: PMC5757912 DOI: 10.1371/journal.pntd.0005939] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 09/06/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Tungiasis (sand flea disease) is a neglected tropical skin disease caused by female sand fleas (Tunga spp.) embedded in the skin of the host. The disease is common in sub-Saharan Africa and predominantly affects children living in impoverished rural communities. In these settings tungiasis is associated with important morbidity. Whether tungiasis impairs life quality has never been studied. METHODS The study was performed in 50 children with tungiasis, living in resource-poor communities in coastal Kenya. Based on the Dermatology Life Quality Index (DLQI) a tool was developed to determine life quality impairment associated with tungiasis in children, the tungiasis-related Dermatology of Life Quality Index (tungiasis-related-DLQI). Pain and itching were assessed using visual scales ranging from 0-3 points. The intensity of infection and the acute and chronic severity of tungiasis were determined using standard methods. RESULTS Seventy eight percent of the patients reported a moderate to very large effect of tungiasis on life quality at the time of the diagnosis. The degree of impairment correlated with the number of viable sand fleas present in the skin (rho = 0.64, p < 0.001), the severity score of acute clinical pathology (rho = 0.74, p < 0.001), and the intensity of pain (rho = 0.82, p < 0.001). Disturbance of sleep and concentration difficulties were the most frequent restriction categories (86% and 84%, respectively). Four weeks after curative treatment, life quality had improved significantly. On the individual level the amelioration of life quality correlated closely with the regression of clinical pathology (rho = 0.61, p < 0.001). CONCLUSION The parasitic skin disease tungiasis considerably impairs life quality in children in rural Kenya. After effective treatment, life quality improves rapidly.
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Affiliation(s)
- Susanne Wiese
- Institute of Microbiology and Hygiene, University Medicine Berlin, Germany
| | - Lynne Elson
- WAJIMIDA Jigger Campaign, Dabaso Tujengane CBO, Watamu, Kenya
| | - Hermann Feldmeier
- Institute of Microbiology and Hygiene, University Medicine Berlin, Germany
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Azam VV, Chikin VV, Borlakov IA. Tungiasis. A Case of Diagnosis of Tropical Dermatosis. VESTNIK DERMATOLOGII I VENEROLOGII 2017. [DOI: 10.25208/0042-4609-2017-93-6-79-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
A case of tungiasis is presented — infestation with Tunga penetrans of a man who was on vacation in Peru, with eruptions localized on toes I and V of the both feet. For treatment of the patient, the parasites were surgically removed out of the lesions, whereupon the lesions were treated with antiseptics.
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Di Nucci DL, Ezquiaga MC, Abba AM. Tunga penetrans in Giant anteater (Myrmecophaga tridactyla) from Argentina. VETERINARY PARASITOLOGY- REGIONAL STUDIES AND REPORTS 2017; 10:82-84. [DOI: 10.1016/j.vprsr.2017.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/15/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
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Sood A, Raman DK, Joshi RK, Gupta D. Tungiasis: Outbreak investigation of a zoonosis during overseas deployment. Med J Armed Forces India 2017; 73:375-379. [PMID: 29386713 DOI: 10.1016/j.mjafi.2017.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/29/2017] [Indexed: 11/24/2022] Open
Abstract
Background Tungiasis is an ectoparasitosis caused by the sand flea Tunga penetrans. It is endemic in the under privileged communities of Latin America, the Caribbean and Sub Saharan Africa with geographic and seasonal variations even within endemic areas. We describe investigation of an outbreak of Tungiasis in troops deployed as part of UN peacekeeping force in Central Africa. Methods Tungiasis was diagnosed in an unusually large number of cases of severely pruritic boils over feet in soldiers of a UN peacekeeping battalion. An outbreak investigation was carried out and the outbreak was described in time, place and person distribution. A retrospective cohort study was done to ascertain the associated risk factors. Results A total of 36 cases were identified of which 33 had laboratory confirmation. Of the 36 cases, 10(27.77%) had only Fortaleza Stage II lesions, 22 (61.11%) a combination of Fortaleza Stage II and III lesions and four (11.11%) cases had a combination of Stage, II, III and IV lesions. Secondary bacterial infection was seen in 25 (69.44%) cases. Epidemiological analysis revealed that it was a common source single exposure outbreak traced to a temporary campsite along one of the patrolling routes. Conclusion In a Military setting an integrated approach combining health education and environmental control is required to prevent such outbreaks.
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Affiliation(s)
- Aradhana Sood
- Associate Professor, Department of Dermatology & Venereology, Armed Forces Medical College, Pune 411040, India
| | - D K Raman
- Associate Professor, Department of Pathology, Armed Forces Medical College, Pune 411040, India
| | - R K Joshi
- Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune 411040, India
| | - Darpan Gupta
- Classified Specialist (Surgery), Command Hospital (Western Command), Chandimandir, India
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Wiese S, Elson L, Reichert F, Mambo B, Feldmeier H. Prevalence, intensity and risk factors of tungiasis in Kilifi County, Kenya: I. Results from a community-based study. PLoS Negl Trop Dis 2017; 11:e0005925. [PMID: 28991909 PMCID: PMC5648262 DOI: 10.1371/journal.pntd.0005925] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 10/19/2017] [Accepted: 09/01/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tungiasis is a neglected tropical disease caused by female sand fleas (Tunga penetrans) embedded in the skin. The disease is associated with important morbidity. Tungiasis is endemic along the Coast of Kenya with a prevalence ranging from 11% to 50% in school-age children. Hitherto, studies on epidemiological characteristics of tungiasis in Africa are scanty. METHODS In a cross-sectional study 1,086 individuals from 233 households in eight villages located in Kakuyuni and Malanga Sub-locations, Kilifi County, on the Kenyan Coast, were investigated. Study participants were examined systematically and the presence and severity of tungiasis were determined using standard methods. Demographic, socio-economic, environmental and behavioral risk factors of tungiasis were assessed using a structured questionnaire. Data were analyzed using bivariate and multivariate regression analysis. RESULTS The overall prevalence of tungiasis was 25.0% (95% CI 22.4-27.5%). Age-specific prevalence followed an S-shaped curve, peaking in the under-15 year old group. In 42.5% of the households at least one individual had tungiasis. 15.1% of patients were severely infected (≥ 30 lesions). In the bivariate analysis no specific animal species was identified as a risk factor for tungiasis. Multivariate analysis showed that the occurrence of tungiasis was related to living in a house with poor construction characteristics, such as mud walls (OR 3.35; 95% CI 1.71-6.58), sleeping directly on the floor (OR 1.68; 95% CI 1.03-2.74), the number of people per sleeping room (OR = 1.77; 95% CI 1.07-2.93) and washing the body without soap (OR = 7.36; 95% CI 3.08-17.62). The odds of having severe tungiasis were high in males (OR 2.29; 95% CI 1.18-44.6) and were very high when only mud puddles were available as a water source and lack of water permitted washing only once a day (OR 25.48 (95% CI 3.50-185.67) and OR 2.23 (95% CI 1.11-4.51), respectively). CONCLUSIONS The results of this study show that in rural Kenya characteristics of poverty determine the occurrence and the severity of tungiasis. Intra-domiciliary transmission seems to occur regularly.
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Affiliation(s)
- Susanne Wiese
- Institute of Microbiology and Hygiene, Charité University Medicine, Berlin, Germany
- * E-mail:
| | - Lynne Elson
- WAJIMIDA Jigger Campaign, Dabaso Tujengane CBO, Watamu, Kenya
| | - Felix Reichert
- Department of Pediatrics, Charité University Medicine, Berlin, Germany
| | - Barbara Mambo
- Kilifi County Research Group, Kilifi County Hospital, Kilifi, Kenya
| | - Hermann Feldmeier
- Institute of Microbiology and Hygiene, Charité University Medicine, Berlin, Germany
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Schuster A, Thielecke M, Raharimanga V, Ramarokoto CE, Rogier C, Krantz I, Feldmeier H. High-resolution infrared thermography: a new tool to assess tungiasis-associated inflammation of the skin. Trop Med Health 2017; 45:23. [PMID: 28919835 PMCID: PMC5599887 DOI: 10.1186/s41182-017-0062-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/25/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Tungiasis is highly prevalent in low- and middle-income countries but remains often under diagnosed and untreated eventually leading to chronic sequels. The objective of the study was to assess whether tungiasis-associated inflammation can be detected and quantified by high-resolution infrared thermography (HRIT) and whether after removal of the parasite inflammation resolves rapidly. METHODS Patients with tungiasis were identified through active case finding. Clinical examination, staging, and thermal imaging as well as conventional photography were performed. In exemplary cases, the embedded sandfly was extracted and regression of inflammation was assessed by thermal imaging 4 days after extraction. RESULTS The median perilesional temperature was significantly higher than the median temperature of the affected foot (rho = 0.480, p = 0.003). Median perilesional temperature measured by high-resolution infrared thermography was positively associated with the degree of pain (rho = 0.395, p < 0.017) and semi-quantitative scores for acute (rho = 0.380, p < 0.022) and chronic (rho = 0.337, p < 0.044) clinical pathology. Four days after surgical extraction, inflammation and hyperthermia of the affected area regressed significantly (rho = 0.457, p = 0.005). In single cases, when clinical examination was difficult, lesions were identified through HRIT. CONCLUSION We proved that HRIT is a useful tool to assess tungiasis-associated morbidity as well as regression of clinical pathology after treatment. Additionally, HRIT might help to diagnose hidden and atypical manifestations of tungiasis. Our findings, although still preliminary, suggest that HRIT could be used for a range of infectious skin diseases prevalent in the tropics. TRIAL REGISTRATION ISRCTN11415557, Registration date: 13 July 2011.
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Affiliation(s)
- Angela Schuster
- Institute for Microbiology and Hygiene, Charité University Medicine, Berlin, Germany
- Clinical Sciences Department, Institute for Tropical Medicine, Antwerp, Belgium
| | - Marlene Thielecke
- Institute for Microbiology and Hygiene, Charité University Medicine, Berlin, Germany
| | | | | | | | - Ingela Krantz
- Skaraborg Institute of Research and Development, Skövde, Sweden
| | - Hermann Feldmeier
- Institute for Microbiology and Hygiene, Charité University Medicine, Berlin, Germany
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Nyangacha RM, Odongo D, Oyieke F, Ochwoto M, Korir R, Ngetich RK, Nginya G, Makwaga O, Bii C, Mwitari P, Tolo F. Secondary bacterial infections and antibiotic resistance among tungiasis patients in Western, Kenya. PLoS Negl Trop Dis 2017; 11:e0005901. [PMID: 28886013 PMCID: PMC5607213 DOI: 10.1371/journal.pntd.0005901] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 09/20/2017] [Accepted: 08/23/2017] [Indexed: 01/21/2023] Open
Abstract
Tungiasis or jigger infestation is a parasitic disease caused by the female sand flea Tunga penetrans. Secondary infection of the lesions caused by this flea is common in endemic communities. This study sought to shed light on the bacterial pathogens causing secondary infections in tungiasis lesions and their susceptibility profiles to commonly prescribed antibiotics. Participants were recruited with the help of Community Health Workers. Swabs were taken from lesions which showed signs of secondary infection. Identification of suspected bacteria colonies was done by colony morphology, Gram staining, and biochemical tests. The Kirby Bauer disc diffusion test was used to determine the drug susceptibility profiles. Out of 37 participants, from whom swabs were collected, specimen were positive in 29 and 8 had no growth. From these, 10 different strains of bacteria were isolated. Two were Gram positive bacteria and they were, Staphylococcus epidermidis (38.3%) and Staphylococcus aureus (21.3%). Eight were Gram negative namely Enterobacter cloacae (8.5%), Proteus species (8.5%), Klebsiellla species (6.4%), Aeromonas sobria (4.3%), Citrobacter species (4.3%), Proteus mirabillis(4.3%), Enterobacter amnigenus (2.1%) and Klebsiella pneumoniae (2.1%). The methicillin resistant S. aureus (MRSA) isolated were also resistant to clindamycin, kanamycin, erythromycin, nalidixic acid, trimethorprim sulfamethoxazole and tetracycline. All the Gram negative and Gram positive bacteria isolates were sensitive to gentamicin and norfloxacin drugs. Results from this study confirms the presence of resistant bacteria in tungiasis lesions hence highlighting the significance of secondary infection of the lesions in endemic communties. This therefore suggests that antimicrobial susceptibility testing may be considered to guide in identification of appropriate antibiotics and treatment therapy among tungiasis patients.
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Affiliation(s)
- Ruth Monyenye Nyangacha
- Center for Traditional Medicine and Drug Research, Kenya Medical Research Institute, Nairobi, Kenya
- School of Biological Sciences, University of Nairobi, Nairobi, Kenya
| | - David Odongo
- School of Biological Sciences, University of Nairobi, Nairobi, Kenya
| | - Florence Oyieke
- School of Biological Sciences, University of Nairobi, Nairobi, Kenya
| | - Missiani Ochwoto
- Production Department, Kenya Medical Research Institute, Nairobi, Kenya
| | - Richard Korir
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Gladys Nginya
- Center for Traditional Medicine and Drug Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Olipher Makwaga
- Center for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Christine Bii
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Peter Mwitari
- Center for Traditional Medicine and Drug Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Festus Tolo
- Center for Traditional Medicine and Drug Research, Kenya Medical Research Institute, Nairobi, Kenya
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Control of Tungiasis in Absence of a Roadmap: Grassroots and Global Approaches. Trop Med Infect Dis 2017; 2:tropicalmed2030033. [PMID: 30270889 PMCID: PMC6082108 DOI: 10.3390/tropicalmed2030033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 07/20/2017] [Accepted: 07/23/2017] [Indexed: 11/16/2022] Open
Abstract
Tungiasis is a tropical skin disease caused by the sand flea Tunga penetrans. It inflicts misery upon tens of millions of people, mostly children, across Central and South America and sub-Saharan Africa, and yet there is no globally accepted roadmap for its control. Here we review how research in the last 15 years has developed control methods and report on new grassroots and digital mapping approaches. Treatment is now possible with a two-component dimethicone, used for the treatment of headlice in Europe, Asia and Canada, but not yet available in most tungiasis-endemic areas. Prevention is possible through the daily use of repellents based on coconut oil. A Kenyan coastal community has successfully controlled tungiasis using a neem and coconut oil mix produced locally to treat cases, combined with spraying floors with neem solution and distributing closed shoes. Development of affordable hard floor technology is underway, although not yet widely available, but is a priority to control off-host stages in the floors of homes. A new web-based digital mapping application will enable researchers and health officials to collaborate, share data and map the prevalence of tungiasis. We conclude that tungiasis can be controlled through a multi-disciplinary, One Health approach.
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Mutebi F, Krücken J, Feldmeier H, Waiswa C, Mencke N, Eneku W, von Samson-Himmelstjerna G. High intensity of Tunga penetrans infection causing severe disease among pigs in Busoga, South Eastern Uganda. BMC Vet Res 2017; 13:206. [PMID: 28662705 PMCID: PMC5492922 DOI: 10.1186/s12917-017-1127-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/21/2017] [Indexed: 11/23/2022] Open
Abstract
Background Towards the improvement of stakeholders’ awareness of animal tungiasis, we report 10 unusual severe clinical cases of pig tungiasis which were associated with very high infection intensities of T. penetrans in an endemic area. Results Morbidity of ten pigs with high sand flea intensities detected during high transmission seasons in an endemic area in Busoga sub region, Uganda is described in detail. The cases of pigs presented with a very high number of embedded sand fleas (median = 276, range = 141–838). Acute manifestations due to severe tungiasis included ulcerations (n = 10), abscess formation (n = 6) and lameness (n = 9). Chronic morphopathological presentations were overgrowth of claws (n = 5), lateral deviation of dew claws (n = 6), detachment (n = 5) or loss of dew claws (n = 1). Treatment of severe cases with a topical insecticidal aerosol containing chlorfenvinphos, dichlorvos and gentian violet resolved acute morbidity and facilitated healing by re-epithelialisation. Conclusions The presentations of tungiasis highlighted in this report show that high intensities of embedded T. penetrans can cause a severe clinical disease in pigs. Effective tungiasis preventive measures and early diagnosis for treatment could be crucial to minimize its effects on animal health.
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Affiliation(s)
- Francis Mutebi
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. box 7062, Kampala, Uganda
| | - Jürgen Krücken
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, 14163, Berlin, Germany.
| | - Hermann Feldmeier
- Institute of Microbiology and Hygiene, Charité University Medicine, Berlin Campus Benjamin Franklin, Sylter Straße 2, 13353, Berlin, Germany
| | - Charles Waiswa
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. box 7062, Kampala, Uganda
| | | | - Wilfred Eneku
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. box 7062, Kampala, Uganda
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Nordin P, Thielecke M, Ngomi N, Mudanga GM, Krantz I, Feldmeier H. Treatment of tungiasis with a two-component dimeticone: a comparison between moistening the whole foot and directly targeting the embedded sand fleas. Trop Med Health 2017; 45:6. [PMID: 28293130 PMCID: PMC5345134 DOI: 10.1186/s41182-017-0046-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tungiasis (sand flea disease) is caused by the penetration of female sand fleas (Tunga penetrans, Siphonaptera) into the skin. It belongs to the neglected tropical diseases and is prevalent in South America, the Caribbean and sub-Saharan Africa. Tungiasis predominantly affects marginalized populations and resource-poor communities in both urban and rural areas. In the endemic areas, patients do not have access to an effective and safe treatment. A proof-of-principle study in rural Kenya has shown that the application of a two-component dimeticone (NYDA®) which is a mixture of two low viscosity silicone oils caused almost 80% of the embedded sand fleas to lose their viability within 7 days. METHODS In this study we compared the efficacy of two distinct modes of application of NYDA®; one targeted application to the area where the parasite protrudes through the skin and one comprehensive application to the whole foot. RESULTS Independent of the two modes of application, the dimeticone caused more than 95% of embedded sand fleas to lose all signs of viability within 7 days. The targeted application killed embedded sand fleas more rapidly compared to when the whole foot was covered. The proportion of viable lesions at day two were 7.0 versus 23.4% (p < 0.01) and at day five 3.9 versus 12.5% (p < 0.02). CONCLUSIONS Our findings suggest that the dimeticone could provide a safe and effective treatment for tungiasis in areas with difficult access to health care. TRIAL REGISTRATION ISRCTN ISRCTN74306878.
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Affiliation(s)
- Per Nordin
- The Skaraborg Institute for Research and Development, Stationsgatan 12, 541 30 Skövde, Sweden.,Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Marlene Thielecke
- Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
| | - Nicholas Ngomi
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Ingela Krantz
- The Skaraborg Institute for Research and Development, Stationsgatan 12, 541 30 Skövde, Sweden
| | - Hermann Feldmeier
- Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
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Canine tungiasis: High prevalence in a tourist region in Bahia state, Brazil. Prev Vet Med 2017; 139:76-81. [PMID: 28364835 DOI: 10.1016/j.prevetmed.2017.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/20/2017] [Accepted: 02/17/2017] [Indexed: 11/22/2022]
Abstract
Tungiasis is a parasitic skin disease neglected by authorities, health professionals, and the general population. Its occurrence is significantly associated with poverty. A cross-sectional study was conducted to describe the prevalence of tungiasis, associated clinical signs and risk factors of the canine population at a tourist site in the city of Ilhéus, Bahia (northeast Brazil). All village households were visited and dogs inspected after authorization by owners. A semi-structured questionnaire was administered. Of the 114 dogs included in the study, 71 (62.3%) were infested; all of them had lesions on their pads. An ectopic lesion on the nose was observed in one dog (1.4%). The number of manipulated lesions outnumbered the number of vital and avital lesions with an average of 88.3%. Edema (95.8%) and hyperkeratosis (85.9%) were the most prevalent clinical signs. Behavioral disorders such as excessive licking (6/71; 8.5%), disobedience (1/71; 1.4%) and prostration (2/71; 2.8%) were reported. In the multi-variate analysis, semi-restricted condition of the dogs (adjusted OR=8.58; 95% CI=2.47-29.76) and the presence of sand on the compound (adjusted OR=14.23, 95% CI=2.88-70.28) were significantly associated with infestation. We concluded that, infestation with Tunga spp. is highly endemic in the canine population of the village. The low level of restrictions on dogs and the presence of sand in areas most frequented by the animals are perpetuating factors of infestation in the community, subject to integrated and multidisciplinary intervention measures.
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66
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Successful Treatment of Severe Tungiasis in Pigs Using a Topical Aerosol Containing Chlorfenvinphos, Dichlorphos and Gentian Violet. PLoS Negl Trop Dis 2016; 10:e0005056. [PMID: 27727268 PMCID: PMC5058476 DOI: 10.1371/journal.pntd.0005056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/20/2016] [Indexed: 11/22/2022] Open
Abstract
Background In endemic communities, zoonotic tungiasis, a severe skin disease caused by penetrating female sand fleas, is a public health hazard causing significant human and animal morbidity. No validated drugs are currently available for treatment of animal tungiasis. Due to the reservoir in domestic animals, integrated management of human and animal tungiasis is required to avert its negative effects. Methods and principal findings A topical aerosol containing chlorfenvinphos 4.8%, dichlorphos 0.75% and gentian violet 0.145% licensed to treat tick infestations, myiasis and wound sepsis in animals in the study area, was tested for its potential tungicidal effects in a randomized controlled field trial against pig tungiasis in rural Uganda. Animals with at least one embedded flea were randomized in a treatment (n = 29) and a control (n = 26) group. One week after treatment, 58.6% of the treated pigs did not show any viable flea lesion whereas all control pigs had at least one viable lesion. After treatment the number of viable lesions (treated median = 0, overall range = 0–18 vs. control median = 11.5, range = 1–180) and the severity score for estimating acute pathology in pig tungiasis (treated median = 1, range = 0–3.5 vs. control median = 7, range = 0–25) were significantly lower in treated than in control pigs (p < 0.001). In the treatment group the median number of viable flea lesions decreased from 8.5 to 0 (p < 0.001). Similarly, the median acute severity score dropped from 6 to 1 (p < 0.001). Every pig in the treatment group showed a decrease in the number of viable fleas and tungiasis-associated acute morbidity while medians for both increased in the control group. Conclusions The study demonstrates that a topical treatment based on chlorfenvinphos, dichlorphos and gentian violet is highly effective against pig tungiasis. Due to its simplicity, the new approach can be used for the treatment of individual animals as well as in mass campaigns. Infection with the sand flea Tunga penetrans causes severe disease in humans and animals. There are no validated drugs for treatment of animal tungiasis preventing implementation of integrated tungiasis control interventions targeting human and animal infections. A field trial was conducted to evaluate the effects of a commercial insecticidal aerosol containing chlorfenvinphos 4.8%, dichlorphos 0.75%, and gentian violet 0.145%, which is licensed to treat tick infestations, myiasis and wound sepsis, on tungiasis in pigs, the major animal reservoir in rural hyperendemic villages in Uganda. Infected pigs were recruited and randomly assigned to treatment (n = 29) and control (n = 26) groups. Seven days after a single application of the aerosol onto the affected body parts, almost 60% of the treated pigs were cured while all control pigs had at least one penetrated sand flea. The number of viable sand fleas and the severity of the tungiasis were significantly lower in the treated pigs than in the controls. This demonstrates for the first time that a simple and effective topical treatment for animal tungiasis based on two organophosphate insecticides and an antibacterial agent can be used to cure individual animals and can be integrated in tungiasis control campaigns.
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Vasievich MP, Villarreal JDM, Tomecki KJ. Got the Travel Bug? A Review of Common Infections, Infestations, Bites, and Stings Among Returning Travelers. Am J Clin Dermatol 2016; 17:451-462. [PMID: 27344566 DOI: 10.1007/s40257-016-0203-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The popularity of international travel continues to increase among Americans, even though they often experience subsequent illness on return from their journey. The pathogens responsible are not necessarily endemic to the destination itself but are often the result of poor sanitary conditions or activities engaged in while away. Skin disease ranks third among all medical concerns in returning travelers. This review addresses the pathogenesis, epidemiology, clinical presentation, and treatment of the most common skin diseases in returning travelers: insect bites and bedbugs, cutaneous larva migrans, scabies, tungiasis, myiasis, leishmaniasis, viral exanthems, and marine envenomation. Primary care physicians and dermatologists should be familiar with these illnesses and a general approach to their evaluation and management.
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Affiliation(s)
- Matthew P Vasievich
- Department of Dermatology, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA.
| | - Jose Dario Martinez Villarreal
- Department of Internal Medicine, University Hospital, "José E. González," Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Kenneth J Tomecki
- Department of Dermatology, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA
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68
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Ugbomoiko US, Ariza L, Babamale AO, Heukelbach J. Prevalence and clinical aspects of tungiasis in south-west Nigerian schoolchildren. Trop Doct 2016; 47:34-38. [PMID: 27402650 DOI: 10.1177/0049475516657503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tungiasis is highly prevalent in resource-poor communities in sub-Saharan Africa, but studies among schoolchildren are scanty. We assessed prevalence, parasite load and clinical aspects of tungiasis in schoolchildren in south-western Nigeria. A total of 545 schoolchildren was examined. Of these, 133 (24.4%; 95% CI, 20.9-28.2%) were infested with Tunga penetrans Boys showed a higher prevalence than girls (31% versus 18%, P < 0.0001); in those infested, the median number of lesions was two, with no gender difference (2 boys, interquartile range, 1-4; 2 girls; interquartile range, 1-4; P = 0.34). The maximum number of 44 lesions was found in a 14-year-old boy. Desquamation was present in 90.2%, followed by erythema (54.9%) and oedema (43.6%); 54.9% showed any chronic pathology and more one-third nail deformations. Our study indicates that tungiasis is an important health problem in rural Nigerian schoolchildren. Sustainable interventions are required to control the disease in this and similar communities.
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Affiliation(s)
| | - Liana Ariza
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | | | - Jorg Heukelbach
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil .,Anton Breinl Centre for Public Health and College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, Australia
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69
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Karagiannidis I, Kanaki T, Brunner M, Zouboulis CC. [Multiple, black, burning papules on the soles of the feet of a 20-year-old woman]. Hautarzt 2016; 67:586-8. [PMID: 27240669 DOI: 10.1007/s00105-016-3803-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- I Karagiannidis
- Klinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau, Deutschland.
| | - T Kanaki
- Klinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau, Deutschland
| | - M Brunner
- Klinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau, Deutschland
| | - C C Zouboulis
- Klinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau, Deutschland
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70
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Mutebi F, Krücken J, Mencke N, Feldmeier H, von Samson-Himmelstjerna G, Waiswa C. Two Severe Cases of Tungiasis in Goat Kids in Uganda. JOURNAL OF INSECT SCIENCE (ONLINE) 2016; 16:iew016. [PMID: 27012871 PMCID: PMC4806713 DOI: 10.1093/jisesa/iew016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 02/09/2016] [Indexed: 06/05/2023]
Abstract
Tungiasis ensues from the penetration and burrowing of female sand fleas (Tunga spp.; Siphonaptera: Tungidae) in the skin of mammals. There are few case reports of severe tungiasis in goats and in these cases the Tunga species were not in most cases clearly identified. Two cases of severe tungiasis caused by Tunga penetrans in goat kids from tungiasis-endemic rural Uganda are reported. These are the first severe cases of tungiasis in goats reported from outside South America.
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Affiliation(s)
- Francis Mutebi
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda (; ),
| | - Jürgen Krücken
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag Street 7-13, 14163 Berlin, Germany (; )
| | | | - Hermann Feldmeier
- Institute of Microbiology and Hygiene, Charité University Medicine, Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Georg von Samson-Himmelstjerna
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag Street 7-13, 14163 Berlin, Germany (; )
| | - Charles Waiswa
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda (; )
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71
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Mutebi F, Krücken J, Feldmeier H, Waiswa C, Mencke N, von Samson-Himmelstjerna G. Tungiasis-associated morbidity in pigs and dogs in endemic villages of Uganda. Parasit Vectors 2016; 9:44. [PMID: 26817587 PMCID: PMC4729147 DOI: 10.1186/s13071-016-1320-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/15/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tunga penetrans (Insecta, Siphonaptera, Tungidae) causes severe morbidity among heavily infected humans and animals in Latin America and sub-Saharan Africa. The clinical pathology of tungiasis in animals has never been studied systematically. METHODS This was a cross-sectional study conducted between January to March 2015, aimed at describing tungiasis-associated clinical pathology in 121 and 20 T. penetrans-infected pigs and dogs, living in nine and five endemic rural villages respectively located in Bugiri District, Busoga, Uganda. RESULTS The parasite load of infected animals ranged from one to 246 (median 8) and one to eight (median 2) in pigs and dogs, respectively. In pigs 99.3% and in dogs 100% of the lesions were located on feet. In pigs, hind legs were significantly more affected than front legs (90.9% vs. 57.9%; p = 0.002) and also had more lesions than the front legs (median 5 vs. 1; p = 0.0001). However, in dogs localization of lesions between front and hind legs never differed significantly (front, 50% vs. hind, 65%; p = 0.51) and so were the number of lesions (median front = 0.5 vs. median hind = 2; p = 0.7). Acute and chronic clinical pathology coexisted. The most common disease manifestations in pigs were hoof wall erosions (68.6%), tissue necrosis of hoof wall and skin (66.1), pain at infection sites (47.9%), hoof deformity (45.5%), fissures (44.6%) and edema (44.6%). In dogs, tungiasis mainly presented with pain at attachment site (80%), ulcers (55%), necrosis (30%) as well as hyperemia and edema (both 15%). One pig had lost dew claws while two had loose detaching claws. Despite a lower number of sand fleas, a higher proportion of infected dogs (20%) than pigs (5.8%) exhibited functional limb use difficulties (p = 0.05). CONCLUSIONS The pattern of clinical manifestations in pigs and dogs were very similar to those reported from affected humans and rats. The important morbidity associated with animal tungiasis makes the disease a serious veterinary health problem in sub-Saharan Africa warranting treatment and control for optimal animal production.
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Affiliation(s)
- Francis Mutebi
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. box 7062, Kampala, Uganda.
| | - Jürgen Krücken
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, 14163, Berlin, Germany.
| | - Hermann Feldmeier
- Institute of Microbiology and Hygiene, Charité University Medicine, Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Charles Waiswa
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. box 7062, Kampala, Uganda.
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Ryan AJ, Cerio R, Paige D, Goldsmith P. An unusual cause of plantar pustulosis. Clin Exp Dermatol 2016; 41:568-9. [DOI: 10.1111/ced.12792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 12/01/2022]
Affiliation(s)
- A. J. Ryan
- Department of Dermatology; The Royal London Hospital; Barts Health NHS Trust; London UK
| | - R. Cerio
- Department of Dermatology; The Royal London Hospital; Barts Health NHS Trust; London UK
| | - D. Paige
- Department of Dermatology; The Royal London Hospital; Barts Health NHS Trust; London UK
| | - P. Goldsmith
- Department of Dermatology; The Royal London Hospital; Barts Health NHS Trust; London UK
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Mwangi JN, Ozwara HS, Gicheru MM. Epidemiology of tunga penetrans infestation in selected areas in Kiharu constituency, Murang'a County, Kenya. Trop Dis Travel Med Vaccines 2015; 1:13. [PMID: 28883944 PMCID: PMC5530937 DOI: 10.1186/s40794-015-0015-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tungiasis is a parasitic skin disease brought about by female Tunga penetrans when they burrow into the skin of their hosts. It is a disease that has largely been ignored. Epidemiology of tungiasis has not been widely studied in Kenya which could negatively affect effective intervention strategies. This study therefore sought to investigate epidemiology of tungiasis in selected areas in Kiharu constituency, Murang'a County in Kenya. METHODS The study population comprised of public primary school pupils, the most vulnerable age group (n = 508) in Gaturi, Kimathi, Kahuhia and Mugoiri in Kiharu constituency. Public primary school pupils in the study area were randomly sampled. Through questionnaires and observations, data was collected. RESULTS The overall prevalence of tungiasis in pupils in the study area was 19.1 %. In multinomial logistic regression analysis some factors were identified to be associated with tungiasis such as lack of regular use of closed foot ware (Adjusted odds ratio = 10.45; 95 % Confidence Interval; 1.49-73.23), living in earthen mud walled houses (aOR = 13.78; 95 % CI = 3.127-60.69), sharing living quarters with domestic animals (aOR = 3.1; 95 % CI = 0.003-.046) and learning in classrooms with dusty floors (aOR = 14.657; 95 % CI = 2.262-94.95). Treatment of tungiasis was found to be mainly through mechanical removal of embedded T. penetrans. CONCLUSION This study shows that tungiasis in the selected study areas of Kiharu constituency is a disease of significant health concern. Factors associated with tungiasis were identified that should be the focus of sustainable and effective control measures.
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Affiliation(s)
- Jamleck N. Mwangi
- Department of Zoological sciences, Kenyatta University, P. O. Box 43844-00100, Nairobi, Kenya
| | - Hastings S. Ozwara
- Department of Tropical and Infectious Diseases, Institute of Primate Research, National Museums of Kenya, P. O. Box 24481, Karen, 00502 Nairobi Kenya
| | - Michael M. Gicheru
- Department of Zoological sciences, Kenyatta University, P. O. Box 43844-00100, Nairobi, Kenya
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Mutebi F, Krücken J, Feldmeier H, Waiswa C, Mencke N, Sentongo E, von Samson-Himmelstjerna G. Animal Reservoirs of Zoonotic Tungiasis in Endemic Rural Villages of Uganda. PLoS Negl Trop Dis 2015; 9:e0004126. [PMID: 26473360 PMCID: PMC4608570 DOI: 10.1371/journal.pntd.0004126] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/08/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Animal tungiasis is believed to increase the prevalence and parasite burden in humans. Animal reservoirs of Tunga penetrans differ among endemic areas and their role in the epidemiology of tungiasis had never been investigated in Uganda. METHODS AND FINDINGS To identify the major animal reservoirs of Tunga penetrans and their relative importance in the transmission of tungiasis in Uganda, a cross sectional study was conducted in animal rearing households in 10 endemic villages in Bugiri District. T. penetrans infections were detected in pigs, dogs, goats and a cat. The prevalences of households with tungiasis ranged from 0% to 71.4% (median 22.2) for animals and from 5 to 71.4% (median 27.8%) for humans. The prevalence of human tungiasis also varied among the population of the villages (median 7%, range 1.3-37.3%). Pig infections had the widest distribution (nine out of 10 villages) and highest prevalence (median 16.2%, range 0-64.1%). Pigs also had a higher number of embedded sand fleas than all other species combined (p < 0.0001). Dog tungiasis occurred in five out of 10 villages with low prevalences (median of 2%, range 0-26.9%). Only two goats and a single cat had tungiasis. Prevalences of animal and human tungiasis correlated at both village (rho = 0.89, p = 0.0005) and household (rho = 0.4, p < 0.0001) levels. The median number of lesions in household animals correlated with the median intensity of infection in children three to eight years of age (rho = 0.47, p < 0.0001). Animal tungiasis increased the odds of occurrence of human cases in households six fold (OR = 6.1, 95% CI 3.3-11.4, p < 0.0001). CONCLUSION Animal and human tungiasis were closely associated and pigs were identified as the most important animal hosts of T. penetrans. Effective tungiasis control should follow One Health principles and integrate ectoparasites control in animals.
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Affiliation(s)
- Francis Mutebi
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Bio-security, Makerere University, Kampala, Uganda
| | - Jürgen Krücken
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
- * E-mail:
| | - Hermann Feldmeier
- Institute of Microbiology and Hygiene, Charité University Medicine, Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Charles Waiswa
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Bio-security, Makerere University, Kampala, Uganda
| | | | - Elizabeth Sentongo
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
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Abstract
Infectious diseases of the skin have become rarer in industrialized nations, but they still affect a considerable part of the population in tropical regions. Skin diseases induced by protozoa, worms and ectoparasites are among the 17 "neglected tropical diseases" defined by the WHO (leishmaniasis, dracunculiasis, lymphatic filariasis, onchocerciasis). Skin symptoms in travellers returning from the tropics may challenge dermatologists in Germany regarding differential diagnostic assessment and therapy. Among the 12 most frequent skin diseases in travellers are cutaneous larva migrans, leishmaniasis and myiasis. In this review, diagnosis, treatment and prevention of some the most relevant tropical dermatoses due to protozoa, worms and ectoparasites are discussed.
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Affiliation(s)
- S Schliemann
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erfurter Str. 35, 07743, Jena, Deutschland,
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76
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Mwangi JN, Ozwara HS, Motiso JM, Gicheru MM. Characterization of Tunga penetrans antigens in selected epidemic areas in Murang'a county in Kenya. PLoS Negl Trop Dis 2015; 9:e0003517. [PMID: 25793704 PMCID: PMC4368547 DOI: 10.1371/journal.pntd.0003517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/03/2015] [Indexed: 11/18/2022] Open
Abstract
Tunga penetrans are fleas that cause tungiasis, a condition characterized by high transmission rate due to poor housing conditions, social neglect and inadequate health care in economically disadvantaged communities in developing countries. This study therefore aimed at characterizing jiggers antigens to identify immunodominant ones to help understand immunological behavior of the parasite that would otherwise be important in future control of the parasite. Samples were gravid fleas and blood samples from infested individuals in Kahuro and Murang'a East district in Murang'a County. Freeze and thaw was used to extract soluble proteins from the fleas. Ouchterlony Double immunodiffusion was used to assess antigen-antibody reactions between extracted soluble protein and the serum from immunized rats, Rattus norvegicus prior to analysis of human sera. These results were comparable to results of immunoelectrphoresis. Jigger protein isolates were analyzed in Sodium Dodecyl Sulfate Polyacrylamide Gel Electrophoresis technique (SDS-PAGE), against Pharmacia standard protein markers. Further analysis of jigger antigens against pooled human sera from infested victims in Western blot revealed three immunodominant antigens. Using simple regression analysis molecular weights of the three immunodominant antigens were estimated as 51.795, 23.395 and 15.38 kDa respectively. These results are important since they would help understand immunological behavior of the parasites. This would help to create basis for designing and improving approaches against jiggers such as development of immune prophylaxis to complement social science approaches that is mainly concerned with maintenance of high standards of hygiene.
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Affiliation(s)
- Jamleck N. Mwangi
- Department of Zoological sciences, Kenyatta University, Nairobi, Kenya
| | - Hastings S. Ozwara
- Department of Tropical and Infectious Diseases, Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
| | - Joshua M. Motiso
- Department of Zoological sciences, Kenyatta University, Nairobi, Kenya
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Noriega L, Di Chiacchio N, Rosa IP, Michalany AO. Subungual Hyperpigmented Nodular Lesion in an Adult's Toe. Skin Appendage Disord 2015; 1:114-6. [DOI: 10.1159/000439386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/12/2015] [Indexed: 11/19/2022] Open
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Linardi PM, Beaucournu JC, de Avelar DM, Belaz S. Notes on the genus Tunga (Siphonaptera: Tungidae) II--neosomes, morphology, classification, and other taxonomic notes. ACTA ACUST UNITED AC 2014; 21:68. [PMID: 25514594 PMCID: PMC4270284 DOI: 10.1051/parasite/2014067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/03/2014] [Indexed: 12/02/2022]
Abstract
This review focuses on the neosomes, morphology, and taxonomy of adult species of the genus Tunga, complementing the previously published data on the phylogeny, ecology, and pathogenic role. Neosomes are structures formed after penetration of adult females into the skin of hosts resulting in significant enlargement, being the most characteristic and most frequently observed form in hosts. Neosomes can be differentiated by shape, measurements, and sites of attachment to principal hosts. The taxonomic value and morphometric data of the most widely used characteristics to separate species – such as frontal curvature, head chaetotaxy, preoral internal sclerotization, ventral and dorsal genal lobes, eyes, maxillary palps, fusion of pronotum and mesonotum, metacoxae, metatarsi chaetotaxy, spermatheca (females), manubrium, basimere, telomere, and phallosome (males) – are comparatively analyzed. The sexes, individual variations, undescribed species, higher taxa, as well as a proposal for division of the genus into two subgenera (Tunga and Brevidigita) are presented (as previously given by Wang). A key for females, males, and gravid females (neosomes) also is included for identifying the 13 known species. Data on host specificity and geographical distribution may also support the identification of Tunga species because some sand fleas and their hosts may have co-evolved.
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Affiliation(s)
- Pedro Marcos Linardi
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Caixa Postal 486, Avenida Presidente Antônio Carlos, 6627, Campus UFMG, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Jean-Claude Beaucournu
- Laboratoire de Parasitologie et Zoologie appliquée, Faculté de Médecine 2, avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France - Institut de Parasitologie de l'Ouest, Faculté de Médecine 2, avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France
| | - Daniel Moreira de Avelar
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Sorya Belaz
- Laboratoire de Parasitologie et Zoologie appliquée, Faculté de Médecine 2, avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France - Laboratoire de Parasitologie, Mycologie et Immunologie parasitaire, Centre Hospitalier Régional Universitaire, 2 rue Henri Le Guilloux, 32033 Rennes Cedex, France
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Feldmeier H, Heukelbach J, Ugbomoiko US, Sentongo E, Mbabazi P, von Samson-Himmelstjerna G, Krantz I. Tungiasis--a neglected disease with many challenges for global public health. PLoS Negl Trop Dis 2014; 8:e3133. [PMID: 25356978 PMCID: PMC4214674 DOI: 10.1371/journal.pntd.0003133] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hermann Feldmeier
- Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
- * E-mail:
| | - Jorg Heukelbach
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | | | - Elizabeth Sentongo
- Makerere University College of Health Sciences, School of Biomedical Sciences, Department of Medical Microbiology, Kampala, Uganda
| | | | - Georg von Samson-Himmelstjerna
- Institute for Parasitology and Tropical Veterinary Medicine, Faculty of Veterinary Medicine, Freie Universität, Berlin, Germany
| | - Ingela Krantz
- Skaraborg Institute for Research and Development, Skövde, Sweden
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80
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Neosomes of tungid fleas on wild and domestic animals. Parasitol Res 2014; 113:3517-33. [PMID: 25141814 PMCID: PMC4172993 DOI: 10.1007/s00436-014-4081-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 08/11/2014] [Indexed: 11/13/2022]
Abstract
Tunga is the most specialized genus among the Siphonaptera because adult females penetrate into the skin of their hosts and, after mating and fertilization, undergo hypertrophy, forming an enlarged structure known as the neosome. In humans and other warm-blooded animals, neosomes cause tungiasis, which arises due to the action of opportunistic agents. Although its effects on humans and domestic animals are well described in the literature, little is known about the impact of tungiasis on wild animals. This review focuses on the morphology, taxonomy, geographical distribution, hosts, prevalence, sites of attachment, and impact of tungid neosomes on wild and domestic animals. Because neosomes are the most characteristic form of the genus Tunga and also the form most frequently found in hosts, they are here differentiated and illustrated to aid in the identification of the 13 currently known species. Perspectives for future studies regarding the possibility of discovering other sand flea species, adaptation to new hosts, and the transfer of tungids between hosts in natural and modified habitats are also presented.
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81
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Gaines J, Sotir MJ, Cunningham TJ, Harvey KA, Lee CV, Stoney RJ, Gershman MD, Brunette GW, Kozarsky PE. Health and safety issues for travelers attending the World Cup and Summer Olympic and Paralympic Games in Brazil, 2014 to 2016. JAMA Intern Med 2014; 174:1383-90. [PMID: 24887552 PMCID: PMC4655589 DOI: 10.1001/jamainternmed.2014.2227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
IMPORTANCE Travelers from around the globe will attend the 2014 Fédération Internationale de Football Association (FIFA) World Cup and the 2016 Olympic and Paralympic Games in Brazil. Travelers to these mass gathering events may be exposed to a range of health risks, including a variety of infectious diseases. Most travelers who become ill will present to their primary care physicians, and thus it is important that clinicians are aware of the risks their patients encountered. OBJECTIVE To highlight health and safety concerns for people traveling to these events in Brazil so that health care practitioners can better prepare travelers before they travel and more effectively diagnose and treat travelers after they return. EVIDENCE REVIEW We reviewed both peer-reviewed and gray literature to identify health outcomes associated with travel to Brazil and mass gatherings. Thirteen specific infectious diseases are described in terms of signs, symptoms, and treatment. Relevant safety and security concerns are also discussed. FINDINGS Travelers to Brazil for mass gathering events face unique health risks associated with their travel. CONCLUSIONS AND RELEVANCE Travelers should consult a health care practitioner 4 to 6 weeks before travel to Brazil and seek up-to-date information regarding their specific itineraries. For the most up-to-date information, health care practitioners can visit the Centers for Disease Control and Prevention (CDC) Travelers' Health website (http://wwwnc.cdc.gov/travel) or review CDC's Yellow Book online (http://wwwnc.cdc.gov/travel/page/yellowbook-home-2014).
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Affiliation(s)
- Joanna Gaines
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Mark J Sotir
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Timothy J Cunningham
- Epidemiology and Surveillance Branch, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Kira A Harvey
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - C Virginia Lee
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Rhett J Stoney
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Mark D Gershman
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Gary W Brunette
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Phyllis E Kozarsky
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia3Emory University School of Medi
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82
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Thielecke M, Nordin P, Ngomi N, Feldmeier H. Treatment of Tungiasis with dimeticone: a proof-of-principle study in rural Kenya. PLoS Negl Trop Dis 2014; 8:e3058. [PMID: 25079375 PMCID: PMC4117482 DOI: 10.1371/journal.pntd.0003058] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/18/2014] [Indexed: 11/19/2022] Open
Abstract
Tungiasis (sand flea disease) is a neglected tropical disease, prevalent in resource-poor communities in South America and sub-Saharan Africa. It is caused by an inflammatory response against penetrated female sand fleas (Tunga penetrans) embedded in the skin of the host. Although associated with debilitating acute and chronic morbidity, there is no proven effective drug treatment. By consequence patients attempt to remove embedded sand fleas with non-sterile sharp instruments, such as safety pins, a procedure that represents a health threat by itself. In this proof-of-principle study we compared the topical application of a mixture of two dimeticones of low viscosity (NYDA) to the topical application of a 0.05% solution of KMnO4 in 47 school children in an endemic area in rural Kenya. The efficacy of the treatment was assessed during a follow up period of seven days using viability signs of the embedded parasites, alterations in the natural development of lesion morphology and the degree of local inflammation as outcome measures. Seven days after treatment, in the dimeticone group 78% (95% CI 67–86%) of the parasites had lost all signs of viability as compared to 39% (95% CI 28–52%) in the KMnO4 group (p<0.001). In the dimeticone group 90% (95% CI 80–95%) of the penetrated sand fleas showed an abnormal development already after 5 days, compared to 53% (95% CI 40–66%; p<0.001) in the KMnO4 group. Seven days after treatment, signs of local skin inflammation had significantly decreased in the dimeticone group (p<0.001). This study identified the topical application of dimeticones of low viscosity (NYDA) as an effective means to kill embedded sand fleas. In view of the efficacy and safety of the topical treatment with dimeticone, the mechanical extraction of embedded sand fleas using hazardous instruments is no longer warranted. Tungiasis (sand flea disease), a parasitic skin disease, causes important morbidity, and eventually leads to mutilation of the feet. Hitherto, the only effective treatment is the surgical extraction of embedded sand fleas. In the endemic areas this is done using inappropriate sharp instruments and causes more harm than good. We identified the three last abdominal segments of Tunga penetrans which protrude through the skin and through which the parasite breathes, defecates, and expels eggs - as an Achilles heel of embedded sand fleas. In a proof-of-principle study we investigated whether this Achilles heel is vulnerable to dimeticone with a low viscosity and a high creeping property. We randomized the left and the right feet to either receive a topical application of KMnO4 (the standard treatment in Kenya) or of dimeticone. The major outcome measure was the absence of viability signs of the treated sand fleas. The study shows that the topical application of a mixture of two dimeticones (NYDA) effectively kills embedded sand fleas within seven days. Since dimeticones are considered to be wholly non-toxic and are not expensive the new treatment could become a means to control tungiasis-associated morbidity on the population level.
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Affiliation(s)
- Marlene Thielecke
- Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
| | - Per Nordin
- Skaraborg Institute for Research and Development, Skövde, Sweden
| | - Nicholas Ngomi
- African Population and Health Research Center, Nairobi, Kenya
| | - Hermann Feldmeier
- Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
- * E-mail:
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83
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Connett J, George R. JAAD Grand Rounds quiz. Vacation dermatoses. J Am Acad Dermatol 2014; 70:961-3. [PMID: 24742847 DOI: 10.1016/j.jaad.2012.12.956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 12/10/2012] [Indexed: 10/25/2022]
Affiliation(s)
| | - Rosalyn George
- Charleston, South Carolina, and Wilmington, North Carolina
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84
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Abstract
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.
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Affiliation(s)
- Jorg Heukelbach
- Department of Community Health, School of Medicine, Federal University of Ceará, Rua Prof. Costa Mendes 1608, Fortaleza 60430-140, Brazil.
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85
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Feldmeier H, Keysers A. Tungiasis - A Janus-faced parasitic skin disease. Travel Med Infect Dis 2013; 11:357-65. [PMID: 24211240 DOI: 10.1016/j.tmaid.2013.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/23/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022]
Abstract
Tungiasis is a parasitic skin disease caused by the penetration of female sand fleas (Tunga penetrans). It is acquired when people walk barefoot or rest on soil, where sand fleas have completed the off-host cycle. Tungiasis is a classic poverty-associated disease which belongs to the family of neglected tropical diseases (NTD). It has a Janus-face: while in travellers tungiasis usually is a benign self-limiting skin disease, inhabitants of endemic areas suffer from heavy infestations and severe, frequently debilitating and incapacitating morbidity. We describe the epidemiological and clinical characteristics of travel-associated tungiasis and compare these features to the situation in resource-poor communities in South America and sub-Saharan Africa.
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Affiliation(s)
- Hermann Feldmeier
- Institute of Microbiology and Hygiene, Charité Medical School, Campus Benjamin Franklin, Hindenburgdamm 27, D-12203 Berlin, Germany.
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86
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Thielecke M, Raharimanga V, Rogier C, Stauss-Grabo M, Richard V, Feldmeier H. Prevention of tungiasis and tungiasis-associated morbidity using the plant-based repellent Zanzarin: a randomized, controlled field study in rural Madagascar. PLoS Negl Trop Dis 2013; 7:e2426. [PMID: 24069481 PMCID: PMC3777867 DOI: 10.1371/journal.pntd.0002426] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 07/28/2013] [Indexed: 11/21/2022] Open
Abstract
Background Tungiasis, a parasitic skin disease caused by the female sand flea Tunga penetrans, is a prevalent condition in impoverished communities in the tropics. In this setting, the ectoparasitosis is associated with important morbidity. It causes disfigurement and mutilation of the feet. Feasible and effective treatment is not available. So far prevention is the only means to control tungiasis-associated morbidity. Methodology In two villages in Central Madagascar, we assessed the efficacy of the availability of closed shoes and the twice-daily application of a plant-based repellent active against sand fleas (Zanzarin) in comparison to a control group without intervention. The study population was randomized into three groups: shoe group, repellent group and control group and monitored for ten weeks. The intensity of infestation, the attack rate and the severity of tungiasis-associated morbidity were assessed every two weeks. Findings In the repellent group, the median attack rate became zero already after two weeks. The intensity of the infestation decreased constantly during the observation period and tungiasis-associated morbidity was lowered to an insignificant level. In the shoe group, only a marginal decrease in the intensity of infestation and in the attack rate was observed. At week 10, the intensity of infestation, the attack rate and the severity score for acute tungiasis remained significantly higher in the shoe group than in the repellent group. Per protocol analysis showed that the protective effect of shoes was closely related to the regularity with which shoes were worn. Conclusions Although shoes were requested by the villagers and wearing shoes was encouraged by the investigators at the beginning of the study, the availability of shoes only marginally influenced the attack rate of female sand fleas. The twice-daily application of a plant-based repellent active against sand fleas reduced the attack to zero and lowered tungiasis-associated morbidity to an insignificant level. Tungiasis (sand flea disease) is a parasitic skin disease present in many resource-poor communities in South America, the Caribbean and sub-Saharan Africa. In this setting tungiasis is associated with important morbidity. Hitherto, the only effective treatment is the surgical extraction of embedded sand fleas. In the endemic areas this is done using inappropriate sharp instruments and causes more harm than good. The prevention of the infestation is the only option to control morbidity. In this study we show that the twice daily application of a herbal repellent based on coconut-oil (Zanzarin), is highly effective in preventing sand flea disease in a heavily affected community in Madagascar. The attack rate became zero immediately after starting the application of the repellent. The degree of tungiasis associated morbidity approached zero within 10 weeks. In contrast, the availability of closed solid shoes had only a marginal protective effect; although shoes were requested by the villagers and wearing shoes was encouraged by the investigators at the beginning of the study. In a control group from the same village the attack rate, the intensity of infestation and of tungiasis-associated morbidity remained unchanged. Our study in rural Madagascar shows that effective und sustainable morbidity control is possible using a repellent derived from coconut oil.
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Affiliation(s)
- Marlene Thielecke
- Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
| | | | | | | | | | - Hermann Feldmeier
- Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
- * E-mail:
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87
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Tungiasis: a neglected epidermal parasitic skin disease of marginalized populations--a call for global science and policy. Parasitol Res 2013; 112:3635-43. [PMID: 23949241 DOI: 10.1007/s00436-013-3551-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Abstract
Tungiasis (sand flea disease) is an ectoparasitic skin disease caused by the female sand flea/jigger flea (Tunga penetrans). As poverty is the major driving force of the disease, it can be called as a poverty-associated plague. It is one of the emerging neglected diseases in Latin America, Caribbean, sub-Saharan Africa, and India. The aim of the present scrutiny was to assess the public health impact of tungiasis, associated risk factors, and emerging opportunities to prevent and control tungiasis. Searches of PubMed, Google Scholar, and online search engines (Google, AOL, and Yahoo) using keywords "parasitic skin disease," "tungiasis," "sand flea," " tungiasis-associated risk factors," "tungiasis prevention and control," and their synonyms were used as a source of references. Searches were made without time limitations. Of 167 potential articles identified by these criteria, 51 appropriate were selected for review. Tungiasis is widespread in the resource-constrained settings of low-income economies. In the tropics, it is highly prevalent among the impoverished populations, but the associated risk factors are often poorly identified and remain uncontrolled. Though it is a self-limiting disease with considerable morbidity, the parasite may cause subsequent secondary morbidity through life-threatening complications and infections like cellulitis, tetanus, and death. However, the direct and indirect sociocultural, economic, and health impact of tungiasis is often undervalued and misunderstood. A systematic assessment on disease burden is still dearth and deficient. Over the decades, tungiasis has been largely neglected by the scientific community, policy makers, and healthcare stakeholders. In the endemic regions, even tungiasis is not listed for the disease control priorities in the regional, national, and international agenda. The majority of the epidermal parasitic skin diseases particularly tungiasis needs a sustainable global scientific research and control policy. This urges intensive efforts to develop a road map that delivers a clear vision towards zero new infection by designing low-cost prevention and control strategies. Besides, there is an urgency to develop culturally appropriate communication techniques and workable collaboration on a global scale by bringing all the stakeholders of endemic countries.
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88
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Schwalfenberg S, Witt LH, Kehr JD, Feldmeier H, Heukelbach J. Prevention of tungiasis using a biological repellent: a small case series. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2013; 98:89-94. [PMID: 15000736 DOI: 10.1179/000349804225003091] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- S Schwalfenberg
- Institute for International Health, Centre for Humanities and Health Sciences, Faculty of Medicine, Free University of Berlin, Fabeckstrasse 60-62, Berlin, Germany
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89
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Establishment of Tunga trimamillata (Siphonaptera: Tungidae) in Brazil. Parasitol Res 2013; 112:3239-42. [DOI: 10.1007/s00436-013-3501-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/12/2013] [Indexed: 10/26/2022]
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90
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Kulakov EL, Mann J, Bagla N, Cooper AJ. Painful nodule on the foot of a traveller returning from Africa. Clin Exp Dermatol 2013; 38:436-8. [DOI: 10.1111/ced.12111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2012] [Indexed: 11/30/2022]
Affiliation(s)
- E. L. Kulakov
- Friends Dermatology Centre; East Kent Hospitals University NHS Trust; Kent and Canterbury Hospital; Canterbury; UK
| | - J. Mann
- Friends Dermatology Centre; East Kent Hospitals University NHS Trust; Kent and Canterbury Hospital; Canterbury; UK
| | - N. Bagla
- Department of Histopathology; East Kent Hospitals University NHS Trust; Kent and Canterbury Hospital; Canterbury; UK
| | - A. J. Cooper
- Friends Dermatology Centre; East Kent Hospitals University NHS Trust; Kent and Canterbury Hospital; Canterbury; UK
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91
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Maco V, Maco VP, Tantalean ME, Gotuzzo E. Histopathological features of tungiasis in Peru. Am J Trop Med Hyg 2013; 88:1212-6. [PMID: 23478579 DOI: 10.4269/ajtmh.12-0645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Tungiasis is an ectoparasitic skin disease caused by Tunga penetrans and Tunga trimamillata. There is a lack of histopathological studies that evaluate the recognition of this flea in tissues. We describe the ex vivo dermoscopic and the histopathological patterns of six cases and relate the findings to the developmental stage of the parasite as defined by the Fortaleza classification: two were classified as Fortaleza 3b, 3 as 4a, and 1 as 4b. Two dermoscopic patterns were observed: a brown pigmented ring and a radial crown with a central pore. The most common histopathological findings were an eosinophilic cuticle, eggs in different stages of development, tracheal rings (parasite), and basal hyperplasia (host). The eosinophilic cuticle, eggs in different stages of evolution, and tracheal rings can help to establish the diagnosis when other parts of the parasite are lacking. The Fortaleza staging may represent a tool for pathology reporting purposes.
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Affiliation(s)
- Vicente Maco
- Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
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92
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Beaucournu JC, Degeilh B, Mergey T, Muñoz-Leal S, González-Acuña D. [The genus Tunga Jarocki, 1838 (Siphonaptera: Tungidae). I: taxonomy, phylogeny, ecology and pathogenicity]. Parasite 2012. [PMID: 23193514 PMCID: PMC4898135 DOI: 10.1051/parasite/2012194297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pour la première fois, les 12 espèces actuellement décrites dans le genre Tunga sont étudiées sur le plan de la taxonomie et de la répartition. Divers aspects de leur biologie et leur rôle pathogène sont également envisagés, et en particulier leur phylogénie, leur chorologie, leur phénologie, leur sexe-ratio et leurs dermecos.
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Affiliation(s)
- J C Beaucournu
- Laboratoire de Parasitologie et Zoologie appliquée, Rennes Cedex, France.
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93
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Grupper M, Potasman I. Outbreak of tungiasis following a trip to Ethiopia. Travel Med Infect Dis 2012; 10:220-3. [PMID: 23031181 DOI: 10.1016/j.tmaid.2012.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 09/04/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
Tungiasis is a skin disease caused by the ectoparasite sand flea Tunga penetrans. Although tungiasis is an important health problem in endemic areas, mainly South America and sub-Saharan Africa, it is reported uncommonly in travelers. We describe an outbreak of tungiasis in a group of travelers to Ethiopia. Following the diagnosis of tungiasis in a member of a group of 17 Israeli travelers to Ethiopia, other affected members were identified by photograph assisted self diagnosis. The characteristics, including relevant demographic and epidemiologic data were recorded using a telephone interview and computerized questionnaire, and analyzed subsequently. The attack rate of tungiasis in the travel group was 53% (9 patients). Most of the patients (89%) wore open sandals during prolonged periods of their journey, but the pattern of shoeware use was similar in unaffected group members. An insect bite was not felt by any patient. The median number of skin lesions was one, and most lesions were located on the foot (7 of 9 travelers), but the hands were also affected in 2 travelers. All skin lesions healed without a need for a major intervention and without major sequela within 5 weeks of their appearance. Tungiasis may be underdiagnosed in travelers. Medical personnel should include tungiasis in pre-travel recommendations, and post-travel assessment.
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Affiliation(s)
- M Grupper
- Infectious Disease Unit, Bnai Zion Medical Center, 47 Golomb St., P.O. Box 9490, Haifa 31048, Israel.
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94
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Buckendahl J, Heukelbach J, Witt L, Schwalfenberg S, Calheiros CML, Feldmeier H. Topographic distribution of the sand flea Tunga penetrans in Wistar rats and humans in two endemic areas in Brazil. Am J Trop Med Hyg 2012; 87:125-7. [PMID: 22764302 DOI: 10.4269/ajtmh.2012.11-0073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Tungiasis is a zoonosis caused by Tunga penetrans. In Brazil, tungiasis is endemic in many resource-poor communities, in which various domestic and sylvatic animals act as reservoirs. Eighty laboratory-raised Wistar rats were exposed to T. penetrans in areas of intense transmission: a fishing village and an urban shantytown in Ceará State, northeast Brazil. The topographic distribution of lesions in Wistar rats was compared with the distribution of lesions in humans in the same area. Our results show that the topographic distribution of embedded sand fleas was almost identical in Wistar rats and humans and that lesions were confined to the feet. In humans, 76% of all lesions were located periungually, whereas in Wistar rats, 67% of lesions were located at the distal end of the digits (P = 0.73). Both had the majority of lesions at the toes and digits: 70.2% versus 65.7% (P = 0.79). The Wistar rat model mirrors human tungiasis in topographic distribution.
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Affiliation(s)
- John Buckendahl
- Institute of Microbiology and Hygiene, Charité University of Medicine, Berlin, Germany.
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95
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Tungiasis (sand flea disease): a parasitic disease with particular challenges for public health. Eur J Clin Microbiol Infect Dis 2012; 32:19-26. [PMID: 22941398 DOI: 10.1007/s10096-012-1725-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 08/02/2012] [Indexed: 10/27/2022]
Abstract
Tungiasis (sand flea disease) is caused by the penetration of females of Tunga penetrans into the skin of the feet. Within 2 weeks of penetration the burrowed flea increases its volume by a factor of 2,000. This is paralleled by intense inflammation of the surrounding tissue. Acute and chronic inflammation leads to the development of painful and debilitating clinical pathology. This results in impaired physical fitness and mobility. The social implications of tungiasis-associated morbidity are multifold. Children with tungiasis are teased and ridiculed, adults feel ashamed and stigmatized. There is anecdotal evidence that tungiasis negatively affects educational achievements. Impaired mobility and physical fitness will have a negative impact on household economics. Sand flea disease is common in resource-poor communities in South America and in sub-Saharan Africa with prevalence in the general population of up to 60%. In East Africa, it has re-emerged in epidemic dimensions in recent years. Hitherto, no effective drug treatment has been at hand. Traditional treatment, i.e., the manipulation of burrowed sand fleas with blunt and inappropriate instruments may facilitate the transmission of blood-derived pathogens. Prevention is feasible through regular application of a repellent based on coconut oil. Owing to its strong association with poverty, sand flea disease would be an excellent starting point for a community-based fight against rural poverty.
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96
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Mazigo HD, Bahemana E, Konje ET, Dyegura O, Mnyone LL, Kweka EJ, Kidenya BR, Heukelbach J. Jigger flea infestation (tungiasis) in rural western Tanzania: high prevalence and severe morbidity. Trans R Soc Trop Med Hyg 2012; 106:259-63. [PMID: 22305586 DOI: 10.1016/j.trstmh.2011.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 12/01/2011] [Accepted: 12/01/2011] [Indexed: 11/28/2022] Open
Abstract
Epidemiologic and clinical data on the parasitic skin disease tungiasis are limited from sub-Saharan Africa, and virtually nonexistent from the East African region. We performed a community-based cross-sectional study in two villages in Kasulu district, western Tanzania. Study participants were examined for the presence of tungiasis and disease-associated morbidity. In total, 586 individuals >5 years of age were enrolled, and 249 (42.5%; 95% CI: 38.5-46.5) diagnosed with tungiasis. The ≥45 year-olds showed highest prevalence of tungiasis (71.1%) and most severe parasite load (median number of embedded fleas: 17.5; interquartile range: 15-22.5). Prevalence was slightly, but not significantly, higher in males than in females (45.3 vs 39.7%; p=0.17). Itching (68.3%), pain (38.6%) and ulcers (30.1%) were common; 22.1% of individuals found it difficult to walk due to tungiasis, and in 21.3% loss of toenails was observed. Considering the high prevalence and considerable morbidity in the population, we conclude that tungiasis is a public health threat in the study villages and that the disease needs to be recognized by health authorities. Future studies on risk factors, animal reservoirs and evidence-based control measures are needed.
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Affiliation(s)
- H D Mazigo
- Department of Medical Parasitology and Entomology, Faculty of Medicine, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania
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97
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De Avelar DM, Linhares AX, Linardi PM. A new species of Tunga (Siphonaptera: Tungidae) from Brazil with a key to the adult species and neosomes. JOURNAL OF MEDICAL ENTOMOLOGY 2012; 49:23-28. [PMID: 22308767 DOI: 10.1603/me11111] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Tunga bossii new species of tungid sand flea belonging to the caecata group is described with illustrations of the adult female, parasitizing the wild rodent Delomys dorsalis (Hensel) from Brazilian Atlantic Forest. Tunga bossii differs from the ten other known species of Tunginae by the size of the first segment of the maxillary palp and the presence of two bristles at the base of the maxilla. Tunga bossii also can be differentiated from other species of the T. caecata group by the eye morphology. A key to the adult species and neosomes of the genus Tunga also is included.
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Affiliation(s)
- Daniel M De Avelar
- Departamento de Parasitologia, Instituto de Ciências Biológicas da Universidade Federal de Minas Gerais, Caixa Postal 486, Avenida Antônio Carlos, 6627, Campus UFMG, Minas Gerais, 31270-901, Brazil
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98
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Veraldi S, Persico MC, Valsecchi M. Tungiasis in a beach volleyball player: a case report. J Am Podiatr Med Assoc 2011; 101:353-5. [PMID: 21817006 DOI: 10.7547/1010353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tungiasis is an infestation caused by penetration of the skin by the gravid female of the flea Tunga penetrans Linnaeus 1758 (Insecta, Siphonaptera: Tungidae). Tunga penetrans is currently found in Central and South America, sub-Saharan Africa, and Central Asia. Prevalence is very high in Brazil. We present a case of tungiasis in an Italian beach volleyball player who acquired the infestation in Brazil.
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Affiliation(s)
- Stefano Veraldi
- Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Università degli Studi di Milano, Fondazione I.R.C.C.S., Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
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99
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Abstract
Ancient parasites of the genus Tunga originated in America and, during the first half of the 19th century, were transported to the Eastern Hemisphere on transatlantic voyages. Although they were first documented by Spanish chroniclers after the arrival of Columbus, little is known about their presence in pre-Hispanic America. To evaluate the antiquity of tungiasis in America, we assessed several kinds of early documentation, including written evidence and pre-Incan earthenware reproductions. We identified 17 written documents and 4 anthropomorphic figures, of which 3 originated from the Chimu culture and 1 from the Maranga culture. Tungiasis has been endemic to Peru for at least 14 centuries. We also identified a pottery fragment during this study. This fragment is the fourth representation of tungiasis in pre-Hispanic America identified and provides explicit evidence of disease endemicity in ancient Peru.
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Affiliation(s)
- Vicente Maco
- Albert Einstein College of Medicine, New York, New York, USA.
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100
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Mazigo HD, Bahemana E, Dyegura O, Mnyone LL, Kweka EJ, Zinga M, Konje ET, Waihenya R, Heukelbach J. Severe tungiasis in Western Tanzania: case series. J Public Health Afr 2011; 2:e21. [PMID: 28299062 PMCID: PMC5345494 DOI: 10.4081/jphia.2011.e21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Accepted: 05/14/2011] [Indexed: 11/23/2022] Open
Abstract
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. However, data on the epidemiology of tungiasis in Tanzania are very limited and the disease does not receive much attention from health care professionals. During a community cross sectional survey in northwest Tanzania, we identified five individuals extremely infested with high number of parasites. A total of 435 lesions were recorded with patients presenting with >75 lesions and showed signs of intense acute and chronic inflammation. Superinfection of the lesions characterized by pustule formation, suppuration and ulceration were common. Loss of nails and walking difficulty was also observed. In Tanzanian communities living under extreme poverty characterized by poor housing condition and inadequate health services, tungiasis may cause severe morbidities. Further studies on risk factors and disease-related behavior of affected populations are needed to design adequate control measures.
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Affiliation(s)
- Humphrey D Mazigo
- Department of Medical Parasitology and Entomology, Faculty of Medicine, Weill-Bugando University, College of Health Sciences, Mwanza, Tanzania
| | - Emmanuel Bahemana
- Weill-Bugando University, College of Health Sciences, Mwanza, Tanzania
| | - Ocimund Dyegura
- Weill-Bugando University, College of Health Sciences, Mwanza, Tanzania
| | - Ladslaus L Mnyone
- Pest Management Center, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Eliningaya J Kweka
- Tropical Pesticides Research Institute, Division of Livestock and Human Disease Vector Control, Arusha, Tanzania
| | - Maria Zinga
- Department of Medical Parasitology and Entomology, Faculty of Medicine, Weill-Bugando University, College of Health Sciences, Mwanza, Tanzania
| | - Eveline T Konje
- Department of Community Medicine, Weill-Bugando University, College of Health Sciences, Mwanza, Tanzania
| | | | - Jorg Heukelbach
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil;; Anton Breinl Centre for Tropical Medicine and Public Health, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia
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