Tungiasis

Question 1

hat causes Tungiasis and where is it endemic?

Answer 1

Tungiasis is caused by the burrowing flea Tunga penetrans. It is endemic in the Caribbean, Central and South America, and sub-Saharan Africa, particularly in warm, dry soils, sandy beaches, stables, and stock farms.

Question 2

What are the risk factors for Tungiasis?

Answer 2

Risk factors include not wearing shoes or wearing open-toed shoes and living in close proximity to domestic or wild animals, which serve as reservoirs.

Question 3

How does Tunga penetrans affect the skin?

Answer 3

The flea burrows head-first into the skin (usually the feet or toes) and extrudes eggs from a punctum before dying and being sloughed off with the epidermis.

Question 4

What is the clinical presentation of Tungiasis?

Answer 4

Early lesions: ~1mm red/brown macules
Within 24 hours: non-tender papule containing the flea
Lesion develops an ulceration/punctum with a characteristic white patch and black dot
Within 1 week: lesion grows to 4mm-10mm, becomes swollen, erythematous, painful, and pruritic
Lesion ruptures, releasing eggs, and the flea dies
Affected skin heals, leaving small punched-out ulcers

Question 5

How is Tungiasis diagnosed?

Answer 5

Clinical diagnosis is sufficient in most cases.

Question 6

What are the treatment options for Tungiasis?

Answer 6

Oral or topical antiparasitic medications: Ivermectin and thiabendazole
Suffocation of the flea with greasy ointment or petroleum jelly
Surgical removal of the flea using sterile forceps, needles, excision, or punch out the entire lesion
Locally freezing the lesion using liquid nitrogen (LN2)
Tetanus prophylaxis
Preventing secondary infections

Question 7

What are prevention strategies for Tungiasis in endemic areas?

Answer 7

Wearing closed shoes in endemic regions
Using plant-based repellants like Zanzarin lotion
Spraying the ground with insecticides