eMedicine Specialties > Infectious Diseases > Parasitic Infections

Tungiasis: Differential Diagnoses & Workup

Author: Paul McKinney, MD, Associate Dean for Public Health, Professor of Medicine, Department of Health Knowledge and Cognitive Sciences, University of Louisville
Contributor Information and Disclosures

Updated: May 15, 2009

Differential Diagnoses

Other Problems to Be Considered

Tick bite
Myiasis
Cercarial dermatitis
Ingrown toenail
Fire ant sting
Creeping eruption due to Ancylostoma species
Dracunculiasis
Scabies

Workup

Laboratory Studies

  • In general, no laboratory studies are indicated other than a histologic examination of excised tissue to confirm the presence of the flea.

Imaging Studies

  • No imaging studies are indicated unless there is a secondary infection with a complication such as gas gangrene.

Other Tests

  • Dermoscopy (direct skin microscopy) may be helpful in identifying typical features, including an irregular central brown discoloration with a plugged opening in the middle or a gray-blue discoloration.13,14

Procedures

  • Extraction of the gravid flea using a sterile needle is both diagnostic and therapeutic.

Histologic Findings

Microscopically, the flea has a thick cuticle and a band of striated muscle stretching from the head to the abdominal orifice. Also visible are hollow, ring-shaped elements from the flea's tracheal and digestive system and numerous round or oval eggs. A report from a small series of skin biopsies indicated that the exoskeleton, hypodermal layer, trachea, digestive tract, and developing eggs were present in all specimens; striated muscle and the hindquarters were present in about half; the head was found in none of the biopsy samples.15 Detailed histopathological findings from 86 cases, including scanning electron microscopy images, elucidated the stages of infestation.16

More on Tungiasis

Overview: Tungiasis
Differential Diagnoses & Workup: Tungiasis
Treatment & Medication: Tungiasis
Follow-up: Tungiasis
Multimedia: Tungiasis
References
Further Reading
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References

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

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

  3. 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. Mar 2008;29(3):354-7. [Medline].

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

  5. 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].

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

  7. Muehlen M, Heukelbach J, Wilcke T. 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. Aug 2003;90(6):449-55. [Medline].

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

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

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

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

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

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

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

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

  16. Eisele M, Heukelbach J, Van Marck E. Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil: I. Natural history of tungiasis in man. Parasitol Res. Jun 2003;90(2):87-99. [Medline].

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

  18. Feldmeier H, Heukelbach J, Eisele M. Bacterial superinfection in human tungiasis. Trop Med Int Health. Jul 2002;7(7):559-64. [Medline].

  19. Basler EA, Stephens JH, Tschen JA. Tunga penetrans. Cutis. Jul 1988;42(1):47-8. [Medline].

  20. Brothers WS, Heckmann RA. Tungiasis in North America. Cutis. Jun 1980;25(6):636-8. [Medline].

  21. Douglas-Jones AG, Llewelyn MB, Mills CM. Cutaneous infection with Tunga penetrans. Br J Dermatol. Jul 1995;133(1):125-7. [Medline].

  22. Goldman L. Tungiasis in travelers from tropical Africa. JAMA. Sep 20 1976;236(12):1386. [Medline].

  23. Lowry MA, Ownbey JL, McEvoy PL. A case of tungiasis. Mil Med. Feb 1996;161(2):128-9. [Medline].

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

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

  26. Zalar GL, Walther RR. Infestation by Tunga penetrans. Arch Dermatol. Jan 1980;116(1):80-1. [Medline].

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Keywords

Tunga penetrans, T penetrans, Sarcopsylla penetrans, S penetrans, Tungidae, chigger flea, sand flea, chigoe, jigger, nigua, pigue, le bicho de pe

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Contributor Information and Disclosures

Author

Paul McKinney, MD, Associate Dean for Public Health, Professor of Medicine, Department of Health Knowledge and Cognitive Sciences, University of Louisville
Paul McKinney, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, Central Society for Clinical Research, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Medical Editor

Mark Raymond Wallace, MD, Infectious Disease Fellowship Director, Orlando Regional Healthcare; Clinical Professor of Medicine, Florida State University
Mark Raymond Wallace, MD 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

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