TungiasisTungiasis

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TungiasisTungiasis

TungiasisTungiasis is an infestation of the skin by a is an infestation of the skin by a burrowing flea called burrowing flea called Tunga penetransTunga penetrans (also known as (also known as Sarcopsylla penetransSarcopsylla penetrans or or Pulex penetransPulex penetrans, or more commonly as , or more commonly as the chigoe flea, bicho de pie (bug of the the chigoe flea, bicho de pie (bug of the foot), jigger, nigua, pico, pigue, and sand foot), jigger, nigua, pico, pigue, and sand flea. Chigoe flea is sometimes confused flea. Chigoe flea is sometimes confused with chigger or harvest mite.with chigger or harvest mite.

Tungiasis Tungiasis

•Acute inflammation with intense erythema and a slight edema is shown.• Lesions are located at the lateral side of the finger and another lesion is lifting up the nail.

Tunga penetrans (jigger or sand flea) Tunga penetrans (jigger or sand flea)

Life Cycle of the Chigoe FleaLife Cycle of the Chigoe Flea

The parasitic chigoe flea lives in warm, dry soil The parasitic chigoe flea lives in warm, dry soil and sand, and is found commonly in beaches, and sand, and is found commonly in beaches, farms, and wooded areas. farms, and wooded areas.

Both the male and female fleas feed on warm-Both the male and female fleas feed on warm-blooded host, but only the impregnated female blooded host, but only the impregnated female flea anchors herself and burrows into the host's flea anchors herself and burrows into the host's skin. skin.

The chigoe flea burrows head first into the upper The chigoe flea burrows head first into the upper dermis, with the tail-end of its abdomen forming dermis, with the tail-end of its abdomen forming an orifice at the skin surface (often causing white an orifice at the skin surface (often causing white patch with a dark tip, bump or ulceration), which patch with a dark tip, bump or ulceration), which the flea uses to breathe.the flea uses to breathe.

Tungiasis lesionTungiasis lesion

In about 1 to 2 weeks, the chigoe flea becomes enlarged (about the size of a pea) when it becomes full with eggs. It then lays about 100 eggs through the skin orifice, which fall to the ground. The flea then dies and is slowly shed by the host. In approximately 3 to 4 days, the eggs then hatch and become adult fleas in 2 to 3 weeks.

Flea eggs shed from the lesion.

Host of the Chigoe FleaHost of the Chigoe Flea

To reproduce, the chigoe flea To reproduce, the chigoe flea requires a warm-blooded host, requires a warm-blooded host, such as human, cattle, sheep, such as human, cattle, sheep, horse, pig, rat, and dog.horse, pig, rat, and dog.

Symptoms of TungiasisSymptoms of Tungiasis The symptoms of chigoe flea infestation include:The symptoms of chigoe flea infestation include: Extreme itching Extreme itching Pain Pain Inflammation Inflammation Fibrous cyst Fibrous cyst Bumps, lesions or nodules (in form of white or Bumps, lesions or nodules (in form of white or

red patches with dark spots) red patches with dark spots) Ulceration, especially in heavy infestation Ulceration, especially in heavy infestation Discharge from the ulcer or bump Discharge from the ulcer or bump In heavy infestation, ulceration and fibrosis can In heavy infestation, ulceration and fibrosis can

occur. Left untreated, secondary infection such occur. Left untreated, secondary infection such as bacteremia, tetanus and gas gangrene can as bacteremia, tetanus and gas gangrene can occur.occur.

Because the flea has limited jumping ability, the most common site of infection in human is the feet, especialy in the areas between the toes and around the toenails.

Severe tungiasis of the toes.

Prevalence of TungiasisPrevalence of Tungiasis

Tungiasis is found mainly in the Tungiasis is found mainly in the Africa, especially in Nigeria, the Africa, especially in Nigeria, the Caribbean, especially in Trinidad, Caribbean, especially in Trinidad, Central and South America, and Central and South America, and India.India.

Prevention of TungiasisPrevention of Tungiasis

Infection by chigoe flea can be Infection by chigoe flea can be effectively prevented by wearing effectively prevented by wearing shoes and spraying insecticides in shoes and spraying insecticides in affected areas.affected areas.

Tungiasis TreatmentTungiasis Treatment The treatment options for chigoe flea infestation include:The treatment options for chigoe flea infestation include: CryotherapyCryotherapy

Similar to cryotherapy for wart, a freezing solution of Similar to cryotherapy for wart, a freezing solution of liquid nitrogen is applied to "freeze" the tungiasis liquid nitrogen is applied to "freeze" the tungiasis nodule. nodule.

Topical medicineTopical medicineTopical anti-parasitic medicine, such as ivermectin Topical anti-parasitic medicine, such as ivermectin (stromectol) can be used.(stromectol) can be used.

Anti-parasitic drugsAnti-parasitic drugsDrugs such as niridazole has been successfully used to Drugs such as niridazole has been successfully used to kill embedded fleas in adults and children.kill embedded fleas in adults and children.

Petrolatum solutionPetrolatum solutionAnother option is to put a thick layer of petrolatum (liquid Another option is to put a thick layer of petrolatum (liquid paraffin or mineral oil) to suffocate the flea.paraffin or mineral oil) to suffocate the flea.

Removal by forcepRemoval by forcepWhen the flea is close enough to the surface, a When the flea is close enough to the surface, a forcep or a needle can be used to gently remove it forcep or a needle can be used to gently remove it from the skin.from the skin.

SurgerySurgeryIf the flea is engorged with blood, it may be difficult If the flea is engorged with blood, it may be difficult to remove with a forcep. Here, a minor surgery to remove with a forcep. Here, a minor surgery using a curette to excise the nodule may be using a curette to excise the nodule may be necessary.necessary.

After removal of the chigoe flea, topical antibiotics After removal of the chigoe flea, topical antibiotics are applied to the wound. Broad spectrum are applied to the wound. Broad spectrum antibiotics and tetanus shot may also be given to antibiotics and tetanus shot may also be given to prevent secondary infections. prevent secondary infections.