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Salle R, Del Giudice P, Skayem C, Hua C, Chosidow O. Secondary Bacterial Infections in Patients with Atopic Dermatitis or Other Common Dermatoses. Am J Clin Dermatol 2024; 25:623-637. [PMID: 38578398 DOI: 10.1007/s40257-024-00856-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/06/2024]
Abstract
Secondary bacterial infections of common dermatoses such as atopic dermatitis, ectoparasitosis, and varicella zoster virus infections are frequent, with Staphylococcus aureus and Streptococcus pyogenes being the bacteria most involved. There are also Gram-negative infections secondary to common dermatoses such as foot dyshidrotic eczema and tinea pedis. Factors favoring secondary bacterial infections in atopic dermatitis, ectoparasitosis, and varicella zoster virus infections mainly include an epidermal barrier alteration as well as itch. Mite-bacteria interaction is also involved in scabies and some environmental factors can promote Gram-negative bacterial infections of the feet. Furthermore, the bacterial ecology of these superinfections may depend on the geographical origin of the patients, especially in ectoparasitosis. Bacterial superinfections can also have different clinical aspects depending on the underlying dermatoses. Subsequently, the choice of class, course, and duration of antibiotic treatment depends on the severity of the infection and the suspected bacteria, primarily targeting S. aureus. Prevention of these secondary bacterial infections depends first and foremost on the management of the underlying skin disorder. At the same time, educating the patient on maintaining good skin hygiene and reporting changes in the primary lesions is crucial. In the case of recurrent secondary infections, decolonization of S. aureus is deemed necessary, particularly in atopic dermatitis.
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Affiliation(s)
- Romain Salle
- Service de Dermatologie Générale et Oncologique, UVSQ, EA4340-BECCOH, AP-HP, Hôpital Ambroise-Paré, Université Paris-Saclay, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.
| | - Pascal Del Giudice
- Unité D'Infectiologie et Dermatologie, Centre Hospitalier Intercommunal de Fréjus-Saint-Raphaël, Fréjus, France
| | - Charbel Skayem
- Service de Dermatologie Générale et Oncologique, UVSQ, EA4340-BECCOH, AP-HP, Hôpital Ambroise-Paré, Université Paris-Saclay, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Camille Hua
- AP-HP, Service de Dermatologie, Hôpital Henri Mondor, Créteil, France
| | - Olivier Chosidow
- Consultation Dermatoses Faciales, Service d'ORL, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
- UPEC Créteil, Créteil, France
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Elson L, Kamau C, Koech S, Muthama C, Gachomba G, Sinoti E, Chondo E, Mburu E, Wakio M, Lore J, Maia M, Adetifa I, Orindi B, Bejon P, Fillinger U. Tungiasis among children in Kenya is associated with poor nutrition status, absenteeism, poor school performance and high impact on quality of life. PLoS Negl Trop Dis 2024; 18:e0011800. [PMID: 38776337 PMCID: PMC11149845 DOI: 10.1371/journal.pntd.0011800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 06/04/2024] [Accepted: 05/10/2024] [Indexed: 05/24/2024] Open
Abstract
Tungiasis is a highly neglected tropical skin disease caused by the sand flea, Tunga penetrans. The flea burrows into the skin inducing a strong inflammatory response, leading to pain and mobility restrictions with potential impacts on quality of life. Few countries implement control efforts and there are few data on the impact of the disease to support policy decisions. We conducted a survey to determine the impact of tungiasis among primary school children across nine counties of Kenya. A total of 10,600 pupils aged 8 to 14 years were randomly selected from 97 primary schools and examined for tungiasis. For 81 cases and 578 randomly selected controls, anthropometric measurements were made, and school attendance and exam scores were collected from school records. Of those with tungiasis, 73 were interviewed regarding their quality of life using a tungiasis-specific instrument. Mixed effect ordered logistic and linear models were used to assess associations between disease status and impact variables. Compared to uninfected pupils, those with tungiasis had lower weight-for-age z-scores (adjusted β -0.41, 95% CI: -0.75-0.06, p = 0.020), missed more days of school the previous term (adjusted Incidence Rate Ratio: 1.49, 95% CI: 1.01-2.21, p = 0.046) and were less likely to receive a high score in mathematics (aOR 0.18, 95% CI: 0.08-0.40, p<0.001) and other subjects. Pupils with severe disease (clinical score >10) were four times more likely to experience severe pain than those with mild disease (OR 3.96, 95% CI: 1.35-11.64, p = 0.012) and a higher impact on their quality of life than those with mild disease (aOR 3.57, 95% CI: 1.17-10.8, p = 0.025) when adjusted for covariates. This study has demonstrated tungiasis has a considerable impact on children's lives and academic achievement. This indicates the need for integrated disease management for school-aged children to protect their physical and cognitive development and their future prospects.
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Affiliation(s)
- Lynne Elson
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | | | | | | | | | | | | | | | - Marta Maia
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ifedayo Adetifa
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust, Kilifi, Kenya
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Benedict Orindi
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust, Kilifi, Kenya
| | - Phillip Bejon
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ulrike Fillinger
- International Centre for Insect Physiology and Ecology (icipe), Nairobi, Kenya
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McNeilly H, Mutebi F, Thielecke M, Reichert F, Banalyaki MB, Arono R, Mukone G, Feldmeier H. Management of very severe tungiasis cases through repeated community-based treatment with a dimeticone oil formula: A longitudinal study in a hyperendemic region in Uganda. Trop Med Int Health 2024; 29:303-308. [PMID: 38279810 DOI: 10.1111/tmi.13974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Tungiasis (sand flea disease) is a neglected tropical disease that is endemic in Sub-Saharan Africa and Latin America. Tungiasis causes pain, mobility restrictions, stigmatisation and reduced quality of life. Very severe cases with hundreds of sand fleas have been described, but treatment of such cases has never been studied systematically. During a larger community-based tungiasis control programme in a hyperendemic region in Karamoja, northeastern Uganda, 96 very severe tungiasis cases were identified and treated with the dimeticone formula NYDA®. They were repeatedly followed-up and treated again when necessary. The present study traces tungiasis frequency, intensity and morbidity among these 96 individuals over 2 years. At baseline, very severe tungiasis occurred in all age groups, including young children. Throughout the intervention, tungiasis frequency decreased from 100% to 25.8% among the 96 individuals. The overall number of embedded sand fleas in this group dropped from 15,648 to 158, and the median number of embedded sand fleas among the tungiasis cases decreased from 141 to four. Walking difficulties were reported in 96.9% at the beginning and in 4.5% at the end of the intervention. Repeated treatment with the dimeticone formula over 2 years was a successful strategy to manage very severe cases in a hyperendemic community. Treatment of very severe cases is essential to control the spread and burden of tungiasis in endemic communities.
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Affiliation(s)
- Hannah McNeilly
- Edinburgh Medical School: Biomedical Sciences, Biomedical Teaching Organisation, The University of Edinburgh, Edinburgh, UK
| | - Francis Mutebi
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Marlene Thielecke
- Charité Center for Global Health, Institute of International Health, Charité University Medicine Berlin, Berlin, Germany
| | - Felix Reichert
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Mike B Banalyaki
- Innovations for Tropical Disease Elimination (IFOTRODE), Kampala, Uganda
| | - Rebecca Arono
- Innovations for Tropical Disease Elimination (IFOTRODE), Kampala, Uganda
| | - George Mukone
- Innovations for Tropical Disease Elimination (IFOTRODE), Kampala, Uganda
| | - Hermann Feldmeier
- Institute of Microbiology, Infectious Diseases and Immunology, Charité University Medicine, Berlin, Germany
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Elson L, Nyawa SM, Matharu A, Fillinger U. Developing low-cost house floors to control tungiasis in Kenya - a feasibility study. BMC Public Health 2023; 23:2483. [PMID: 38087242 PMCID: PMC10714545 DOI: 10.1186/s12889-023-17427-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
CONTEXT Tungiasis is a neglected tropical skin disease endemic in resource-poor communities. It is caused by the penetration of the female sand flea, Tunga penetrans, into the skin causing immense pain, itching, difficulty walking, sleeping and concentrating on school or work. Infection is associated with living in a house with unsealed earthen house floors. METHODS This feasibility study used a community-based co-creation approach to develop and test simple, locally appropriate, and affordable flooring solutions to create a sealed, washable floor for the prevention of tungiasis. Locally used techniques were explored and compared in small slab trials. The floor with best strength and lowest cost was pilot trialed in 12 households with tungiasis cases to assess its durability and costs, feasibility of installation in existing local houses using local masons and explore community perceptions. Disease outcomes were measured to estimate potential impact. RESULTS It was feasible to build the capacity of a community-based organization to conduct research, develop a low-cost floor and conduct a pilot trial. The optimal low-cost floor was stabilized local subsoil with cement at a 1:9 ratio, installed as a 5 cm depth slab. A sealed floor was associated with a lower mean infection intensity among infected children than in control households (aIRR 0.53, 95%CI 0.29-0.97) when adjusted for covariates. The cost of the new floor was US$3/m2 compared to $10 for a concrete floor. Beneficiaries reported the floor made their lives much easier, enabled them to keep clean and children to do their schoolwork and eat while sitting on the floor. Challenges encountered indicate future studies would need intensive mentoring of masons to ensure the floor is properly installed and households supervised to ensure the floor is properly cured. CONCLUSION This study provided promising evidence that retrofitting simple cement-stabilised soil floors with locally available materials is a feasible option for tungiasis control and can be implemented through training of community-based organisations. Disease outcome data is promising and suggests that a definitive trial is warranted. Data generated will inform the design of a fully powered randomized trial combined with behaviour change communications. TRIAL REGISTRATION ISRCTN 62801024 (retrospective 07.07.2023).
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Affiliation(s)
- Lynne Elson
- KEMRI-Wellcome Trust, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Dabaso Tujengane CBO, Watamu, Kenya
| | | | - Abneel Matharu
- Human Health Theme, International Centre for Insect Physiology and Ecology, Nairobi, Kenya
| | - Ulrike Fillinger
- Human Health Theme, International Centre for Insect Physiology and Ecology, Nairobi, Kenya.
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Thielecke M, McNeilly H, Mutebi F, Banalyaki MB, Arono R, Wiese S, Reichert F, Mukone G, Feldmeier H. High Level of Knowledge about Tungiasis but Little Translation into Control Practices in Karamoja, Northeastern Uganda. Trop Med Infect Dis 2023; 8:425. [PMID: 37755887 PMCID: PMC10537667 DOI: 10.3390/tropicalmed8090425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/28/2023] Open
Abstract
Tungiasis is a neglected tropical disease (NTD) that can cause significant suffering and disability. Health promotion is an important pillar in NTD control programs, assuming that better knowledge contributes to reduced risk behavior and reduced risk of infection. The study objective was to assess tungiasis-related knowledge and its translation into control practices in a rural and highly endemic setting in Karamoja, Northeastern Uganda. We applied a mixed-methods design on household and community level. A semi-quantitative questionnaire on knowledge, practices, and attitudes (KAP) regarding tungiasis was administered to 1329 individuals with the main caring responsibilities in the household. Additionally, eight community dialogue meetings were held and analyzed. Overall, knowledge of tungiasis in humans was high but knowledge of tungiasis in animals was low. Most questionnaire respondents knew the causative agent and clinical presentations of tungiasis in humans, risk factors, and preventive measures. This tungiasis-related knowledge was translated into simple prevention measures. However, adequate tungiasis control was impeded due to a lack of resources, such as access to water and effective medical treatment. In conclusion, health promotion campaigns should be integrated with support towards adequate tungiasis control measures, such as provision of safe treatment, hardening of non-solid floors in the houses, and improved access to water.
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Affiliation(s)
- Marlene Thielecke
- Charité Center for Global Health, Institute of International Health, Charité University Medicine, 13353 Berlin, Germany
| | - Hannah McNeilly
- Edinburgh Medical School: Biomedical Sciences, The University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Francis Mutebi
- Innovations for Tropical Disease Elimination (IFOTRODE), Kampala P.O. Box 24461, Uganda
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Mike B. Banalyaki
- Innovations for Tropical Disease Elimination (IFOTRODE), Kampala P.O. Box 24461, Uganda
| | - Rebecca Arono
- Innovations for Tropical Disease Elimination (IFOTRODE), Kampala P.O. Box 24461, Uganda
| | - Susanne Wiese
- Institute of Microbiology, Infectious Diseases and Immunology, Charité University Medicine, 12203 Berlin, Germany
| | - Felix Reichert
- Department of Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany
| | - George Mukone
- Innovations for Tropical Disease Elimination (IFOTRODE), Kampala P.O. Box 24461, Uganda
| | - Hermann Feldmeier
- Institute of Microbiology, Infectious Diseases and Immunology, Charité University Medicine, 12203 Berlin, Germany
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McNeilly H, Thielecke M, Mutebi F, Banalyaki M, Reichert F, Wiese S, Feldmeier H. Tungiasis Stigma and Control Practices in a Hyperendemic Region in Northeastern Uganda. Trop Med Infect Dis 2023; 8:tropicalmed8040206. [PMID: 37104332 PMCID: PMC10144114 DOI: 10.3390/tropicalmed8040206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Neglected tropical diseases are known to be highly stigmatized conditions. This study investigates tungiasis-related stigma and control practices in the impoverished Napak District in rural northeastern Uganda, where tungiasis is hyperendemic and effective treatment is unavailable. We conducted a questionnaire survey with the main household caretakers (n = 1329) in 17 villages and examined them for tungiasis. The prevalence of tungiasis among our respondents was 61.0%. Questionnaire responses showed that tungiasis was perceived as a potentially serious and debilitating condition and that tungiasis-related stigma and embarrassment were common. Among the respondents, 42.0% expressed judging attitudes, associating tungiasis with laziness, carelessness, and dirtiness, and 36.3% showed compassionate attitudes towards people with tungiasis. Questionnaire responses further indicated that people made an effort to keep their feet and house floors clean (important tungiasis prevention measures), but lack of water was a common problem in the area. The most frequent local treatment practices were hazardous manual extraction of sand fleas with sharp instruments and application of various and sometimes toxic substances. Reliable access to safe and effective treatment and water are therefore key to reducing the need for dangerous treatment attempts and breaking the vicious cycle of tungiasis stigma in this setting marked by poverty.
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Elson L, Matharu AK, Riithi N, Ouma P, Mutebi F, Feldmeier H, Krücken J, Fillinger U. Characterization of tungiasis infection and morbidity using thermography in Kenya revealed higher disease burden during COVID-19 school closures. Infect Dis Poverty 2023; 12:24. [PMID: 36941724 PMCID: PMC10027580 DOI: 10.1186/s40249-023-01080-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/09/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Tungiasis is a neglected tropical skin disease caused by the sand flea Tunga penetrans. Female fleas penetrate the skin, particularly at the feet, and cause severe inflammation. This study aimed to characterize disease burden in two highly affected regions in Kenya, to test the use of thermography to detect tungiasis-associated inflammation and to create a new two-level classification of disease severity suitable for mapping, targeting, and monitoring interventions. METHODS From February 2020 to April 2021, 3532 pupils age 8-14 years were quasi-randomly selected in 35 public primary schools and examined for tungiasis and associated symptoms. Of the infected pupils, 266 were quasi-randomly selected and their households visited, where an additional 1138 family members were examined. Inflammation was assessed using infra-red thermography. A Clinical score was created combining the number of locations on the feet with acute and chronic symptoms and infra-red hotspots. RESULTS The overall prevalence of tungiasis among all the school pupils who were randomly selected during survey rounds 1 and 3 was 9.3% [95% confidence interval (CI): 8.4-10.3]. Based on mixed effects logistic models, the odds of infection with tungiasis among school pupils was three times higher in Kwale (coastal Kenya) than in Siaya [western Kenya; adjusted odds ratio (aOR) = 0.36, 95% CI: 0.18-0.74]; three times higher in males than in females (aOR = 3.0, 95% CI: 2.32-3.91) and three times lower among pupils sleeping in a house with a concrete floor (aOR = 0.32, 95% CI: 0.24-0.44). The odds of finding an infected person among the household population during surveys before the COVID-19 pandemic was a third (aOR = 0.32, 95% CI: 0.19-0.53) of that when schools were closed due to COVID-19 restrictions and approximately half (aOR = 0.44, 95% CI: 0.29-0.68) in surveys done after school re-opening (round 3). Infection intensity was positively correlated with inflammation as measured by thermography (Spearman's rho = 0.68, P < 0.001) and with the clinical score (rho = 0.86, P < 0.001). Based on the two-level classification, severe cases were associated with a threefold higher level of pain (OR = 2.99, 95% CI: 2.02-4.43) and itching (OR = 3.31, 95% CI: 2.24-4.89) than mild cases. CONCLUSIONS Thermography was a valuable addition for assessing morbidity and the proposed two-level classification of disease severity clearly separated patients with mild and severe impacts. The burden of tungiasis was considerably higher in households surveyed during COVID-19 restrictions suggesting underlying risks are found in the home environment more than in school.
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Affiliation(s)
- Lynne Elson
- KEMRI-Wellcome Trust Research Programme, Hospital Road, Kilifi, Kenya.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Abneel K Matharu
- International Centre of Insect Physiology and Ecology, Human Health Theme, Nairobi, Kenya
| | - Naomi Riithi
- International Centre of Insect Physiology and Ecology, Human Health Theme, Nairobi, Kenya
| | - Paul Ouma
- International Centre of Insect Physiology and Ecology, Human Health Theme, Nairobi, Kenya
| | - Francis Mutebi
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Hermann Feldmeier
- Institute of Microbiology, Infectious Diseases and Immunology, Charité University Medicine, Berlin, Germany
| | - Jürgen Krücken
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Ulrike Fillinger
- International Centre of Insect Physiology and Ecology, Human Health Theme, Nairobi, Kenya
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dos Santos KC, Brandão Guedes PE, Teixeira JBDC, Harvey TV, Carlos RSA. Treatment of Animal Tungiasis: What’s New? Trop Med Infect Dis 2023; 8:tropicalmed8030142. [PMID: 36977143 PMCID: PMC10051256 DOI: 10.3390/tropicalmed8030142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/02/2023] Open
Abstract
In tropical and subtropical countries, particularly in disadvantaged communities, tungiasis is a severe public health problem, which is often neglected by the authorities. The sand fleas Tunga penetrans, predominant in endemic areas, and Tunga trimamillata, whose cases in humans are less frequent, are the cause of this zoonosis. Domestic animals are potential reservoirs and disseminators of tungiasis, so controlling their infection would significantly advance the prevention of human cases. This literature review compiles the most recent studies and innovations in treating animal tungiasis. Studies of approaches to the treatment of animal tungiasis, as well as disease control and prevention, are described. Isoxazolines are highlighted as promising drugs to treat animal tungiasis, with high efficacy and pharmacological protection. The positive impacts of this discovery on public health are also discussed, since dogs are an essential risk factor for human tungiasis.
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Affiliation(s)
- Katharine Costa dos Santos
- Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Brazil
| | - Paula Elisa Brandão Guedes
- Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Brazil
| | | | - Tatiani Vitor Harvey
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX 77843, USA
| | - Renata Santiago Alberto Carlos
- Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Brazil
- Correspondence:
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Mutebi F, McNeilly H, Thielecke M, Reichert F, Wiese S, Mukone G, Feldmeier H. Prevalence and Infection Intensity of Human and Animal Tungiasis in Napak District, Karamoja, Northeastern Uganda. Trop Med Infect Dis 2023; 8:tropicalmed8020111. [PMID: 36828527 PMCID: PMC9963877 DOI: 10.3390/tropicalmed8020111] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
Tungiasis is an important but highly neglected cause of morbidity in resource-poor communities in Latin America and sub-Saharan Africa. Data upon which implementation of control measures can be based are scarce. Before piloting an integrated tungiasis control program in three parishes of Napak district, Uganda, a cross-sectional survey involving the systematic examination of humans and domestic mammals was implemented to establish the occurrence patterns of tungiasis. The study population was 5482 residents, of which 4035 (73.6%) participated in the study. The prevalence of tungiasis in humans was 62.8% (95% CI: 61.3-64.3%), with slightly more males than females affected (p = 0.01). Age-specific prevalence and intensity of human tungiasis followed an S-curve pattern, with children of 5-14 years and the elderly (≥60 years) being the most affected. Half of all lesions (50%) had been manipulated by sharp objects. The prevalence of tungiasis in animals was lower (14.2%, 95% CI: 10.9-18.0) than that of humans (p < 0.001). Animal tungiasis occurred in decreasing order of frequency in pigs (80%), dogs (24%), goats (16.3%), cats (8.1%) and sheep (4.9%). In conclusion, human tungiasis was highly prevalent but animal infections were comparatively few in the study area. Nevertheless, effective control measures should be based on One Health principles.
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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, Kampala P.O. Box 7062, Uganda
- Innovations for Tropical Disease Elimination (IFOTRODE), Kampala P.O. Box 24461, Uganda
- Correspondence: or
| | - Hannah McNeilly
- Edinburgh Medical School: Biomedical Sciences, The University of Edinburgh, Edinburgh EH8 9XD, UK
| | - Marlene Thielecke
- Charité Center for Global Health, Institute of International Health, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Felix Reichert
- Department of Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany
| | - Susanne Wiese
- Institute of Microbiology, Infectious Diseases and Immunology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - George Mukone
- Innovations for Tropical Disease Elimination (IFOTRODE), Kampala P.O. Box 24461, Uganda
| | - Hermann Feldmeier
- Institute of Microbiology, Infectious Diseases and Immunology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
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Spatial Distribution of Off-Host Stages of Tunga penetrans in the Soil within the Home Range of Nine Infected Dogs in An Endemic Tourist Area in Brazil. Trop Med Infect Dis 2023; 8:tropicalmed8020098. [PMID: 36828514 PMCID: PMC9959503 DOI: 10.3390/tropicalmed8020098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/26/2022] [Accepted: 12/30/2022] [Indexed: 02/05/2023] Open
Abstract
Tungiasis is a neglected disease caused by the sand flea Tunga penetrans, and dogs are considered the main reservoirs in Brazil. This study aimed to identify the role of dogs as tungiasis dispersers and to investigate the presence of T. penetrans in the soil of an endemic tourist area. Nine dogs infected by T. penetrans were included in this study and received GPS collars to analyze their movement through the village. Duplicate sand samples were collected in different areas of the community. Those areas were classified as peridomicile (n = 110), open area (n = 110), beach (n = 50), and river (n = 58). The analysis of the points recorded by the collars showed that the dogs roamed throughout the community, potentially facilitating the spread of the disease. Samples contaminated with developmental forms of the parasite were found in the circulation area of three dogs. Adult fleas were found in 3/328 samples. These data emphasize that infected dogs' roaming can influence the fleas' dispersion in the soil. Statistically, none of the study variables had a significant correlation (p > 0.5) with the presence of T. penetrans in the area analyzed. This study was the first to assess infected dogs' role as tungiasis propagators.
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Antiparasitic Activity of Tea Tree Oil (TTO) and Its Components against Medically Important Ectoparasites: A Systematic Review. Pharmaceutics 2022; 14:pharmaceutics14081587. [PMID: 36015213 PMCID: PMC9416580 DOI: 10.3390/pharmaceutics14081587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/14/2022] [Accepted: 07/22/2022] [Indexed: 12/04/2022] Open
Abstract
Ectoparasites are pathogens that can infect the skin and cause immense pain, discomfort, and disease. They are typically managed with insecticides. However, the fast-emerging antimicrobial resistance and the slow rate of development of new bio-actives combined with environmental and health concerns over the continued use of neurotoxic insecticides warrant newer and alternative methods of control. Tea tree oil (TTO), as an alternative agent, has shown remarkable promise against ectoparasites in recent studies. To our knowledge, this is the first systematic review to assess preclinical and clinical studies exploring the antiparasitic activity of TTO and its components against clinically significant ectoparasites, such as Demodex mites, scabies mites, house dust mites, lice, fleas, chiggers, and bed bugs. We systematically searched databases, including PubMed, MEDLINE (EBSCOhost), Embase (Scopus), CENTRAL, Cochrane Library, CINAHL, ScienceDirect, Web of Science, SciELO, and LILACS in any language from inception to 4 April 2022. Studies exploring the therapeutic activity of TTO and its components against the ectoparasites were eligible. We used the ToxRTool (Toxicological data reliability assessment) tool, the Joanna Briggs Institute (JBI) critical appraisal tools, and the Jadad scale to assess the methodological qualities of preclinical (in vitro and in vivo) studies, non-randomised controlled trials (including cohort, case series, and case studies), and randomised controlled trials, respectively. Of 497 identified records, 71 studies were included in this systematic review, and most (66%) had high methodological quality. The findings of this review revealed the promising efficacy of TTO and its components against ectoparasites of medical importance. Most importantly, the compelling in vitro activity of TTO against ectoparasites noted in this review seems to have translated well into the clinical environment. The promising outcomes observed in clinical studies provide enough evidence to justify the use of TTO in the pharmacotherapy of ectoparasitic infections.
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Milstein MS, Shaffer CA, Suse P, Marawanaru A, Heinrich DA, Larsen PA, Wolf TM. A mixed-methods approach to understanding domestic dog health and disease transmission risk in an indigenous reserve in Guyana, South America. PLoS Negl Trop Dis 2022; 16:e0010469. [PMID: 35687596 PMCID: PMC9223617 DOI: 10.1371/journal.pntd.0010469] [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: 08/05/2021] [Revised: 06/23/2022] [Accepted: 05/04/2022] [Indexed: 11/19/2022] Open
Abstract
Domestic dogs (Canis lupus familiaris) can transmit a variety of pathogens due to their ubiquitousness in urban, rural and natural environments, and their close interactions with wildlife and humans. In this study, we used a mixed-methods approach to assess the role of domestic dogs as potential intermediaries of disease transmission from wildlife to humans among indigenous Waiwai in the Konashen Community Owned Conservation Area, Guyana. To address these objectives we 1) performed physical examinations and collected biological samples to assess Waiwai domestic dog health, and 2) administered questionnaires to characterize the role of dogs in the community and identify potential transmission pathways between wildlife, dogs, and humans. We observed ectoparasites on all dogs (n = 20), including: fleas (100%), ticks (15%), botflies (30%), and jigger flea lesions (Tunga penetrans) (80%). Ten percent of dogs were seropositive for Ehrlichia canis/ewingii, 10% were positive for Dirofilaria immitis, and one dog was seropositive for Leishmania infantum. All dogs (n = 20) were seronegative for: canine distemper virus, Brucella canis, Leptospira serovars, Trypanosoma cruzi, Anaplasma phagocytophilum/platys and Borrelia burgdorferi. Our questionnaire data revealed that the Waiwai remove ectoparasites from their dogs, clean up dog feces, and administer traditional and/or Western medicine to their dogs. White blood cell, strongyle-type ova, and eosinophil counts were lower in dogs that were not frequently used for hunting, dogs that did receive traditional and/or western medicine, and dogs that were frequently kept in elevated dog houses, although differences were not statistically significant. While our results suggest that the Waiwai have developed cultural practices that may promote dog health and/or prevent zoonotic disease transmission, more research is necessary to determine the efficacy of these practices. Our study provides important data on the health of dogs and the potential for disease transmission to humans in a zoonotic hotspot. Domestic dogs are found throughout the world and interact closely with both wildlife and humans. Dogs can harbor numerous diseases that can be transmitted to other domestic and wildlife species, and human populations. They can serve as bridges, moving diseases between unconnected populations. Additionally, dogs can help in the early detection of wildlife and human diseases. Therefore, understanding what pathogens domestic dogs harbor can inform both wildlife and human health. In this study, we performed physical examinations, collected biological samples, and administered questionnaires to assess dog health and understand the role of dogs as potential bridges of disease transmission from wildlife to humans among indigenous Waiwai in the Konashen Community Owned Conservation Area, Guyana. On physical exam, we observed ectoparasites on all dogs, however, few pathogens were detected with diagnostic screening. Our questionnaire data revealed that the Waiwai engage in husbandry practices that may promote Waiwai dog health.
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Affiliation(s)
- Marissa S. Milstein
- Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
- * E-mail:
| | - Christopher A. Shaffer
- Department of Anthropology, Grand Valley State University, Allendale, Michigan, United States of America
| | - Phillip Suse
- Masakenari Village, Konashen Indigenous District, Region 9, Guyana
| | - Aron Marawanaru
- Masakenari Village, Konashen Indigenous District, Region 9, Guyana
| | - Daniel A. Heinrich
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Peter A. Larsen
- Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Tiffany M. Wolf
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
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Oranges T, Veraldi S, Granieri G, Fidanzi C, Janowska A, Dini V, Romanelli M. Parasites causing cutaneous wounds: Theory and practice from a dermatological point of view. Acta Trop 2022; 228:106332. [PMID: 35092728 DOI: 10.1016/j.actatropica.2022.106332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 11/27/2022]
Abstract
A wide range of parasites can infest open wounds, or cause wounds due to the effects of the infestation. Parasitic infestations can involve the skin and subcutaneous tissues, with various clinical manifestations. In case of cutaneous wounds related to infestations, protozoa, helminths and arthropods are the main groups of parasites involved and emerging new aspects have been recently reported. Treating the wound correctly is fundamental in these patients in order to reduce the development of pathological scars and prevent complications. In particular, a gentle debridement for devitalized/infested tissue removal, the appropriate use of topical antiseptics and dressings such as hydrogel, hydrocolloids and antimicrobial dressings can be useful to control superinfections, moisture balance, inflammation and to promote edge proliferation.
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Affiliation(s)
- Teresa Oranges
- Department of Dermatology, University of Pisa, Via Roma 67, Pisa 56126, Italy; Department of Pediatrics, Dermatology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Stefano Veraldi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giammarco Granieri
- Department of Dermatology, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Cristian Fidanzi
- Department of Dermatology, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Agata Janowska
- Department of Dermatology, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Valentina Dini
- Department of Dermatology, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Marco Romanelli
- Department of Dermatology, University of Pisa, Via Roma 67, Pisa 56126, Italy.
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Ebrahim AA, Mpango EP, Temba JA, Abbas ZG, Mashili FL. Tunga penetrans causing a rapidly progressing foot ulcer in a patient with uncontrolled type 2 diabetes mellitus. Oxf Med Case Reports 2022; 2022:omac016. [PMID: 35316989 PMCID: PMC8931829 DOI: 10.1093/omcr/omac016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/05/2022] [Accepted: 01/14/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Tungiasis is a parasitic disease resulting from infestation by a female flea Tunga penetrans. The parasites are endemic in the tropics and can infect patients with diabetes mellitus (DM). Augmented by uncontrolled hyperglycemia and pre-existing neuropathy, the parasite may trigger a locally spreading inflammation, which may aggravate the trauma introduced during its extraction, leading into a rapidly progressing foot ulcer. To the best of our knowledge, no such cases in patients with type 2 diabetes have ever been published from Tanzania and likely none worldwide. This case report shows that, in diabetic patients, the wound resulting from the extraction of T. penetrans may get infected and aggravated by the ongoing inflammatory reaction, rapidly evolve into limb-threatening condition and mortality. Preventive measures are necessary and should be emphasized in patients with DM. Studies are needed to increase our understanding of the pathophysiology, proper management and sequalae of ulcers of this nature.
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Affiliation(s)
- Ashabilan A Ebrahim
- Department of Physiology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Elisia P Mpango
- Department of Surgery, Amana Regional Hospital, Dar es Salaam, Tanzania
| | - Joseph A Temba
- Department of Physiology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | | | - Fredirick L Mashili
- Department of Physiology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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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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Evaluating the potentials of randomised integrated control trial on tungiasis in a South-western Nigerian community. Acta Trop 2021; 223:106076. [PMID: 34358514 DOI: 10.1016/j.actatropica.2021.106076] [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: 02/01/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 11/22/2022]
Abstract
Considering the fact that new, safe and incorporable treatment alternatives to therapeutic prophylaxis for tungiasis are lacking and sometimes proving difficult, this present study evaluated the potentials of integrating control approach involving focal premise treatment using 5% emulsifiable concentrate of cypermethrin, and topical application of Piper guineense oil with personal protection. Of the 90 houses selected, their floors were classified into paved rooms & unpaved verandas, paved verandas & unpaved rooms, paved rooms & verandas, and unpaved rooms & verandas, and tested for the presence of sand fleas using the sweeping and beating as well as soil collection and extraction by tullgren funnel method before fumigation. A total of 100 individuals partitioned into four groups of 25 individuals each were assigned 3%, 5%, 10% and 15% of P. guineense oil irrespective of stages of embedded fleas. The mean of sand fleas decreased from 1.14, 0.07, 0.21, and 1.66 to 0.37, 0.02, 0.09 and 1.08 after two weeks of single spray compared to the untreated location (p < 0.001). Furthermore, the mean lesions of stage I reduced to 0 after 2 to 6 days of 3%, 5%, 10% and 15% ointment application, and stage II and III after 10 to 12 days of 10% and 15% application respectively. The difference between tungiasis stages and exposure time for P. guineense ointment was highly significant p = 0.007 and p = 0.0002. Notable reduction in severity score of acute and chronic tungiasis was observed thus indicating effectiveness of the topical ointment. Hexanolic oil extracts of P. guineense in 10% and 15% concentration would kill embedded sand flea and ameliorate the sufferings in endemic settings.
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Abrha S, Tesfaye W, Thomas J. Therapeutic Potential of Tea Tree Oil for Tungiasis. Am J Trop Med Hyg 2021; 105:1157-1162. [PMID: 34731831 DOI: 10.4269/ajtmh.21-0427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/10/2021] [Indexed: 11/07/2022] Open
Abstract
Tungiasis (sand flea disease) is a neglected tropical disease caused by penetration of female sand fleas, Tunga penetrans, into a person's skin usually in their feet. The disease inflicts immense pain and suffering on millions of people, particularly children. The condition is most prevalent in Latin America, the Caribbean, and sub-Saharan Africa. Currently, there is no standard drug treatment for tungiasis. The available treatment options are fairly limited and unrealistic to use in endemic areas; as a result, in desperation, the affected people do more harm to themselves by extracting the fleas with non-sterile instruments, further exposing themselves to secondary bacterial infections and/or transmission of diseases such as hepatitis B virus, hepatitis C virus, or HIV. This highlights the urgent need for simpler, safer, and effective treatment options for tungiasis. Tea tree oil (TTO) has long been used as an antiseptic with extensive safety and efficacy data. The evidence on parasiticidal properties of TTO against ectoparasites such as head lice, mites, and fleas is also compelling. The purpose of this review is to discuss the current tungiasis treatment challenges in endemic settings and highlight the potential role of TTO in the treatment of tungiasis.
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Affiliation(s)
- Solomon Abrha
- Faculty of Health, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia.,Department of Pharmaceutics, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Wubshet Tesfaye
- Faculty of Health, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia
| | - Jackson Thomas
- Faculty of Health, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia
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Gitau AK, Oyieke FA, Mukabana WR. Assessment of the role played by domestic animals in jigger infection in Kandara sub-county, Kenya (case control study). Pan Afr Med J 2021; 39:231. [PMID: 34659604 PMCID: PMC8498669 DOI: 10.11604/pamj.2021.39.231.25106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 06/26/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction tungiasis is an ectoparasitosis caused by penetration of female sand flea, Tunga penetrans, into the skin of the susceptible animal and the consequent hypertrophy of the parasite. The objective of this study was to assess the association between domestic animals and jigger infection among the residents of Kandara sub-county in central Kenya. Methods this was a case-control study that involved 776 individuals. Half of this number entailed case group who were jigger infected while the other half was the control, composed of jigger free participants. Structured questionnaires were, administered among the heads of the households to which the participants belonged to gather information concerning the animals they kept. Univariate analysis was, applied. Results in this study, there were significant differences in age (P=0.008) between the two groups. Disparities in source of income (P<0.001) and level of education (P<0.001) came out as very significant factors in jigger infection. The case group was 10 times more likely to keep dogs than the control(9.6; 95% CI, 5.9-15.6). Case group was also 7 times more likely to rear chicken in comparison to the control (6.6; 95%, 4.2-10.4). The case group was 12 times more likely to let dogs loose in the compound in comparison to the control (12.1: 95%, 5.9-24.5). When compared to the control, this group was also 17 times more likely to keep chicken inside their houses (16.7: 95% CI, 6.8-35.9). Conclusion: there is a very high association between domestic animals and occurrence of tungiasis in Kandara sub-county.
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Amare HH, Lindtjorn B. Risk factors for scabies, tungiasis, and tinea infections among schoolchildren in southern Ethiopia: A cross-sectional Bayesian multilevel model. PLoS Negl Trop Dis 2021; 15:e0009816. [PMID: 34613968 PMCID: PMC8494366 DOI: 10.1371/journal.pntd.0009816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/16/2021] [Indexed: 11/21/2022] Open
Abstract
Background Skin problems cause significant sickness in communities with poor living conditions, but they have received less attention in national or global health studies because of their low mortality rates. In many developing regions, the prevalence of parasitic skin diseases among schoolchildren is not reported. Previous studies thus have attempted to identify risk factors for these conditions using the frequentist approach. This study aimed to assess the occurrence and risk factors of skin infections among rural schoolchildren in southern Ethiopia by combining a frequentist and a Bayesian approach. Methodology/Principal findings Using three-stage random sampling, we assessed 864 schoolchildren aged 7–14 years from the Wonago district in southern Ethiopia. We detected potential risk factors for scabies, tungiasis, and tinea infections and recorded their hygienic practices and socio-demographic information. The frequentist model revealed a clustering effect of 8.8% at the classroom level and an insignificant effect at the school level. The Bayesian model revealed a clustering effect of 16% at the classroom level and 5.3% at the school level. Almost three-fourths of the sample had at least one type of skin problem, and boys were at higher overall risk than girls (adjusted odds ratio [aOR] 1.55 [95% Bayesian credible interval [BCI] 1.01, 2.28). Risk factors included unclean fingernails (aOR 1.85 [95% BCI 1.08, 2.97]); not washing the body (aOR 1.90 [95% BCI 1.21, 2.85]) and hair (aOR 3.07 [95% BCI 1.98, 4.57]) with soap every week; sharing a bed (aOR 1.97 [95% BCI 1.27, 2.89]), clothes (aOR 5.65 [95% BCI 3.31, 9.21]), or combs (aOR 3.65 [95% BCI 2.28, 5.53]); and living in a poor household (aOR 1.76 [95% BCI 1.03, 2.83]). Washing legs and feet with soap daily was identified as a protective factor for each of the three skin diseases (aOR 0.23 [95% BCI 0.15, 0.33]). Conclusions/Significance We observed high variation in skin problems at the classroom level, indicating the presence of shared risk factors in these locations. The findings suggest the need to improve children’s personal hygiene via health education by schoolteachers and health workers. Skin problems are common disorders in resource poor settings. Scabies and tungiasis are neglected tropical diseases causing significant sickness in communities with poor living conditions. Scabies is dermatosis caused by a burrowing mite, Sarcoptes scabiei var. hominis. Tungiasis is caused by a flea, Tunga penetrans, infesting the skin, usually on the feet or hands. Tinea infection is a fungal dermatophyte infection of the skin and the most common dermatological problem among schoolchildren in Ethiopia, especially tinea capitis. Application of a Bayesian approach to identify possible risk factors for these problems has seldom been used. We found that compared to the frequentist model, the Bayesian model better explained school- and classroom-level variations in skin problems among schoolchildren. Our findings also suggest that transmission of skin infections, especially fungal and scabies infections, frequently occurs in schools and classrooms. We identified several risk factors for these conditions, including low socioeconomic status; unclean fingernails; not washing with soap at least every week; and sharing beds, clothes, and combs. Thus, it is important to improve the personal hygiene of schoolchildren through education. Regular checkups by teachers also can improve skin health and related morbidity in rural schoolchildren in southern Ethiopia.
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Affiliation(s)
- Hiwot Hailu Amare
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
- Department of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
- * E-mail:
| | - Bernt Lindtjorn
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
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Abrha S, Christenson JK, McEwen J, Tesfaye W, Vaz Nery S, Chang AY, Spelman T, Kosari S, Kigen G, Carroll S, Heukelbach J, Feldmeier H, Bartholomaeus A, Daniel M, Peterson GM, Thomas J. Treatment of tungiasis using a tea tree oil-based gel formulation: protocol for a randomised controlled proof-of-principle trial. BMJ Open 2021; 11:e047380. [PMID: 34326048 PMCID: PMC8323357 DOI: 10.1136/bmjopen-2020-047380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Tungiasis (sand flea disease or jigger infestation) is a neglected tropical disease caused by penetration of female sand fleas, Tunga penetrans, in the skin. The disease inflicts immense pain and suffering on millions of people, particularly children, in Latin America, the Caribbean and sub-Saharan Africa. Currently, there is no standard treatment for tungiasis, and a simple, safe and effective tungiasis treatment option is required. Tea tree oil (TTO) has long been used as a parasiticidal agent against ectoparasites such as headlice, mites and fleas with proven safety and efficacy data. However, current data are insufficient to warrant a recommendation for its use in tungiasis. This trial aims to generate these data by comparing the safety and efficacy of a 5% (v/w) TTO proprietary gel formulation with 0.05% (w/v) potassium permanganate (KMnO4) solution for tungiasis treatment. METHODS AND ANALYSIS This trial is a randomised controlled trial (RCT) in primary schools (n=8) in South-Western Kenya. The study will include school children (n=88) aged 6-15 years with a confirmed diagnosis of tungiasis. The participants will be randomised in a 1:1 ratio to receive a 3-day two times a day treatment of either 5% TTO gel or 0.05% KMnO4 solution. Two viable embedded sandflea lesions per participant will be targeted and the viability of these lesions will be followed throughout the study using a digital handheld microscope. The primary outcome is the proportion of observed viable embedded sand fleas that have lost viability (non-viable lesions) by day 10 (9 days after first treatment). Secondary outcomes include improvement in acute tungiasis morbidities assessed using a validated severity score for tungiasis, safety assessed through adverse events and product acceptability assessed by interviewing the participants to rate the treatment in terms of effectiveness, side effects, convenience, suitability and overall satisfaction. ETHICS AND DISSEMINATION The trial protocol has been reviewed and approved by the University of Canberra Human Research Ethics Committee (HREC-2019-2114). The findings of the study will be presented at scientific conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBERS Australian New Zealand Clinical Trials Registry (ACTRN12619001610123); PACTR202003651095100 and U1111-1243-2294.
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Affiliation(s)
- Solomon Abrha
- Pharmacy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
- Department of Pharmaceutics, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Julia K Christenson
- Pharmacy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - John McEwen
- Pharmacy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Wubshet Tesfaye
- Pharmacy, Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Susana Vaz Nery
- The Public Health Interventions Research Program, The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, New South Wales, Australia
| | - Aileen Y Chang
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Tim Spelman
- Public Health, Burnet Institute International Health Research Group, Melbourne, Victoria, Australia
| | - Sam Kosari
- Pharmacy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Gabriel Kigen
- Department of Pharmacology and Toxicology, Moi University School of Medicine, Eldoret, Central, Kenya
| | - Simon Carroll
- Pharmacy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
- Global School Partners, Canberra, Australian Capital Territory, Australia
| | - Jorg Heukelbach
- Department of Community Health, Federal University of Ceará, Fortaleza, Brazil, Fortaleza, Brazil
| | - Hermann Feldmeier
- Institute of Microbiology and Infection Immunology, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
| | - Andrew Bartholomaeus
- Diamantina Institute, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Mark Daniel
- Centre for Research and Action in Public Health, Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia
| | | | - Jackson Thomas
- Pharmacy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
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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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Abrha S, Heukelbach J, Peterson GM, Christenson JK, Carroll S, Kosari S, Bartholomeus A, Feldmeier H, Thomas J. Clinical interventions for tungiasis (sand flea disease): a systematic review. THE LANCET. INFECTIOUS DISEASES 2021; 21:e234-e245. [PMID: 34237261 DOI: 10.1016/s1473-3099(20)30853-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 12/30/2022]
Abstract
Tungiasis (sand flea disease) is an epidermal parasitic skin disease occurring in resource-limited communities. There is no standard treatment for tungiasis, and available treatment options are scarce. To our knowledge, this is the first systematic review aimed to assess randomised controlled trials (RCTs) investigating interventions for tungiasis. We systematically searched databases including MEDLINE (EBSCOhost), CENTRAL, CINAHL, PubMed, Web of Science, SciELO, LILACS and Embase (Scopus) for RCTs in any language, from inception of the databases until June 12, 2021. RCTs exploring preventive and therapeutic interventions for tungiasis were eligible. We used the revised Cochrane Collaboration's risk of bias tool to assess the risk of bias and Jadad scale to quantify the methodological quality of the RCTs. Of the 1839 identified records, only eight RCTs involving 808 participants were included, and several methodological deficiencies were identified in most of the trials. Trial interventions included: oral drugs niridazole and ivermectin and topical interventions of ivermectin lotion, metrifonate lotion, thiabendazole lotion, thiabendazole ointment, dimeticones (NYDA), and a neem seed and coconut oils-based mixture for treatment and coconut oil-based lotion (Zanzarin) for prevention. The coconut oil-based lotion for prevention and dimeticones for treatment of tungiasis have displayed the most promise. Most of the RCTs included in this study had low methodological quality. There is a clear unmet need for high-quality RCTs examining safe and effective prevention and treatment alternatives of tungiasis in endemic settings.
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Affiliation(s)
- Solomon Abrha
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia; Department of Pharmaceutics, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Jorg Heukelbach
- Postgraduate Program of Public Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Gregory M Peterson
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia; College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | | | | | - Sam Kosari
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
| | - Andrew Bartholomeus
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia; Daimantina Institute, University of Queensland, Wolloongabba, QLD, Australia
| | - Hermann Feldmeier
- Institute of Microbiology and Infection Immunology, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
| | - Jackson Thomas
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia.
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Clinical and macroscopic morphological features of canine tungiasis. Parasitol Res 2021; 120:807-818. [PMID: 33474585 DOI: 10.1007/s00436-020-07013-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
Tungiasis is a public health problem in endemic resource-poor communities, where dogs are important reservoirs of Tunga spp., contributing significantly to the process of transmission of this zoonosis. In order to optimize the diagnosis of canine tungiasis, macroscopic morphological characteristics and clinical signs of the lesions were investigated, based on the inspection of 40 dogs infested by T. penetrans from an endemic rural community in northeastern Brazil. Of the 1546 lesions found in these dogs, including all stages of development of the parasite, 89.1% (1378) were located on the paw pads. Dogs aged up to 5 years had the greatest number of lesions. Dark pigmentation and hyperkeratosis of the paw pads made it difficult to identify the lesions. Among all the clinical signs observed were hyperemia (38; 95%), pain (32; 80%), fissure (11; 27.5%), onychogryphosis (29; 72.5%), cluster of lesions (26; 65%), hyperkeratosis (25; 62.5%), lameness (15; 37.5%), and fissure (11; 27.5%). Ectopic lesions were found especially in the nipples (64; 4.1%) and abdomen (51; 3.3%). The maximum diameter of the stage III neosomes was 6 mm. Dogs with a higher number of lesions had a higher degree of hyperkeratosis. Age over 1 year was associated with a higher rate of dispersion of the parasite in the environment (p = 0.04). The identification of the initial stages of tungiasis can guarantee a more effective control of the disease in dogs, which will mainly depend on the treatment of adult animals and the application of continuous preventive actions based on One Health in these communities.
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Ashour DS, Othman AA. Parasite-bacteria interrelationship. Parasitol Res 2020; 119:3145-3164. [PMID: 32748037 DOI: 10.1007/s00436-020-06804-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/06/2020] [Indexed: 12/18/2022]
Abstract
Parasites and bacteria have co-evolved with humankind, and they interact all the time in a myriad of ways. For example, some bacterial infections result from parasite-dwelling bacteria as in the case of Salmonella infection during schistosomiasis. Other bacteria synergize with parasites in the evolution of human disease as in the case of the interplay between Wolbachia endosymbiont bacteria and filarial nematodes as well as the interaction between Gram-negative bacteria and Schistosoma haematobium in the pathogenesis of urinary bladder cancer. Moreover, secondary bacterial infections may complicate several parasitic diseases such as visceral leishmaniasis and malaria, due to immunosuppression of the host during parasitic infections. Also, bacteria may colonize the parasitic lesions; for example, hydatid cysts and skin lesions of ectoparasites. Remarkably, some parasitic helminths and arthropods exhibit antibacterial activity usually by the release of specific antimicrobial products. Lastly, some parasite-bacteria interactions are induced as when using probiotic bacteria to modulate the outcome of a variety of parasitic infections. In sum, parasite-bacteria interactions involve intricate processes that never cease to intrigue the researchers. However, understanding and exploiting these interactions could have prophylactic and curative potential for infections by both types of pathogens.
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Affiliation(s)
- Dalia S Ashour
- Medical Parasitology Department, Faculty of Medicine, Tanta University, Tanta, 31527, Egypt.
| | - Ahmad A Othman
- Medical Parasitology Department, Faculty of Medicine, Tanta University, Tanta, 31527, Egypt
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Ectoparasites. J Am Acad Dermatol 2020; 82:551-569. [DOI: 10.1016/j.jaad.2019.05.110] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/16/2019] [Accepted: 05/31/2019] [Indexed: 12/18/2022]
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Miller H, Trujillo-Trujillo J, Mutebi F, Feldmeier H. Efficacy and safety of dimeticones in the treatment of epidermal parasitic skin diseases with special emphasis on tungiasis: an evidence-based critical review. Braz J Infect Dis 2020; 24:170-177. [PMID: 32105621 PMCID: PMC9392017 DOI: 10.1016/j.bjid.2020.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/20/2020] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
Epidermal parasitic skin diseases encompass scabies, pediculosis, cutaneous larva migrans, myiasis, and tungiasis. Tungiasis is probably the most neglected of all Neglected Tropical Diseases (NTD). It occurs in South America, the Caribbean and Sub-Saharan Africa and affects marginalized populations where people live in extreme poverty. In endemic communities the prevalence can be up to 30% in general population and 85% in children. Over time, chronic pathology develops characterized by hyperkeratosis, edema around the nail rim, fissures, ulcers, deformation and loss of nails. This leads to a pattern of disabilities, eventually resulting in impairment of mobility. Dimeticones are a family of silicon oils with a potential to kill parasites located on top or inside the epidermis by a physical mode of action. They are considered the treatment of choice for pediculosis capitis and pediculosis pubis. With regard to tungiasis, the so called rear abdominal cone of the parasites has been identified as a target for treatment with dimeticones. NYDA®, a mixture of two dimeticones with different viscosity, is the only dimeticone product for which data on the mode of action, efficacy and safety with regard to tungiasis exists. The product has been shown highly effective against embedded sand fleas, even in very intense infection with more than 500 parasites situated on top of each other. A randomized controlled trial showed that seven days after a targeted application of NYDA® 97% (95% CI 94–99%) of the embedded sand fleas had lost all signs of viability. Comprehensive toxicological investigations on the dimeticones contained in NYDA® showed that there is practically no risk of embryotoxicity, fetotoxicity, teratogenicity, and other toxicity. The safety of dimeticones was also demonstrated in clinical trials with a total of 106 participants with tungiasis, in which not a single adverse event was observed.
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Affiliation(s)
| | | | - Francis Mutebi
- Makerere University, Animal Resources and Biosecurity, College of Veterinary Medicine, Kampala, Uganda
| | - Hermann Feldmeier
- Charité University Medicine, Institute of Microbiology and Infection Immunology, Berlin, Germany
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Abstract
These are cutaneous diseases caused by insects, worms, protozoa, or coelenterates which may or may not have a parasitic life. In this review the main ethological agents, clinical aspects, laboratory exams, and treatments of these dermatological diseases will be studied.
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Elson L, Randu K, Feldmeier H, Fillinger U. Efficacy of a mixture of neem seed oil (Azadirachta indica) and coconut oil (Cocos nucifera) for topical treatment of tungiasis. A randomized controlled, proof-of-principle study. PLoS Negl Trop Dis 2019; 13:e0007822. [PMID: 31756189 PMCID: PMC6897421 DOI: 10.1371/journal.pntd.0007822] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 12/06/2019] [Accepted: 10/01/2019] [Indexed: 01/08/2023] Open
Abstract
Background Tungiasis is a neglected tropical skin disease caused by the female sand flea (Tunga penetrans), which burrows into the skin causing intense pain, itching and debilitation. People in endemic countries do not have access to an effective and safe home treatment. The aim of this study was to determine the efficacy of a traditionally used and readily available mixture of neem and coconut oil for treatment of tungiasis in coastal Kenya. Methodology Ninety-six children aged 6–14 years with at least one embedded viable flea were randomized to be treated with either a mixture of 20% neem (Azadirachta indica) seed oil in coconut oil (NC), or with a 0.05% potassium permanganate (KMnO4) foot bath. Up to two viable fleas were selected for each participant and monitored for 6 days after first treatment using a digital microscope for signs of viability and abnormal development. Acute pathology was assessed on all areas of the feet using a previously established score. Children reported pain levels and itching on a visual scale. Results The NC was not more effective in killing embedded sand fleas within 7 days than the current standard with KMnO4, killing on average 40% of the embedded sand fleas six days after the initial treatment. However, the NC was superior with respect to the secondary outcomes of abnormal development and reduced pathology. There was a higher odds that fleas rapidly aged in response to NC compared to KMnO4 (OR 3.4, 95% CI: 1.22–9.49, p = 0.019). NC also reduced acute pathology (p<0.005), and there was a higher odds of children being pain free (OR 3.5, p = 0.001) when treated with NC. Conclusions Whilst NC did not kill more fleas than KMnO4 within 7 days, secondary outcomes were better and suggest that a higher impact might have been observed at a longer observation period. Further trials are warranted to assess optimal mixtures and dosages. Trial registration The study was approved by the Kenya Medical Research Institute (KEMRI) Scientific and Ethical Review Unit (SERU), Nairobi (Non-SSC Protocol No. 514, 1st April 2016) and approved by and registered with the Pharmacy and Poisons Board’s Expert Committee on Clinical Trials PPB/ECCT/16/05/03/2016(94), the authority mandated, by Cap 244 Laws of Kenya, to regulate clinical trials in the country. The trial was also registered with the Pan African Clinical Trial Registry (PACTR201901905832601). Tungiasis is a disease caused by the female sand flea which burrows into the skin of the feet and causes intense pain and itching. People in endemic tropical areas do not have access to a simple, effective and safe method for treatment at home. The most common treatment used during clinical outreach activities is a foot bath in a disinfectant. Here we report on a clinical trial testing the effectiveness of a mixture of neem and coconut oils to kill the embedded fleas and reduce inflammation, pain and itching. We found the oil mixture reduced the proportion of fleas alive in the foot after 6 days in a similar way as the footbath in disinfectant, which is unavailable to households. However, unlike the footbath, the neem oil treatment caused most of the fleas to rapidly age in the foot and decreased the inflammation, leaving more children pain-free after one week. We conclude the neem and coconut oil mixture could be a promising approach for the treatment of tungiasis but its activity on the fleas might be slower. We need to follow up with longer observation time and test different dosages and application times.
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Affiliation(s)
- Lynne Elson
- CGMRC, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
- Dabaso Tujengane CBO, Kilifi, Kenya
- * E-mail:
| | | | - Hermann Feldmeier
- Institute of Microbiology and Infection Immunology, Charité University Medicine, Berlin, Germany
| | - Ulrike Fillinger
- Human Health Theme, International Centre of Insect Physiology and Ecology, Nairobi, Kenya
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Nsanzimana J, Karanja S, Kayongo M, Nyirimanzi N, Umuhoza H, Murangwa A, Muganga R, Musafili A. Factors associated with tungiasis among primary school children: a cross-sectional study in a rural district in Rwanda. BMC Public Health 2019; 19:1192. [PMID: 31464600 PMCID: PMC6716852 DOI: 10.1186/s12889-019-7481-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tungiasis is a relatively frequent ectoparasitosis in low-income settings, yet its morbidity and social impact are still not well understood due to the scarcity of information. In Rwanda, data on the magnitude and conditions leading to the tungiasis is rare. This study sought to determine the prevalence and factors associated with tungiasis among primary school children in Rwandan setting. METHOD A descriptive cross-sectional study utilising systematic random sampling method was adopted to select 384 children from three primary schools. From July to October 2018, data were collected on socio-demographic characteristics of children, parents, and households. Logistic regression was applied to analyse socio-demographic factors associated with tungiasis with a level of significance set at P-value< 0.05. RESULTS Prevalence of tungiasis among three primary schools was 23%. Factors associated with tungiasis included walking barefoot (AOR: 78.41; 95% CI: 17.91-343.10), irregular wearing of shoes (AOR: 24.73; 95% CI: 6.27-97.41), having dirty feet (AOR: 12.69; 95% CI: 4.93-32.64), wearing dirty clothes (AOR: 12.69; 95% CI: 4.18-38.50), and living in a house with earthen plastered floor (AOR: 28.79; 95% CI: 7.11-116.57). Children infected with tungiasis attended class less frequently (AOR: 19.16, 95%CI: 7.20-50.97) and scored lower (AOR: 110.85, 95%CI: 43.08-285.20) than those non-infected. The low school attendance and poor performance could be partly explained by difficulty of walking, lack of concentration during school activities, and isolation or discrimination from classmates. CONCLUSION Tungiasis was a public health challenge among school going children in a rural Rwandan setting. This study revealed that children affected with tungiasis had poor hygiene, inadequate housing environments and consequently poor school attendance and performance. Improving socio-economic conditions of households with special emphasis on hygiene of family members and housing conditions, would contribute to preventing tungiasis.
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Affiliation(s)
| | - Simon Karanja
- Medical Epidemiology, School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Moses Kayongo
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Kigali, Rwanda
| | | | - Hyacinthe Umuhoza
- Department of Infection Prevention and Control, Kigeme District Hospital, Nyamagabe, Rwanda
| | | | - Raymond Muganga
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Aimable Musafili
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Cellulitis Surrounding Protruding Calcified Mass on Lower Leg. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Mutebi F, Krücken J, von Samson-Himmelstjerna G, Waiswa C, Mencke N, Eneku W, Andrew T, Feldmeier H. Animal and human tungiasis-related knowledge and treatment practices among animal keeping households in Bugiri District, South-Eastern Uganda. Acta Trop 2018; 177:81-88. [PMID: 29017876 DOI: 10.1016/j.actatropica.2017.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Zoonotic tungiasis caused by Tunga penetrans remains a serious public and animal health problem among endemic villages in Uganda and many sub Saharan African countries. Studies on human and animal tungiasis-related knowledge and treatment practices in endemic communities have never been undertaken, a limitation to development of sustainable control measures. METHODS A cross sectional study using semi-structured questionnaires (Supplementary file S1) was conducted among 236 animal rearing households in 10 endemic villages in Bugiri District, South-Eastern Uganda. Focus group discussions and observation checklists were used to validate and clarify the findings. RESULTS Most respondents knew the aetiology (89.4%), clinical signs (98%) and the ecology of T. penetrans as well as the major risk factors of human tungiasis (65.2%). In contrast, very few respondents were aware of animal tungiasis. Only 4.8% of those with infected animals on the compound knew that some of their animals were infected and 13.6% of the respondents had ever seen tungiasis-affected animals. Pigs (13.1%, n=31) and dogs (0.85%, n=2) were the only T. penetrans animal hosts known to animal owners. Affected humans were treated by extraction of embedded sand fleas using non-sterile sharp instruments in all households that reported occurrence of human tungiasis at least once (n=227). Also, affected animals were mainly treated by mechanical removal of embedded sand fleas in households that have ever experienced animal tungiasis (four out of 12; 33.3%). In a few instances, plant and animal pesticides (n=3) and other chemicals such as grease, paraffin and wood preservative (n=3) were also used to treat animal tungiasis. CONCLUSION The study revealed a high level of knowledge on human tungiasis but inadequate knowledge on the zoonotic nature of tungiasis. Commonly applied methods for treatment of human and animal tungiasis are a health hazard by themselves. Concerted i.e. One Health-based efforts aiming at promoting appropriate treatment of tungiasis, adequate living conditions and increased awareness on tungiasis in the communities are indicated in order to eliminate tungiasis-associated disease.
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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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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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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: 17] [Impact Index Per Article: 2.4] [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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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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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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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, 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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Biofilm formation by clinical isolates and its relevance to clinical infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 830:1-28. [PMID: 25366218 DOI: 10.1007/978-3-319-11038-7_1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Reports of biofilms have increased exponentially in the scientific literature over the past two decades, yet the vast majority of these are basic science investigations with limited clinical relevance. Biofilm studies involving clinical isolates are most often surveys of isolate collections, but suffer from lack of standardization in methodologies for producing and assessing biofilms. In contrast, more informative clinical studies correlating biofilm formation to patient data have infrequently been reported. In this chapter, biofilm surveys of clinical isolates of aerobic and anaerobic bacteria, mycobacteria, and Candida are reviewed, as well as those pertaining to the unique situation of cystic fibrosis. In addition, the influence of host components on in vitro biofilm formation, as well as published studies documenting the clinical impact of biofilms in human infections, are presented.
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Biofilms of Clostridium species. Anaerobe 2014; 30:193-8. [DOI: 10.1016/j.anaerobe.2014.09.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 09/10/2014] [Accepted: 09/14/2014] [Indexed: 12/30/2022]
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Feldmeier H. Treatment of parasitic skin diseases with dimeticones a new family of compounds with a purely physical mode of action. Trop Med Health 2014; 42:15-20. [PMID: 25425946 PMCID: PMC4204056 DOI: 10.2149/tmh.2014-s02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Epidermal parasitic skin diseases (EPSD) are common in the tropics and sub-tropics. They are caused by mites, lice and other blood-sucking insects. In resource-poor countries they are associated with considerable morbidity. Hitherto, EPSD are treated with insecticides with a neurotoxic mode of action. The efficacy of this treatment is variable, and the development and spread of resistant mites and lice is alarming. A new concept for treating EPSD is presented which is based on the topical application of dimeticones, silicone oils of low viscosity which rapidly kill insects and mites by a physical mode of action. They creep into the respiratory system and block oxygen supply. The physical mode of action makes the development of resistant parasite strains very unlikely. Due to their safety and efficacy, dimeticones are promising candidates for population-based intervention programmes targeted against EPSD in resource-poor settings.
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Affiliation(s)
- Hermann Feldmeier
- Institute of Microbiology and Hygiene, Charité University Medicine , Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
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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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Linardi PM, de Avelar DM. 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] [Key Words] [MESH Headings] [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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Affiliation(s)
- Pedro Marcos Linardi
- Departamento de Parasitologia, Instituto de Ciências Biológicas da Universidade Federal de Minas Gerais, Caixa Postal 486, Avenida Antônio Carlos, 6627, Campus UFMG, Belo Horizonte, Minas Gerais, 31270-901, Brazil,
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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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Abstract
BACKGROUND Tungiasis is endemic in poverty-stricken communities of South and Central America, Africa, Asia, and the Caribbean. This ectoparasitosis, caused by the female sand flea Tunga penetrans, is associated with considerable longterm morbidity in severely affected patients, including toe deformation and limited mobility. In Haiti, tungiasis is poorly documented but is known to occur. This study is the first formal investigation of tungiasis in Haiti. METHODS A total of 383 patients in four regions (Belle Fontaine, Vallue, Savanette, Cerca Carvajal) were examined and interviewed to determine disease prevalence, demographics and clinical presentation, and tungiasis-related behaviors. RESULTS Prevalences of tungiasis ranged from 10.6 to 81.8% across the four regions. The overall prevalence of tungiasis in the patients examined was 31.1%. Of the affected patients, 63% were male and 37% were female, 37% were aged 0-10 years, and 100% reported pain and pruritus. Lesions occurred on the feet in 93.3% and on the hands in 22.7% of affected patients. The most common complications observed were chronic inflammation (54.2%) and hyperkeratosis (48.2%). CONCLUSIONS This study establishes tungiasis as endemic in four regions of Haiti and reveals disease characteristics similar to those reported previously, suggesting that there are common factors underlying this disease in various regions, which are likely to be poverty-related. These findings emphasize the need to acknowledge tungiasis as a clinically relevant public health issue in order to decrease the frequency of tungiasis-related morbidity in endemic areas.
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Affiliation(s)
- Shesly J Louis
- Department of Dermatology, Hôpital Universitaire la Paix (State University Hospital la Paix), Port-au-Prince, Haiti
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