Tungiasis 

Tungiasis 

3 Interesting Facts of Tungiasis 

  1. Tungiasis usually affects the feet. The lesion begins as a punctum or ulcer and resembles a discolored nodule, with a central black dot.
  2. The diagnosis is often suspected based on the travel history and clinical examination. Excision, which is also the treatment of choice, will often provide firm histologic evidence of the infestation.
  3. Tungiasis can be prevented by avoiding direct contact with infested sand. Tungiasis is often self-limited because the organism dies, and the skin sheds. When treatment is necessary, physical removal is preferred, and often, if the flea is engorged, excision will be necessary. Topical antiparasitic medications such as ivermectin, metrifonate, and thiabendazole have been reported. Also, suffocation of the flea using petrolatum jelly or killing the flea with liquid nitrogen is possible. Precautions should be taken to prevent secondary infections and tetanus/gangrene.

Etiology and Risk Factors

What causes Tungiasis and what are the risk factors for this condition?

  • Tungiasis is a disease caused by the sand flea, Tunga penetrans.
  • This flea burrows into the skin of humans, usually on the foot, and then lives in parasitic fashion, imbibing blood from the host and laying eggs onto the epithelial surface, where its own hindquarters protrude.
  • It is thought that the disease was acquired by Christopher Columbus, when he made landfall in the Caribbean, but it has spread to parts of Africa, India, Pakistan, and Latin America.

Diagnosis

Approach to Diagnosis

  • The diagnosis is often suspected based on the travel history and clinical examination.

Workup

Physical Examination

  • Tungiasis usually affects the feet. The lesion begins as a punctum or ulcer and resembles a discolored nodule, with a central black dot.
  • The flea breathes through an opening in the skin, and the lesion ranges in size from 4 to 10 mm.
  • Lesions can be pruritic, or even painful, although sometimes no symptoms are experienced. In some situations, there may be inflammation and swelling.
  • Superinfection is a concern and often is a complicating factor of tungiasis.

Diagnostic Procedures

  • Excision, which is also the treatment of choice, will often provide firm histologic evidence of the infestation

How is Tungiasis treated?

Nondrug and Supportive Care

  • Tungiasis can be prevented by avoiding direct contact with infested sand. Tungiasis is often self-limited because the organism dies, and the skin sheds.

Treatment Procedures

  • When treatment is necessary, physical removal is preferred, and often, if the flea is engorged, excision will be necessary.
  • Topical antiparasitic medications such as ivermectin, metrifonate, and thiabendazole have been reported.
  • Also, suffocation of the flea using petrolatum jelly or killing the flea with liquid nitrogen is possible.
  • Precautions should be taken to prevent secondary infections and tetanus/gangrene.

References

Feldmeier H, Keysers A. Tungiasis – A Janus-faced parasitic skin disease. Travel medicine and infectious disease. 2013;11(6):357-365. Reference

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