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Dos Santos KC, Tielemans E, Cutolo AA, Guedes PEB, Harvey TV, de Carvalho Teixeira JB, Vitor RC, da Paixão Sevá A, de Melo Navarro AW, Lima ACR, Botteon KD, Bittar TV, Albuquerque GR, de Almeida Borges F, Beugnet F, Carlos RSA. Efficacy of an oral formulation of afoxolaner and milbemycin oxime against Tunga penetrans in naturally infected dogs. Parasit Vectors 2023; 16:446. [PMID: 38042848 PMCID: PMC10693705 DOI: 10.1186/s13071-023-06063-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/16/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND The sand flea Tunga penetrans is one of the agents of tungiasis, an important parasitic skin disease affecting humans and several mammalian species. Tungiasis is mainly observed in disadvantaged rural and peripheral urban communities in Latin America and sub-Saharan Africa. The dog is a major reservoir of Tunga fleas. Hematophagous adult female Tunga spp. embed and grow in their host's epidermis and cause cutaneous inflammatory disorders. NexGard Spectra® is an orally administered endectocide for dogs, a co-formulation of the isoxazoline afoxolaner and the macrocyclic lactone milbemycin oxime. The objective of this study was to assess the efficacy of this product against canine tungiasis. METHODS A blinded, negative-controlled field trial was conducted in a Brazilian community known to be highly endemic for tungiasis. Sixty-six dogs naturally infected with live T. penetrans were randomly allocated to a treated group (44 dogs) and an untreated control group (22 dogs). In a first phase, dogs from the treated group were treated on days 0, 30, and 60. Efficacy was evaluated on the basis of the macroscopic parasitic skin lesions (Fortaleza classification) on days 7, 14, 21, 30, 45, 60, 75, and 90. In a second phase, to evaluate natural reinfections, all dogs were treated on day 90 and evaluated every 2 weeks thereafter until at least 30% of dogs were infected with live sand fleas. RESULTS During the first phase, efficacy (reduction in live sand fleas) of 92.4% was demonstrated on day 7. From day 14 until day 90, the efficacy of NexGard Spectra® was 100%. In the second phase, all dogs were free of live T. penetrans from 15 until 45 days after the day 90 treatment; 60 days post-treatment, 11% of dogs were reinfected, and 75 days post-treatment, 40% of dogs were reinfected. CONCLUSIONS NexGard Spectra® was demonstrated to be highly effective against canine tungiasis. In addition to an obvious beneficial effect on the health and welfare of the treated dog, the use of this product may have a one-health benefit on human cases by controlling the main reservoir of sand fleas.
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Affiliation(s)
- Katharine Costa Dos Santos
- Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Rod. Jorge Amado, Km 16 - Salobrinho, Ilhéus, Bahia, 45662-900, Brazil
| | - Eric Tielemans
- Boehringer Ingelheim Animal Health, 29 Avenue Tony Garnier, 69007, Lyon, France.
| | - Andre Antonio Cutolo
- Missouri Research Center, Boehringer Ingelheim Animal Health, 6498 Jade Rd., Fulton, MO, 65251, USA
| | - Paula Elisa Brandão Guedes
- Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Rod. Jorge Amado, Km 16 - Salobrinho, Ilhéus, Bahia, 45662-900, Brazil
| | | | - Jamille Bispo de Carvalho Teixeira
- Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Rod. Jorge Amado, Km 16 - Salobrinho, Ilhéus, Bahia, 45662-900, Brazil
| | - Rebeca Costa Vitor
- Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Rod. Jorge Amado, Km 16 - Salobrinho, Ilhéus, Bahia, 45662-900, Brazil
| | - Anaiá da Paixão Sevá
- Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Rod. Jorge Amado, Km 16 - Salobrinho, Ilhéus, Bahia, 45662-900, Brazil
| | - Adan William de Melo Navarro
- Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Rod. Jorge Amado, Km 16 - Salobrinho, Ilhéus, Bahia, 45662-900, Brazil
| | - Ana Carolina Ribeiro Lima
- Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Rod. Jorge Amado, Km 16 - Salobrinho, Ilhéus, Bahia, 45662-900, Brazil
| | - Karin Denise Botteon
- Boehringer-Ingelheim Saúde Animal, 14171 Pça. das Nações Unidas, 18° andar (Torre B), São Paulo, SP, 01449-010, Brazil
| | - Thammy Vieira Bittar
- Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Rod. Jorge Amado, Km 16 - Salobrinho, Ilhéus, Bahia, 45662-900, Brazil
| | - George Rêgo Albuquerque
- Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Rod. Jorge Amado, Km 16 - Salobrinho, Ilhéus, Bahia, 45662-900, Brazil
| | - Fernando de Almeida Borges
- Faculdade de Medicina Veterinária e Zootecnia, Universidade Federal de Mato Grosso do Sul (UFMS), Av. Sen. Filinto Müler, 2443 - Pioneiros, Campo Grande, Mato Grosso do Sul, 79070-900, Brazil
| | - Frederic Beugnet
- Boehringer Ingelheim Animal Health, 29 Avenue Tony Garnier, 69007, Lyon, France
| | - Renata Santiago Alberto Carlos
- Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Rod. Jorge Amado, Km 16 - Salobrinho, Ilhéus, Bahia, 45662-900, Brazil.
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Teixeira JBDC, dos Santos KC, Guedes PEB, Vitor RC, Bitar TV, Harvey TV, Sevá ADP, Carlos RSA. Tungiasis: Participation of Cats and Chickens in the Dispersion and Maintenance of the Disease in an Endemic Tourist Area in Brazil. Trop Med Infect Dis 2023; 8:456. [PMID: 37888584 PMCID: PMC10611092 DOI: 10.3390/tropicalmed8100456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/18/2023] [Accepted: 09/02/2023] [Indexed: 10/28/2023] Open
Abstract
Tunga spp. are fleas commonly found in impoverished tropical regions. In Vila Juerana, a tourist community in Ilheus, Bahia, Brazil, where tungiasis is endemic, dogs are the main host of fleas during their life cycle. However, there is no information about the role of cats and chickens in tungiasis in the village. Of the 272 households investigated, 112 had domestic animals, 48 had only dogs, 28 had only cats, and nine had only chickens. Of the 27 households with cohabitation among species, 16 had cats and dogs, eight had chickens and dogs, and three had dogs, cats, and chickens. The injuries due to tungiasis were ranked according to the Fortaleza classification, considering stages I, II, and III as viable lesions. The paws/feet of 71/111 (63.9%) cats and 173/439 (39.4%) chickens were inspected. Dogs that lived with positive cats and chickens also were inspected. Among the 38% (27/7; 95% IC 26.74-49.32) positive cats, 16 cohabited houses with infected dogs but none lived with positive chickens. Of the chickens, 2.3% (4/173; 95% IC 0.07-4.5) had lesions caused by tungiasis. In each household where a cat was infected, the dog was also positive. Two chickens cohabited with an infected dog and the other two did not coexist with other species. Cohabitation with infected dogs and the absence of house confinement restrictions in Vila Juerana make cats important carriers that spread tungiasis in this community. Chickens had a low frequency of tungiasis lesions despite living in proximity to infected dogs and cats.
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Affiliation(s)
- Jamille Bispo de Carvalho Teixeira
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
| | - Katharine Costa dos Santos
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
| | - Paula Elisa Brandão Guedes
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
| | - Rebeca Costa Vitor
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
| | - Thammy Vieira Bitar
- Departamento de Ciências Agrárias e Ambientais (DCAA), Curso de Medicina Veterinária, Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil;
| | | | - Anaiá da Paixão Sevá
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
| | - Renata Santiago Alberto Carlos
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
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Dinulos JE, Dinulos JG. Present and future: infectious tropical travel rashes and the impact of climate change. Ann Allergy Asthma Immunol 2022; 130:452-462. [PMID: 36574899 PMCID: PMC9789609 DOI: 10.1016/j.anai.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
In this article, we discuss pertinent cutaneous findings with which patients may present after travel to tropical destinations. We address arthropod-borne infectious diseases such as cutaneous leishmaniasis, Chagas disease, cutaneous larva migrans, and myiasis. We discuss other relevant diseases with cutaneous signs such as monkey pox and severe acute respiratory syndrome coronavirus 2. We provide clinicians with information regarding the background, diagnosis, treatment, and prevention of these tropical rashes. In addition, we address the impact that climate change will have on the temporal and geographic incidence of these rashes. Viral, fungal, and vector-borne diseases have seen a geographic expansion into more northern latitudes. Among these are tick-borne Lyme disease, aquatic snail-related seabather's eruption, and atopic dermatitis. As these diseases spread, we believe that the updated information within this article is significant to the practicing physician in today's warming world.
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Affiliation(s)
| | - James G Dinulos
- Seacoast Dermatology, PLLC, Portsmouth, New Hampshire; Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Dermatology, University of Connecticut School of Medicine, Framingham, Connecticut.
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dos Santos KC, Chiummo RM, Heckeroth AR, Zschiesche E, Brandão Guedes PE, Harvey TV, de Jesus AV, da Paixão Sevá A, de Oliveira JTS, dos Santos Freire Z, Krücken J, de Almeida Borges F, von Samson-Himmelstjerna G, Alberto Carlos RS. Efficacy of oral fluralaner (Bravecto) against Tunga penetrans in dogs: A negative control, randomized field study in an endemic community in Brazil. PLoS Negl Trop Dis 2022; 16:e0010251. [PMID: 35286319 PMCID: PMC8947607 DOI: 10.1371/journal.pntd.0010251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 03/24/2022] [Accepted: 02/11/2022] [Indexed: 12/01/2022] Open
Abstract
The sand flea Tunga penetrans is one of the zoonotic agents of tungiasis, a parasitic skin disease of humans and animals. The dog is one of its main reservoirs. This negatively controlled, randomized, double-masked clinical trial evaluated the therapeutic and residual efficacy of fluralaner for treatment of dogs naturally infested with T. penetrans. Sixty-two dogs from an endemically affected community in Brazil were randomly assigned to either receive oral fluralaner (Bravecto chewable tablets) at a dose of 25 to 56 mg fluralaner/kg body weight, or no treatment (31 dogs per group). Dogs were clinically examined using a severity score for acute canine tungiasis (SCADT), parasitological examinations as defined by the Fortaleza classification, and pictures of lesions on days 0 (inclusion and treatment), 7 ± 2, 14 ± 2, 21 ± 2, 28 ± 2, 60 ± 7, 90 ± 7, 120 ± 7 and 150 ± 7. The percentage of parasite-free dogs after treatment was >90% between days 14 and 90 post-treatment with 100% efficacy on study days 21, 28 and 60. Sand flea counts on fluralaner treated dogs were significantly lower (p<0.025) than control dogs on all counts from day 7 to 120. The number of live sand fleas on treated dogs was reduced by > 90% on day 7, > 95% on days 14 and 90, and 100% from day 21 to 60, and with a significant difference between groups from day 7 to 120. From day 7 to day 120, mean SCADT scores were significantly reduced in treated dogs with a mean of 0.10 compared to 1.54 on day 120 in untreated dogs. Therefore, a single oral fluralaner administration is effective for treating and achieving long lasting (> 12 weeks) prevention for tungiasis in dogs. Tungiasis is a dermatological disease that affects humans and animals infested with sand fleas (Tunga spp.), especially in communities exposed to contaminated sandy and dry soil, where living conditions are precarious and access to basic health is limited. These sand fleas penetrate host skin and cause severe acute and chronic injuries that can dramatically compromise the host’s health. Dogs are a primary reservoir and disseminator of these fleas in South America. In this clinical field trial, the efficacy of a single oral dose of fluralaner (Bravecto chewable tablets) was evaluated for treatment and prevention of tungiasis in dogs in an endemic area of Brazil. The treatment was assessed through absence of live sand fleas and resolution of characteristic tungiasis skin lesions. Fluralaner was 100% effective from the third to the eighth week post-treatment, eliminated live sand fleas and protected against new infestations during the study. Therefore, fluralaner proved to be an excellent therapeutic option for treatment and a highly effective control option for canine tungiasis.
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Affiliation(s)
- Katharine Costa dos Santos
- UESC, State University of Santa Cruz, Department of Agricultural and Environmental Sciences, Postgraduate Program in Animal Science, Ilhéus, Bahia, Brazil
| | | | | | - Eva Zschiesche
- MSD, Animal Health Innovation GmbH, Schwabenheim, Germany
| | - Paula Elisa Brandão Guedes
- UESC, State University of Santa Cruz, Department of Agricultural and Environmental Sciences, Postgraduate Program in Animal Science, Ilhéus, Bahia, Brazil
| | - Tatiani Vitor Harvey
- UESC, State University of Santa Cruz, Department of Agricultural and Environmental Sciences, Postgraduate Program in Animal Science, Ilhéus, Bahia, Brazil
| | - Anderson Vieira de Jesus
- UESC, State University of Santa Cruz, Department of Agricultural and Environmental Sciences, Postgraduate Program in Animal Science, Ilhéus, Bahia, Brazil
| | - Anaiá da Paixão Sevá
- UESC, State University of Santa Cruz, Department of Agricultural and Environmental Sciences, Postgraduate Program in Animal Science, Ilhéus, Bahia, Brazil
| | - Joana Thaisa Santos de Oliveira
- UESC, State University of Santa Cruz, Department of Agricultural and Environmental Sciences, Postgraduate Program in Animal Science, Ilhéus, Bahia, Brazil
| | - Zelina dos Santos Freire
- UFMS, Federal University of Mato Grosso do Sul, Faculty of Veterinary Medicine and Animal Science, Campo Grande, Mato Grosso do Sul, Brazil
| | - Jürgen Krücken
- Freie Universität Berlin, Institute for Parasitology and Tropical Veterinary Medicine, Berlin, Germany
| | - Fernando de Almeida Borges
- UFMS, Federal University of Mato Grosso do Sul, Faculty of Veterinary Medicine and Animal Science, Campo Grande, Mato Grosso do Sul, Brazil
| | - Georg von Samson-Himmelstjerna
- Freie Universität Berlin, Institute for Parasitology and Tropical Veterinary Medicine, Berlin, Germany
- * E-mail: (GvSH); (RSAC)
| | - Renata Santiago Alberto Carlos
- UESC, State University of Santa Cruz, Department of Agricultural and Environmental Sciences, Postgraduate Program in Animal Science, Ilhéus, Bahia, Brazil. CNPq Reseracher - PQ2
- * E-mail: (GvSH); (RSAC)
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Larson PS, Ono M, Changoma M, Goto K, Kaneko S, Moji K, Minakawa N. Presence of dogs and proximity to a wildlife reserve increase household level risk of tungiasis in Kwale, Kenya. Trop Med Health 2021; 49:54. [PMID: 34225821 PMCID: PMC8256484 DOI: 10.1186/s41182-021-00338-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/26/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Tungiasis is a ectopic skin disease caused by some species of fleas in the Tunga genus, most notably T. penetrans. The disease afflicts poor and marginalized communities in developing countries. Transmission of tungiasis comprises a complex web of factors including domesticated animals and wildlife. This research explores animal and environmental risk factors for tungiasis in an area adjacent to a wildlife reserve in Kwale, Kenya. Methods A two-stage complex sampling strategy was used. Households were selected from three areas in and around Kwale Town, Kenya, an area close to the Kenyan Coast. Households were listed as positive if at least one member had tungiasis. Each household was administered a questionnaire regarding tungiasis behaviors, domesticated animal assets, and wild animal species that frequent the peridomiciliary area. Associations of household tungiasis were tests with household and environmental variables using regression methods. Results The study included 319 households. Of these, 41 (12.85%) were found to have at least one person who had signs of tungiasis. There were 295 (92.48%) households that possessed at least one species of domesticated animal. It was reported that wildlife regularly come into the vicinity of the home 90.59% of households. Presence of dogs around the home (OR 3.85; 95% CI 1.84; 8.11) and proximity to the park were associated with increased risk for tungiasis infestation in humans in a multivariate regression model. Conclusions Human tungiasis is a complex disease associated with domesticated and wild animals. Canines in particular appear to be important determinants of household level risk.
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Affiliation(s)
- Peter S Larson
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) project, Kenya, Nagasaki, Nagasaki, Japan. .,University of Michigan School of Natural Resources and Environment, Ann Arbor, MI, USA.
| | - Masanobu Ono
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) project, Kenya, Nagasaki, Nagasaki, Japan
| | - Mwatasa Changoma
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) project, Kenya, Nagasaki, Nagasaki, Japan.,Chemi Chemi, Kwale, Kenya
| | - Kensuke Goto
- Division of Health and Safety Sciences Education, Osaka Kyoiku University, Osaka, Japan
| | - Satoshi Kaneko
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) project, Kenya, Nagasaki, Nagasaki, Japan
| | - Kazuhiko Moji
- Nagasaki University School of Tropical Medicine and Global Health (TMGH), Nagasaki, Japan
| | - Noboru Minakawa
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) project, Kenya, Nagasaki, Nagasaki, Japan
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Sikka N, Siev A, Boyer R, Pourmand A. Tungiasis, a rare case of plantar inflammatory disease, a review of travelers skin lesions for emergency providers. Am J Emerg Med 2019; 37:1215.e5-1215.e7. [PMID: 30922527 DOI: 10.1016/j.ajem.2019.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022] Open
Abstract
Parasitic infections while common in underdeveloped nations are rarely seen in developed urban centers. We report a case of a thirty-three-year-old male with no past medical history who presented to the emergency department with a chief complaint of "eggs coming out of my foot" after returning home from Brazil. Based on clinical presentation, travel history, and appearance of the lesion, diagnosis was most consistent with tungiasis infection which was confirmed by the pathology examination. It is important to make the appropriate diagnosis when skin lesions are found in returning travelers and emergency providers should take broad differential diagnosis into consideration.
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Affiliation(s)
- N Sikka
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - A Siev
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - R Boyer
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - A Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
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Santos RP, Resende C, da Luz Duarte M, Brito C. Tungiasis: a poorly-known diagnosis in Europe. Two paradigmatic cases from Portugal. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2017; 26:115-117. [PMID: 29264904 DOI: 10.15570/actaapa.2017.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tungiasis is a cutaneous parasitosis caused by infestation of the skin by gravid fleas of the genus Tunga, mainly Tunga penetrans. This flea is very common in tropical and subtropical regions of the globe, but not in Europe. The infestation is acquired by walking barefoot or lying in places where the flea is present, usually beaches or sandy soils. We report two unrelated cases of imported tungiasis in Portugal that presented to our clinic in the same week. We draw attention to one of the most common dermatological diseases in travelers returning from tropical countries, the diagnosis of which is primarily clinical but nonetheless is largely unfamiliar to clinicians attending those patients.
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Affiliation(s)
| | | | | | - Celeste Brito
- Department of Dermatology, Hospital de Braga, Braga, Portugal
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Díaz CJ, Escandón-Vargas K. Tungiasis in a Colombian patient. Braz J Infect Dis 2017; 21:484-485. [PMID: 28286017 PMCID: PMC9427953 DOI: 10.1016/j.bjid.2016.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/16/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Claudia J Díaz
- School of Dermatology and Dermatological Surgery, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia.
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Zimmerman RF, Belanger ES, Pfeiffer CD. Skin infections in returned travelers: an update. Curr Infect Dis Rep 2015; 17:467. [PMID: 25821190 DOI: 10.1007/s11908-015-0467-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Dermatologic manifestations of travel-related illness are particularly vexing due to the broad differential diagnosis and clinicians' unfamiliarity with uncommonly seen diseases. This paper aims to educate and update the reader on selected infectious diseases in the returned traveler whose disease manifestations are primarily dermatologic. First, the evolving epidemiology of these infections is examined; understanding the geographic distribution of infectious etiologies helps refine and narrow the differential diagnosis. This is followed by a discussion of six important clinical syndromes including cutaneous larva migrans (CLM), cutaneous leishmaniasis, tungiasis, myiasis, antibiotic-resistant skin and soft tissue infection, and selected infections associated with fever and rash (e.g., measles, chikungunya virus infection, dengue fever, rickettsial spotted fevers). Familiarity with these syndromes and a situational awareness of their epidemiology will facilitate a prompt, accurate diagnosis and lead to appropriate treatment and prevention of further disease spread.
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Affiliation(s)
- Robert F Zimmerman
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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Eldridge M, Cohen SH. Cutaneous manifestations of infection in returning travelers. Curr Infect Dis Rep 2014; 16:426. [PMID: 25129114 DOI: 10.1007/s11908-014-0426-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Dermatologic problems are common in returning travelers who seek medical care. Some common illnesses such as cellulitis or abscesses occur in travelers but are not unique to this patient group. Additionally, dermatologic illnesses not due to infection such as drug eruptions or phototoxicity are seen. Skin manifestations occur in many tropical illnesses such as dengue, schistosomiasis, and leishmaniasis. This article reviews the common causes of cutaneous illnesses associated with travel including non-infectious causes, infections that are not limited to travelers, and infections that are almost exclusively seen in travelers.
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Affiliation(s)
- Matthew Eldridge
- Division of Infectious Diseases, University of California, Davis, 4150 V Street, Suite 500, Sacramento, CA, 95817, USA,
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Une lésion du pied. Rev Med Interne 2013; 34:655-6. [DOI: 10.1016/j.revmed.2013.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 02/08/2013] [Accepted: 02/11/2013] [Indexed: 11/19/2022]
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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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Affiliation(s)
| | | | - Jih-Ching Lien
- * Address correspondence to Jih-Ching Lien, Taiwan Anti-malaria Advisory Mission in the Democratic Republic of Sao Tome and Principe, Ministry of Foreign Affairs of Taiwan, No. 9, Lane 136, Chungching North Road Section 3, Taipei City, Taiwan, Republic of China. E-mail:
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