Tungiasis Clinical Presentation

Updated: Mar 07, 2023
  • Author: Darvin Scott Smith, MD, MSc, DTM&H, FIDSA; Chief Editor: John L Brusch, MD, FACP  more...
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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 [49]
  • Walking along beach areas with bare feet or in sandals
  • Pain or itching and papular or nodular eruptions, usually on the feet (although infection can occur on any area of the body to which the flea has access)

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. [50]

Infestation in its simplest form is manifested by the appearance of a white patch with a black dot.

A tungiasis lesion in substage 3a. A tungiasis lesion in substage 3a.

Lesions can also occur under the nail, potentially making diagnosis more difficult.

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. [51]

Tunga penetrans flea. Courtesy of Wikimedia Common Tunga penetrans flea. Courtesy of Wikimedia Commons [author Philipp Weigell, https://commons.wikimedia.org/wiki/File:Tunga_penetrans_%281%29.JPG].



Image of Tungiasis infection on both feet. Courtes Image of Tungiasis infection on both feet. Courtesy of PLOS [Miller H, Ocampo J, Ayala A, Trujillo J, Feldmeier H. Very severe tungiasis in Amerindians in the Amazon lowland of Colombia: A case series. PLOS Neglected Tropical Diseases. 2019 Feb 7. Online at: https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0007068.].