Tungiasis: a poorly-known diagnosis in Europe. Two paradigmatic cases from Portugal

Current status of the knowledge on the epidemiology of tungiasis in the Americas

Objectives.

To present the state-of-the-knowledge on the epidemiology of tungiasis in the Region of the Americas.

Methods.

A search of publications on the epidemiology of tungiasis in the Americas was performed in PubMed and LILACS databases from January 2007 to June 2021. In addition, a manual literature search on articles on the epidemiology of tungiasis was performed.

Results.

A total of 83 articles were analyzed which contained relevant information on tungiasis cases and their geographical distribution, prevalence and risk factors, life cycle, sites where transmission takes place, and zoonotic aspects. The on-host and off-host life cycles have been researched in detail. In certain contexts, the whole life cycle is completed indoors enabling transmission around the whole year. Cases were reported from 10 countries; 71% of them were from Brazil. In the general population, the prevalence varied between 1.0% and 82.6% according to the settings. Age-specific prevalence indicated that children and the elderly bear the highest disease burden. Risk factor studies indicate that tungiasis is associated with severe poverty.

Conclusions.

In the Americas, there are important gaps in information and knowledge of tungiasis. Understanding the burden, epidemiology, distribution, magnitude, related risk factors, and reservoirs, among others, is needed to develop and implement integrated control measures tailored to the context and patterns of transmission in the affected communities.

Tungiasis Presenting as Onychomycosis: Probably the First Report of Flea Infestation of the Nail Observed Using Modified Potassium Hydroxide Mount Technique

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.