Dermatologic Manifestations of Tungiasis
- Author: Neil F Gibbs, MD; Chief Editor: William D James, MD more...
Background
Tungiasis is an infestation by the burrowing flea Tunga penetrans or related species.[1] The flea has many common names as listed above. Tungiasis was first reported in crewmen who sailed with Christopher Columbus. The flea is indigenous to the West Indies/Caribbean/Central America region, but it has spread to Africa, India, Pakistan, and South America. Travelers to endemic areas may import cases to other countries, including the United States. These painful infections can cause significant morbidity in groups, such as soldiers.
To reproduce, the flea requires a warm-blooded host. In addition to humans, reservoir hosts include pigs, dogs, cats, cattle, sheep, horses, mules, rats, mice, and other wild animals.[2, 3, 4, 5]
Pathophysiology
The main habitat is warm, dry soil and sand of beaches, stables, and stock farms. Upon contact, the fleas invade unprotected skin. The most common site of involvement is the feet (interdigital skin and subungual area). The flea has limited jumping ability.
Both the male and the nonfertilized female flea feed intermittently on warm-blooded hosts. Once impregnated, however, the female flea anchors herself to the skin by using biting mouthparts and burrows into the epidermis. Because the process is painless, a keratolytic enzyme may be involved. The flea expands, often reaching 1 cm in diameter. The head is down into the upper dermis feeding from blood vessels, while the caudal tip of the abdomen is at the skin surface, often forming a punctum or an ulceration. The flea breathes through this opening. In many cases, this is described as a white patch with a black dot.
Over 1-2 weeks, more than 100 eggs, which fall to the ground, are individually released from this exposed orifice. Afterwards, the flea dies and is slowly sloughed by the host. The eggs hatch on the ground in 3-4 days, go through larval and pupal stages and become adults in 2-3 weeks. The complete life cycle lasts approximately 1 month.
Epidemiology
Frequency
United States
Imported cases rarely occur in the United States.[6, 7]
International
In the endemic areas, the prevalence ranges from 15-40%, but cases in other areas are sporadic. Six percent of the patients visiting a travel-associated dermatosis clinic in Paris had tungiasis.[5]
Mortality/Morbidity
Individual lesions may be painful, although sometimes they are pruritic or even asymptomatic. In most cases, tungiasis resolves without complications. However, heavy infestations may lead to severe inflammation, ulceration, and fibrosis. The risk of secondary infection is high. Lymphangitis, gangrene, and ainhum may occur. Death from tetanus associated with tungiasis has been reported.[4]
Veraldi S, Valsecchi M. Imported tungiasis: a report of 19 cases and review of the literature. Int J Dermatol. Oct 2007;46(10):1061-6. [Medline].
Chadee DD. Tungiasis among five communities in south-western Trinidad, West Indies. Ann Trop Med Parasitol. Jan 1998;92(1):107-13. [Medline].
Feldmeier H, Eisele M, Van Marck E, Mehlhorn H, Ribeiro R, Heukelbach J. Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil: IV. Clinical and histopathology. Parasitol Res. Oct 2004;94(4):275-282. [Medline].
Pilger D, Schwalfenberg S, Heukelbach J, Witt L, Mehlhorn H, Mencke N, et al. Investigations on the biology, epidemiology, pathology, and control of Tunga penetrans in Brazil: VII. The importance of animal reservoirs for human infestation. Parasitol Res. Apr 2008;102(5):875-80. [Medline].
Caumes E, Carriere J, Guermonprez G, Bricaire F, Danis M, Gentilini M. Dermatoses associated with travel to tropical countries: a prospective study of the diagnosis and management of 269 patients presenting to a tropical disease unit. Clin Infect Dis. Mar 1995;20(3):542-8. [Medline].
Mashek H, Licznerski B, Pincus S. Tungiasis in New York. Int J Dermatol. Apr 1997;36(4):276-8. [Medline].
Sanusi ID, Brown EB, Shepard TG, Grafton WD. Tungiasis: report of one case and review of the 14 reported cases in the United States. J Am Acad Dermatol. May 1989;20(5 Pt 2):941-4. [Medline].
Bauer J, Forschner A, Garbe C, Rocken M. Dermoscopy of tungiasis. Arch Dermatol. Jun 2004;140(6):761-3. [Medline].
Clyti E, Couppie P, Deligny C, Jouary T, Sainte-Marie D, Pradinaud R. [Effectiveness of 20% salicylated vaseline in the treatment of profuse tungiasis. Report of 8 cases in French Guiana]. Bull Soc Pathol Exot. Jan 2003;96(5):412-4. [Medline].
Heukelbach J, Eisele M, Jackson A, Feldmeier H. Topical treatment of tungiasis: a randomized, controlled trial. Ann Trop Med Parasitol. Oct 2003;97(7):743-9. [Medline].
Heukelbach J, Franck S, Feldmeier H. Therapy of tungiasis: a double-blinded randomized controlled trial with oral ivermectin. Mem Inst Oswaldo Cruz. Dec 2004;99(8):873-6. [Medline].
Ade-Serrano MA, Olomolehin OG, Adewunmi A. Treatment of human tungiasis with niridazole (Ambilhar) a double-blind placebo-controlled trial. Ann Trop Med Parasitol. Feb 1982;76(1):89-92. [Medline].
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