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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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Amugune BL, Matharu AK, Ouma P, Mutebi F, Elson L, Fillinger U, Krücken J. Cost-Effective PCR-Based Identification of Tunga penetrans (Siphonaptera) Larvae Extracted from Soil Samples Containing PCR Inhibitor-Rich Material. INSECTS 2022; 14:5. [PMID: 36661934 PMCID: PMC9865934 DOI: 10.3390/insects14010005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
Tungiasis is a neglected tropical disease caused by skin-penetrating female Tunga penetrans fleas. Although tungiasis causes severe health problems, its ecology is poorly understood and morphological descriptions of the larvae are unavailable. To identify T. penetrans immature stages and sites where they develop, diagnostic PCRs are required. However, flea larvae feed on soil organic matter rich in PCR inhibitors. Here, three DNA preparation methods, including a soil DNA kit that removes inhibitors, a simple ammonium acetate precipitation approach (AmAcet) and a crude lysate of larvae (CL), were combined with amplification by the highly processive FIREPol® Taq or the inhibitor-resistant Phusion® polymerase. Independent of the polymerase used, the frequency of successful amplification, Cq values and PCR efficacies for the low-cost CL and AmAcet methods were superior to the commercial kit for amplification of a 278 bp partial internal transcribed spacer-2 (ITS-2) and a 730 bp pan-Siphonaptera cytochrome oxidase II PCR. For the CL method combined with Phusion® polymerase, the costs were approximately 20-fold lower than for the methods based on the soil DNA kit, which is a considerable advantage in resource-poor settings. The ITS-2 PCR did not amplify Ctenocephalides felis genomic or Tunga trimammilata ITS-2 plasmid DNA, meaning it can be used to specifically identify T. penetrans.
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Affiliation(s)
- Billy L. Amugune
- International Centre of Insect Physiology and Ecology, Human Health Theme, Nairobi 00100, Kenya
| | - Abneel K. Matharu
- International Centre of Insect Physiology and Ecology, Human Health Theme, Nairobi 00100, Kenya
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, 14163 Berlin, Germany
| | - Paul Ouma
- International Centre of Insect Physiology and Ecology, Human Health Theme, Nairobi 00100, Kenya
| | - Francis Mutebi
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala 10218, Uganda
| | - Lynne Elson
- KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
| | - Ulrike Fillinger
- International Centre of Insect Physiology and Ecology, Human Health Theme, Nairobi 00100, Kenya
| | - Jürgen Krücken
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, 14163 Berlin, Germany
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Harvey TV, Linardi PM, Carlos RSA, Heukelbach J. Tungiasis in domestic, wild, and synanthropic animals in Brazil. Acta Trop 2021; 222:106068. [PMID: 34331896 DOI: 10.1016/j.actatropica.2021.106068] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
Tungiasis is an ectoparasitic skin disease of humans and warm-blooded animals caused by fleas of the genus Tunga (Jarocki, 1938). Dogs, cats, pigs, and synanthropic rodents are the main animal reservoirs. Of the 14 known species, 12 are found in Latin America and, among these, eight are found in Brazil, including the two zoonotic species Tunga penetrans and Tunga trimamillata. Tunga penetrans predominates among humans and Brazilian pets, where the dog is the most affected species, and its presence is a risk factor associated with the disease in humans. Tunga spp. are widely distributed throughout the national territory, with T. penetrans being the most dispersed and the most frequent in animals from endemic areas, especially in underprivileged communities. Infections in animals, associated with inadequate management, favor the spread and perpetuation of the disease. Intense injuries can result in sequelae and serious clinical conditions, compromising the health, welfare, and productivity of animals, as well as leading to death. Health precariousness, lack of control and neglect in the management of populations of domestic and synanthropic animals, poor hygiene habits of individuals, lack of information from both the population and related professionals, lack of effective treatment, and of perception of tungiasis as a disease are among the main challenges for the control of this parasitosis. As recommended for other zoonotic Neglected Tropical Diseases, strategies based on the concept of One Health can guarantee more effective results in the fight against human and animal tungiasis.
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Affiliation(s)
- Tatiani Vitor Harvey
- Autonomous Veterinarian, 16 Aberdeen Avenue, Cambridge, MA, Zipcode 02138, United States.
| | - Pedro Marcos Linardi
- UFMG. Universidade Federal de Minas Gerais, Departamento de Parasitologia, Instituto de Ciências Biológicas, Caixa Postal 486, Avenida Antônio Carlos, 6627, Campus UFMG, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil.
| | - Renata Santiago Alberto Carlos
- UESC. Universidade Estadual de Santa Cruz, Departamento de Ciências Agrárias e Ambientais, Faculdade de Medicina Veterinária, Campus Soane Nazaré de Andrade. Rodovia Jorge Amado Km 16. Bairro Salobrinho. Ilhéus, Bahia, CEP 45662-900, Brazil.
| | - Jorg Heukelbach
- Postgraduate Program in Public Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, CEP 60.430-140, Brazil.
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Enwemiwe VN, Ojianwuna CC, Anyaele OO. Intensity and clinical morbidities of tungiasis in an impoverished south-west Nigerian community. Parasite Epidemiol Control 2021; 14:e00215. [PMID: 34124398 PMCID: PMC8173311 DOI: 10.1016/j.parepi.2021.e00215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 04/10/2021] [Accepted: 05/16/2021] [Indexed: 11/28/2022] Open
Abstract
Sand fleas infestation, Tunga penetrans, remains a neglected tropical disease of public-health concern in many countries. Tungiasis can lead to destruction of the feet causing serious discomfort and deformities. This study aim was to determine the intensity rate and clinical morbidities of tungiasis among the people living in Igbokoda, Ondo State, Nigeria. A community-based cross-sectional survey was conducted among households in three villages in Igbokoda. Hands and feet of selected household members were examined, while fleas on different floor types of houses were sampled by soil collection and extraction by tullgren funnel method. Sand fleas were equally sampled from legs of infested individuals by hand picking. Intensity was determined in terms of number of lesions and fleas in different floor-types. Tungiasis-associated morbidities was assessed using acute and chronic lesions severity scores. The study revealed that moderate infestation was observed in 173 infested individuals and severe infestation in 16 infested individuals. A total of 5293 lesions was observed out of which 3098 were viable. The flea burdens on sampled floors and legs were 127 and 146 fleas respectively occurring mostly in unpaved veranda and rooms (65 and 62 fleas respectively). Tungiasis lesions observed in males were more intense compared to females. Flea lesions and burdens with respect to age stratification and location were significant P < 0.0001. Difficulty in walking, pain upon pressure and deformation of the feet were the most common tungiasis-associated morbidity recorded. Also, tungiasis-associated morbidities, and flea number sampled on legs and on floor of environment were reportedly intense. Therefore, scaling up an appropriate and affordable intervention approach targeted at the fleas would serve as a relief to the scourge of tungiasis in Igbokoda community.
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Affiliation(s)
- Victor N Enwemiwe
- Department of Animal and Environmental Biology, Delta State University, Abraka, Nigeria.,Department of Zoology, University of Ibadan, Ibadan, Nigeria
| | - Cynthia C Ojianwuna
- Department of Animal and Environmental Biology, Delta State University, Abraka, Nigeria
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Clinical implications and treatment options of tungiasis in domestic animals. Parasitol Res 2021; 120:4113-4123. [PMID: 33818640 DOI: 10.1007/s00436-021-07121-y] [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: 01/20/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
Tunga penetrans, Tunga trimamillata and Tunga hexalobulata are the three species of sand fleas which cause tungiasis in domestic animals. Tunga penetrans and T. trimamillata are zoonotic in the tropical and sub-tropical endemic communities of Latin America and Africa. Tungiasis in animals frequently occurs alongside human tungiasis. Currently, most of the attention given to tungiasis is focusing on the human disease, and animal tungiasis is extremely neglected despite its public health and animal health significance. This review highlights recent findings concerning the clinical implications and treatment options but also summarises the occurrence, major features, public health and economic significance of tungiasis in domestic animals. Pigs, dogs, cats and domestic ruminants have been reported to harbour high intensities of sand fleas in endemic communities. High infection intensities cause significant animal morbidity which is often exacerbated by excoriations and secondary bacterial infections which are potentially fatal. In addition to the potential economic losses accruing from tungiasis-related morbidity, infected domestic animals contribute to transmission and persistence of sand fleas and eventually also to severe human disease. Although control of animal tungiasis is possible by adoption of proper husbandry practices, affected communities may not afford the resources required to implement them. Also, there are no widely acceptable and affordable insecticides for treatment of tungiasis in animals. Extension services aiming at increasing awareness on tungiasis and its control should be intensified. Also, available commercial insecticides should be evaluated for therapeutic and prophylactic properties against animal tungiasis.
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Campbell Z, Coleman P, Guest A, Kushwaha P, Ramuthivheli T, Osebe T, Perry B, Salt J. Prioritizing smallholder animal health needs in East Africa, West Africa, and South Asia using three approaches: Literature review, expert workshops, and practitioner surveys. Prev Vet Med 2021; 189:105279. [PMID: 33581421 PMCID: PMC8024747 DOI: 10.1016/j.prevetmed.2021.105279] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/18/2020] [Accepted: 01/18/2021] [Indexed: 12/15/2022]
Abstract
Managing the health needs of livestock contributes to reducing poverty and improving the livelihoods of smallholder and pastoralist livestock keepers globally. Animal health practitioners, producers, policymakers, and researchers all must prioritize how to mobilize limited resources. This study employed three approaches to prioritize animal health needs in East and West Africa and South Asia to identify diseases and syndromes that impact livestock keepers. The approaches were a) systematic literature review, b) a series of expert workshops, and c) a practitioner survey of veterinarians and para-veterinary professionals. The top constraints that emerged from all three approaches include endo/ ectoparasites, foot and mouth disease, brucellosis, peste des petits ruminants, Newcastle disease, and avian influenza. Expert workshops additionally identified contagious caprine pleuropneumonia, contagious bovine pleuropneumonia, mastitis, and reproductive disorders as constraints not emphasized in the literature review. Practitioner survey results additionally identified nutrition as a constraint for smallholder dairy and pastoralist small ruminant production. Experts attending the workshops agreed most constraints can be managed using existing veterinary technologies and best husbandry practices, which supports a shift away from focusing on individual diseases and new technologies towards addressing systemic challenges that limit access to veterinary services and inputs. Few research studies focused on incidence/ prevalence of disease and impact, suggesting better incorporation of socio-economic impact measures in future research would better represent the interests of livestock keepers.
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Affiliation(s)
- Zoë Campbell
- International Livestock Research Institute (ILRI), P.O. Box 30709, Nairobi, 00100, Kenya.
| | - Paul Coleman
- H20 Venture Partners, 33-35 George Street, Oxford, OX1 2AY, United Kingdom
| | - Andrea Guest
- H20 Venture Partners, 33-35 George Street, Oxford, OX1 2AY, United Kingdom
| | - Peetambar Kushwaha
- GALVmed Asia Office, Unit 118 & 120 B, Splendor Forum, Plot No 3, Jasola District Centre, Jasola, New Delhi, 110025, India
| | - Thembinkosi Ramuthivheli
- GALVmed Africa Office, International Livestock Research Institute (ILRI), Swing One, Naivasha Road, Nairobi, Kenya
| | - Tom Osebe
- GALVmed Africa Office, International Livestock Research Institute (ILRI), Swing One, Naivasha Road, Nairobi, Kenya
| | - Brian Perry
- Nuffield College of Clinical Medicine, University of Oxford, United Kingdom; College of Medicine and Veterinary Medicine, University of Edinburgh, Arthurstone House, Meigle, Blairgowrie, PH12 8QW, Scotland, United Kingdom
| | - Jeremy Salt
- GALVmed UK Office, Doherty Building, Pentlands Science Park, Bush Loan, Penicuik Edinburgh, EH26 0PZ, Scotland, United Kingdom
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Kandi V. Tungiasis Presenting as Onychomycosis: Probably the First Report of Flea Infestation of the Nail Observed Using Modified Potassium Hydroxide Mount Technique. Cureus 2018; 10:e2278. [PMID: 29736361 PMCID: PMC5935425 DOI: 10.7759/cureus.2278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Tungiasis is an infection/infestation of the flea Tunga penetrans. These are bloodsucking ectoparasitic insects belonging to the phylum Arthropoda, and they do not possess wings, but they have long legs enabling them to jump up to 30 cm high. The fleas are usually present on the skin and in the hair of domestic and wild animals and are prevalent throughout the world. They may also be present in an environment consisting of dry sandy soils, and they infect people who walk barefoot and reside in flea-infested areas. Human tungiasis is both an accidental and zoonotic infection, where the fleas enter the human skin and cause severe morbidity if not properly managed. There are a few reports of human tungiasis, most of which were diagnosed with skin infections. This is a first-of-its-kind observation of fleas in the nail, from a patient who is suspected to be suffering from onychomycosis. The nail in this case was processed differently, by using a modified potassium hydroxide (KOH) mount technique.
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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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Mutebi F, Krücken J, Feldmeier H, Waiswa C, Mencke N, Eneku W, von Samson-Himmelstjerna G. High intensity of Tunga penetrans infection causing severe disease among pigs in Busoga, South Eastern Uganda. BMC Vet Res 2017; 13:206. [PMID: 28662705 PMCID: PMC5492922 DOI: 10.1186/s12917-017-1127-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/21/2017] [Indexed: 11/23/2022] Open
Abstract
Background Towards the improvement of stakeholders’ awareness of animal tungiasis, we report 10 unusual severe clinical cases of pig tungiasis which were associated with very high infection intensities of T. penetrans in an endemic area. Results Morbidity of ten pigs with high sand flea intensities detected during high transmission seasons in an endemic area in Busoga sub region, Uganda is described in detail. The cases of pigs presented with a very high number of embedded sand fleas (median = 276, range = 141–838). Acute manifestations due to severe tungiasis included ulcerations (n = 10), abscess formation (n = 6) and lameness (n = 9). Chronic morphopathological presentations were overgrowth of claws (n = 5), lateral deviation of dew claws (n = 6), detachment (n = 5) or loss of dew claws (n = 1). Treatment of severe cases with a topical insecticidal aerosol containing chlorfenvinphos, dichlorvos and gentian violet resolved acute morbidity and facilitated healing by re-epithelialisation. Conclusions The presentations of tungiasis highlighted in this report show that high intensities of embedded T. penetrans can cause a severe clinical disease in pigs. Effective tungiasis preventive measures and early diagnosis for treatment could be crucial to minimize its effects on animal health.
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Affiliation(s)
- Francis Mutebi
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. box 7062, Kampala, Uganda
| | - Jürgen Krücken
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, 14163, Berlin, Germany.
| | - Hermann Feldmeier
- Institute of Microbiology and Hygiene, Charité University Medicine, Berlin Campus Benjamin Franklin, Sylter Straße 2, 13353, Berlin, Germany
| | - Charles Waiswa
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. box 7062, Kampala, Uganda
| | | | - Wilfred Eneku
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. box 7062, Kampala, Uganda
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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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