A classical case of Tungiasis reported in NEJM

Dr Marianna M. Barbosa, and Dr Adauto D. Barbosa, M.D., at Fluminense Federal University, Rio de Janeiro, Brazil have reported a case of Tungiasis. The case has appeared in the NEJM.

Tungiasis is a cutaneous parasitosis caused by the female sand flea Tunga penetrans (and in some areas also T. trimamillata It is also commonly known as pulga de areia, nigua, pique, bicho do pé, bichodo porco or jatecuba, and in English-speaking countries, as jigger, sand flea or chigoe. Tungiasis is a zoonosis and affects humans and animals alike.Tunga penetrans is distributed in tropical and subtropical regions of the world. In South America, tungiasis has been reported from Columbia to Argentina.

The diagnosis of tungiasis is made clinically and based on the morphological characteristics of the different developmental stages.

In endemic areas, surgical extraction of burrowed sand fleas is the standard treatment. Usually, this is done by the patients themselves or a care-giver. Surgical extraction should only be performed in an appropriately equipped health facility or by an experienced community health worker using sterile instruments.

Metrifonate, thiabendazole and ivermectin have been tested as topical applications. However, none proved to be sufficiently effective.

An otherwise healthy 10-year-old girl presented to the primary care clinic with a 10-day history of multiple itchy papules on the soles of her feet and on her toes. The lesions had black dots in the centre and were painful. Two weeks earlier, the family had travelled to rural Brazil.

During this time, the patient had played in a pigsty without wearing shoes. Sand fleas were removed from multiple lesions, and tungiasis was diagnosed. Tungiasis is a skin infestation caused by the sand flea Tunga penetrans, an ectoparasite that is found throughout tropical and subtropical parts of the world.

The patient had previously received all the recommended tetanus vaccinations. Treatment included flea removal and local wound care. After treatment, there was complete remission of the lesions, with no complications at follow-up.

For more details click on the link: DOI: 10.1056/NEJMicm1810588