Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Tungiasis Clinical Presentation

  • Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
 
Updated: Oct 21, 2015
 

History

Lesions can range from asymptomatic to pruritic to extremely painful. Note the following history findings:

  • Travel to areas with T penetrans, including Central America, South America, India, and tropical Africa[41]
  • Walking along beach areas with bare feet or in sandals
  • Pain or itching and papular or nodular eruptions, usually on the feet (can occur on any area of the body to which the flea has access)
Next

Physical Examination

Typical areas of involvement include the plantar surface of the foot, the intertriginous regions of the toes, and the periungual regions. However, other ectopic sites of infection have also been reported, including the hands, elbows, thighs, and gluteal region.[42]

Infestation in its simplest form is manifested by the appearance of a white patch with a black dot (see the image below). More advanced infestation manifests as crusted, erythematous papules; painful, pruritic nodules; crateriform lesions; and secondary infections, including lymphangitis and septicemia. A case presenting with a large bullous lesion has also been described.[43]

A tungiasis lesion in substage 3a. A tungiasis lesion in substage 3a.
Previous
 
 
Contributor Information and Disclosures
Author

Darvin Scott Smith, MD, MSc, DTM&H Adjunct Associate Clinical Professor, Department of Microbiology and Immunology, Stanford University School of Medicine; Chief of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, Kaiser Redwood City Hospital

Darvin Scott Smith, MD, MSc, DTM&H is a member of the following medical societies: American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Stephanie A Nevins Research Assistant, Department of Genetics, Snyder Lab, Stanford University School of Medicine

Disclosure: Nothing to disclose.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Additional Contributors

Zachary S Wettstein Stanford University

Disclosure: Nothing to disclose.

Acknowledgements

Neil F Gibbs, MD Voluntary Associate Professor, Departments of Pediatrics and Medicine, University of California, San Diego School of Medicine; Program Director, Pediatric Dermatologist, Department of Dermatology, Naval Medical Center, San Diego

Neil F Gibbs, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

William D James, MD Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Paul McKinney, MD, Associate Dean for Public Health, Professor of Medicine, Department of Health Knowledge and Cognitive Sciences, University of Louisville School of Medicine

Disclosure: Nothing to disclose.

Abdul-Ghani Kibbi, MD Professor and Chair, Department of Dermatology, American University of Beirut Medical Center, Lebanon

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Head of Infectious Disease Fellowship Program, Orlando Regional Medical Center

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References
  1. Veraldi S, Valsecchi M. Imported tungiasis: a report of 19 cases and review of the literature. Int J Dermatol. 2007 Oct. 46(10):1061-6. [Medline].

  2. Gibbs SS. The diagnosis and treatment of tungiasis. Br J Dermatol. 2008 Sep. 159(4):981. [Medline].

  3. 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. 2004 Oct. 94(4):275-282. [Medline].

  4. 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. 2008 Apr. 102(5):875-80. [Medline].

  5. Caumes E, Carrière 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. 1995 Mar. 20(3):542-8. [Medline].

  6. 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. 2003 Jan. 96(5):412-4. [Medline].

  7. Hotez PJ, Bottazzi ME, Franco-Paredes C, Ault SK, Periago MR. The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination. PLoS Negl Trop Dis. 2008 Sep 24. 2(9):e300. [Medline]. [Full Text].

  8. Fein H, Naseem S, Witte DP, Garcia VF, Lucky A, Staat MA. Tungiasis in North America: a report of 2 cases in internationally adopted children. J Pediatr. 2001 Nov. 139(5):744-6. [Medline].

  9. Escamilla-Martinez E, Gómez-Martín B, Sánchez-Rodríguez R, Martínez-Nova A, Martínez-Granada LJ, Altube-Arabiurrutia E. Tungiasis--traveler's ectoparasitosis of the foot: a case report. Foot Ankle Int. 2008 Mar. 29(3):354-7. [Medline].

  10. Bourée P, Ossé L, Rabenandrasana F. [Tungiasis, an uncommon ectoparisitic disease]. Rev Prat. 2009 Feb 20. 59(2):163-5. [Medline].

  11. Feldmeier H, Sentongo E, Krantz I. Tungiasis (sand flea disease): a parasitic disease with particular challenges for public health. Eur J Clin Microbiol Infect Dis. 2013 Jan. 32(1):19-26. [Medline].

  12. 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. 1989 May. 20(5 Pt 2):941-4. [Medline].

  13. Mashek H, Licznerski B, Pincus S. Tungiasis in New York. Int J Dermatol. 1997 Apr. 36(4):276-8. [Medline].

  14. Poppiti R Jr, Kambour M, Robinson MJ, Rywlin AM. Tunga penetrans in south Florida. South Med J. 1983 Dec. 76(12):1558-60. [Medline].

  15. Brothers W, Heckmann R. Tungiasis (Tunga penetrans) in Utah. J Parasitol. 1979 Oct. 65(5):782. [Medline].

  16. Hager J, Jacobs A, Orengo IF, Rosen T. Tungiasis in the United States: a travel souvenir. Dermatol Online J. 2008 Dec 15. 14(12):3. [Medline].

  17. GIDEON Infectious Diseases - Tungiasis. Date Accessed: 5/5/2011. [Full Text].

  18. Nte AR, Eke FU. Jigger infestation in children in a rural area of Rivers State of Nigeria. West Afr J Med. 1995 Jan-Mar. 14(1):56-8. [Medline].

  19. Arene FO. The prevalence of sand flea (Tunga penetrans) among primary and post-primary school pupils in Choba area of the Niger Delta. Public Health. 1984 Sep. 98(5):282-3. [Medline].

  20. Ade-Serrano MA, Ejezie GC. Prevalence of tungiasis in Oto-Ijanikin village, Badagry, Lagos State, Nigeria. Ann Trop Med Parasitol. 1981 Aug. 75(4):471-2. [Medline].

  21. de Carvalho RW, de Almeida AB, Barbosa-Silva SC, Amorim M, Ribeiro PC, Serra-Freire NM. The patterns of tungiasis in Araruama township, state of Rio de Janeiro, Brazil. Mem Inst Oswaldo Cruz. 2003 Jan. 98(1):31-6. [Medline].

  22. Ugbomoiko US, Ofoezie IE, Heukelbach J. Tungiasis: high prevalence, parasite load, and morbidity in a rural community in Lagos State, Nigeria. Int J Dermatol. 2007 May. 46(5):475-81. [Medline].

  23. Feldmeier H, Witt L, Schwalfenberg S, Linardi PM, Ribeiro RA, Capaz RA, et al. Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil. VI. Natural history of the infestation in laboratory-raised Wistar rats. Parasitol Res. 2007 Dec. 102(1):1-13. [Medline].

  24. Heukelbach J, Franck S, Feldmeier H. High attack rate of Tunga penetrans (Linnaeus 1758) infestation in an impoverished Brazilian community. Trans R Soc Trop Med Hyg. 2004 Jul. 98(7):431-4. [Medline].

  25. Kehr JD, Heukelbach J, Mehlhorn H, Feldmeier H. Morbidity assessment in sand flea disease (tungiasis). Parasitol Res. 2007 Jan. 100(2):413-21. [Medline].

  26. Kibaki L. Intensity the war on jiggers. Available at http://www.capitalfm.co.ke/eblog/2011/03/17. Accessed: June 20, 2013.

  27. Olukya G. Jiggers-something rotten in Uganda. Available at http:www.timeslive.co.za/africa/article722622.ece. Accessed: June 20, 2013.

  28. Mazigo HD, Bahemana E, Konje ET, Dyegura O, Mnyone LL, Kweka EJ, et al. Jigger flea infestation (tungiasis) in rural western Tanzania: high prevalence and severe morbidity. Trans R Soc Trop Med Hyg. 2012 Apr. 106(4):259-63. [Medline].

  29. Grupper M, Potasman I. Outbreak of tungiasis following a trip to Ethiopia. Travel Med Infect Dis. 2012 Sep. 10(5-6):220-3. [Medline].

  30. Ugbomoiko US, Ofoezie IE, Heukelbach J. Tungiasis: high prevalence, parasite load, and morbidity in a rural community in Lagos State, Nigeria. Int J Dermatol. 2007 May. 46(5):475-81. [Medline].

  31. Muehlen M, Heukelbach J, Wilcke T, Winter B, Mehlhorn H, Feldmeier H. Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil. II. Prevalence, parasite load and topographic distribution of lesions in the population of a traditional fishing village. Parasitol Res. 2003 Aug. 90(6):449-55. [Medline].

  32. Damazio OR, Silva MV. Tungiasis in schoolchildren in Criciúma, Santa Catarina State, South Brazil. Rev Inst Med Trop Sao Paulo. 2009 Mar-Apr. 51(2):103-8. [Medline].

  33. Joseph JK, Bazile J, Mutter J, Shin S, Ruddle A, Ivers L, et al. Tungiasis in rural Haiti: a community-based response. Trans R Soc Trop Med Hyg. 2006 Oct. 100(10):970-4. [Medline].

  34. Widmer CE, Azevedo FC. Tungiasis in a free-ranging jaguar (Panthera onca) population in Brazil. Parasitol Res. 2012 Mar. 110(3):1311-4. [Medline].

  35. Linardi PM, Calheiros CM, Campelo-Junior EB, Duarte EM, Heukelbach J, Feldmeier H. Occurrence of the off-host life stages of Tunga penetrans (Siphonaptera) in various environments in Brazil. Ann Trop Med Parasitol. 2010 Jun. 104(4):337-45. [Medline].

  36. Muehlen M, Feldmeier H, Wilcke T, Winter B, Heukelbach J. Identifying risk factors for tungiasis and heavy infestation in a resource-poor community in northeast Brazil. Trans R Soc Trop Med Hyg. 2006 Apr. 100(4):371-80. [Medline].

  37. Ugbomoiko US, Ariza L, Ofoezie IE, Heukelbach J. Risk factors for tungiasis in Nigeria: identification of targets for effective intervention. PLoS Negl Trop Dis. 2007 Dec 5. 1(3):e87. [Medline]. [Full Text].

  38. Chadee DD. Tungiasis among five communities in south-western Trinidad, West Indies. Ann Trop Med Parasitol. 1998 Jan. 92(1):107-13. [Medline].

  39. Feldmeier H, Heukelbach J, Eisele M, Sousa AQ, Barbosa LM, Carvalho CB. Bacterial superinfection in human tungiasis. Trop Med Int Health. 2002 Jul. 7(7):559-64. [Medline].

  40. Joseph JK, Bazile J, Mutter J, Shin S, Ruddle A, Ivers L. Tungiasis in rural Haiti: a community-based response. Trans R Soc Trop Med Hyg. 2006 Oct. 100(10):970-4. [Medline].

  41. Rathe M, Rafn A, Poulsen T, Mohey R. [Tungiasis case after a trip to Kenya]. Ugeskr Laeger. 2009 Mar 2. 171(10):818. [Medline].

  42. Heukelbach J, Wilcke T, Eisele M, Feldmeier H. Ectopic localization of tungiasis. Am J Trop Med Hyg. 2002 Aug. 67(2):214-6. [Medline].

  43. Veraldi S, Schianchi R, Cremonesi R. Bullous tungiasis. Int J Dermatol. 2005 Dec. 44(12):1067-9. [Medline].

  44. Di Stefani A, Rudolph CM, Hofmann-Wellenhof R, Müllegger RR. An additional dermoscopic feature of tungiasis. Arch Dermatol. 2005 Aug. 141(8):1045-6. [Medline].

  45. Cabrera R, Daza F. Dermoscopy in the diagnosis of tungiasis. Br J Dermatol. 2009 May. 160(5):1136-7. [Medline].

  46. Bauer J, Forschner A, Garbe C, Röcken M. Dermoscopy of tungiasis. Arch Dermatol. 2004 Jun. 140(6):761-3. [Medline].

  47. Smith MD, Procop GW. Typical histologic features of Tunga penetrans in skin biopsies. Arch Pathol Lab Med. 2002 Jun. 126(6):714-6. [Medline].

  48. Eisele M, Heukelbach J, Van Marck E, Mehlhorn H, Meckes O, Franck S, et al. Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil: I. Natural history of tungiasis in man. Parasitol Res. 2003 Jun. 90(2):87-99. [Medline].

  49. Heukelbach J, Eisele M, Jackson A, Feldmeier H. Topical treatment of tungiasis: a randomized, controlled trial. Ann Trop Med Parasitol. 2003 Oct. 97(7):743-9. [Medline].

  50. Heukelbach J, Franck S, Feldmeier H. Therapy of tungiasis: a double-blinded randomized controlled trial with oral ivermectin. Mem Inst Oswaldo Cruz. 2004 Dec. 99(8):873-6. [Medline].

  51. Feldmeier H, Kehr JD, Heukelbach J. A plant-based repellent protects against Tunga penetrans infestation and sand flea disease. Acta Trop. 2006 Oct. 99(2-3):126-36. [Medline].

  52. Thielecke M, Raharimanga V, Rogier C, Stauss-Grabo M, Richard V, Feldmeier H. Prevention of tungiasis and tungiasis-associated morbidity using the plant-based repellent Zanzarin: a randomized, controlled field study in rural Madagascar. PLoS Negl Trop Dis. 2013. 7 (9):e2426. [Medline].

  53. Feldmeier H, Heukelbach J, Ugbomoiko US, Sentongo E, Mbabazi P, von Samson-Himmelstjerna G, et al. Tungiasis--a neglected disease with many challenges for global public health. PLoS Negl Trop Dis. 2014 Oct. 8 (10):e3133. [Medline].

  54. Buckendahl J, Heukelbach J, Ariza L, Kehr JD, Seidenschwang M, Feldmeier H. Control of tungiasis through intermittent application of a plant-based repellent: an intervention study in a resource-poor community in Brazil. PLoS Negl Trop Dis. 2010 Nov 9. 4(11):e879. [Medline]. [Full Text].

  55. Ade-Serrano MA, Olomolehin OG, Adewunmi A. Treatment of human tungiasis with niridazole (Ambilhar) a double-blind placebo-controlled trial. Ann Trop Med Parasitol. 1982 Feb. 76(1):89-92. [Medline].

Previous
Next
 
A. Tangential cut through a fully developed, gravid flea embedded in the stratum corneum of the epidermis. The flea's head and thorax are enfolded in the hypertrophic anterior abdominal segments. The epidermis is hyperplastic and shows papillomatosis, parakeratosis, and hyperkeratosis.B. Tangential cut through the posterior abdominal segments of an embedded sand flea. Next to the chitinous cuticle, a microabscess has formed.C. Dead parasite; the exoskeleton of the posterior abdominal segment has remained intact; the cuticle has disintegrated at the epidermal–dermal interface. The carcass is infiltrated by neutrophils, and pus has formed.D. The head of the flea is located at the epidermal–dermal interface, has penetrated the basal membrane, and is surrounded by many erythrocytes, presumably having leaked from a blood vessel. The abdomen of the parasite is separated from host tissue by a thick, chitinous cuticle.
A tungiasis lesion in substage 3a.
Scanning electron micrograph of flea on day 3 after penetration. The hypertrophic zone between abdominal segments 2 and 3 is gaining a bulging shape and looks like a life-belt (x100).
Scanning electron micrograph of flea on day 8 after penetration. The hypertrophy zone has taken the shape of a sphere. The 3 parts of abdominal segment 2 are completely bent apart. Together with the newly developed, crescent-shaped chitinous clasps, the anterior part of the flea looks like a 3-leafed clover (x32).
Scanning electron micrograph of flea 6 hours after beginning of penetration. The penetration is almost completed; only the last abdominal segments protrude through the skin (x240).
Scanning electron micrograph of flea in stage 2. The rear end, the genital opening, and the 4 pairs of stigmata form a miniature cone, which towers above the crater caused by pushing in abdominal segments 7 and 8 (x190).
Life cycle of Tunga penetrans - Fortaleza stages included. Compiled and designed by Fausto Bustos and Lucas Manfield.
Histopathologic findings in tungiasis.
Life cycle of the chigoe flea, Tunga penetrans.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.