A healthy 35-year-old man presented with small eggs and a brownish lesion on the medial edge of his right big toe (Panel A). Two weeks before presentation, he had returned from a holiday trip to Brazil, where he had been barefoot. [content.nejm.org]

The infestation is acquired by walking barefoot or lying in places where the flea is present, usually beaches or sandy soils. We report two unrelated cases of imported tungiasis in Portugal that presented to our clinic in the same week. [ncbi.nlm.nih.gov]

• Inflammation

  This is paralleled by intense inflammation of the surrounding tissue. Acute and chronic inflammation leads to the development of painful and debilitating clinical pathology. This results in impaired physical fitness and mobility. [ncbi.nlm.nih.gov]

  Diagram of the lesion showing greyish white halo with black central core and surrounding inflammation 4. Ectopic tungiasis has been described involving conjunctiva, tongue, hands, elbows, thigh, gluteal region and knee. 5. [histopathology-india.net]

  Tungiasis causes skin inflammation, severe pain, itching, and a lesion at the site of infection that is characterized by a black dot at the center of a swollen red lesion, surrounded by what looks like a white halo. [findwords.info]

  Breaking the insect in the process may lead to additional inflammation or infection. [mcdinternational.org]

• Gangrene

  Secondary bacterial infections, including tetanus and gangrene, are not uncommon with tungiasis. [cdc.gov]

  Complications include nail dystrophy, deformity of the fingers or toes, scarring, nail loss, cellulitis, lymphangitis, tetanus, osteomyelitis, gangrene, and spontaneous amputation of the toes. 10. [histopathology-india.net]

  Complications, though rare, may involve ulceration, gangrene, secondary infection, tetanus, and death. This burrowing flea is endemic to Latin America, the Caribbean, Africa, and India. [web.stanford.edu]

  But elsewhere, this parasitic flea causes an inflammatory skin disease called tungiasis, which can lead to gangrene, amputations and painful lesions. [globalhealthnow.org]

• Swelling

  A swelling palpable in the body of her tongue was excised and sent for histology. Tungiasis of the tongue was diagnosed after microscopic examination of formalin-fixed paraffin-embedded Haematoxylin and Eosin-stained tissue sections. [ncbi.nlm.nih.gov]

  Both males and females feed intermittently on their host, but only mated females burrow into the skin (epidermis) of the host, where they cause a nodular swelling. [cdc.gov]

  The pregnant female flea burrows under the skin, sucks blood, swells, and releases eggs. A localized nodule will form at the point of infestation, possibly causing pain and inflammation. [web.stanford.edu]

• Falling

  She will also be producing more than 100 eggs that will fall out of the cavity it has produced. [news-medical.net]

  Over the next two weeks, over 100 eggs are released through the exposed opening and fall to the ground. The flea then dies and is slowly sloughed by the host's skin. The eggs hatch on the ground in 3-4 days. [web.stanford.edu]

  Over the 1-2 weeks whilst it feeds on the host’s blood the flea will lay more than 100 eggs that fall to the ground through the opening of the lesion. Medical interventions include: physical removal of the flea using sterile forceps or needles. [dermnetnz.org]

• Fever

  One child presented with fever which was considered to be caused by superinfected tungiasis. Complications were nail dystrophy (48 patients), deformity of the fingers or toes (12 patients), scarring (4 patients) and nail loss (4 patients). [ncbi.nlm.nih.gov]

  One child presented with fever which was considered to be caused by superinfected tungiasis. 8. Histologically, the skin shows diffuse papillary epithelial hyperplasia with severe orthokeratotic hyperkeratosis. [histopathology-india.net]

  Current Issue Learning/CME Learning/CME CME Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia Case 39-2022: A 31-Year-Old Woman with Postpartum Abdominal Pain and Fever [nejm.org]

  This section also includes photographs of physical findings in travelers; the photographs highlight such diseases as African tick-bite fever, chikungunya, dengue, swimmer's itch, African trypanosomiasis, leishmaniasis, measles, tungiasis, and cutaneous [medical-dictionary.thefreedictionary.com]

• Pneumonia

  Eight were Gram negative namely Enterobacter cloacae (8.5%), Proteus species (8.5%), Klebsiellla species (6.4%), Aeromonas sobria (4.3%), Citrobacter species (4.3%), Proteus mirabillis(4.3%), Enterobacter amnigenus (2.1%) and Klebsiella pneumoniae (2.1% [ncbi.nlm.nih.gov]

• Skin Disease

  Abstract Tungiasis is a parasitic skin disease caused by the penetration of female sand fleas (Tunga penetrans). It is acquired when people walk barefoot or rest on soil, where sand fleas have completed the off-host cycle. [ncbi.nlm.nih.gov]

  03 Aug 2017 Background The prevalence of skin disease in low and middle income countries is high and communicable skin diseases are a significant public health problem. [londonntd.org]

• Ulcer

  A 19-year-old male with epilepsy and mental disability presented with ulcerated and inflamed toes. Clinical examination revealed the presence of approximately 810 embedded jigger fleas on the feet, and another 60 lesions on the hands. [ncbi.nlm.nih.gov]

  The lesions are usually located on the feet and is characterized by pruritic and painful papules and ulcers. The lesions may be either single or multiple, with a whitish halo and a brown-black central core. [histopathology-india.net]

  Case Overview TUNGIASIS Member Rated 0 Patient case no. 10642 Date added 04 August 2009 Patient details Age Adult Location Argentina Localisation Lower limbs / feet / toes Primary Lesions Cyst Translucent nodule Ulcer Pathophysiology infectious diseases [dermquest.com]

• Larva Migrans

  BACKGROUND: Hookworm-related cutaneous larva migrans (CLM) and tungiasis are commonly diagnosed in travelers returning from endemic areas, but reliable data on disease occurrence do not exist. [ncbi.nlm.nih.gov]

  Cutaneous larva migrans: the creeping eruptions. Cutis 2003;72:111-5 45. Bowman DD, Montgomery SP, Zajac AM, Eberhard ML, Kazacos KR. Hookworms of dogs and cats as agents of cutaneous larva migrans. Trands Parasitol 2010;26(4):162-7 46. [podyplomie.pl]

• Cutaneous Larva Migrans

  BACKGROUND: Hookworm-related cutaneous larva migrans (CLM) and tungiasis are commonly diagnosed in travelers returning from endemic areas, but reliable data on disease occurrence do not exist. [ncbi.nlm.nih.gov]

  Cutaneous larva migrans: the creeping eruptions. Cutis 2003;72:111-5 45. Bowman DD, Montgomery SP, Zajac AM, Eberhard ML, Kazacos KR. Hookworms of dogs and cats as agents of cutaneous larva migrans. Trands Parasitol 2010;26(4):162-7 46. [podyplomie.pl]

• Papule

  The lesions are usually located on the feet and is characterized by pruritic and painful papules and ulcers. The lesions may be either single or multiple, with a whitish halo and a brown-black central core. [histopathology-india.net]

  Trotter CMAJ August 14, 2007 177 (4) 343-344; DOI: https://doi.org/10.1503/cmaj.061246 © 2007 Canadian Medical Association Figure 1: Papule with a small dark spot in the patient's right heel. [cmaj.ca]

  Diagnosis A skin biopsy of a suspected papule or nodule may be performed. Eggs may be seen on microscopic examination when a serosanguineous exudates oozes from the central opening. [signssymptoms.org]

  Physical exam revealed clusters of monomorphic yellowish-brown papules and nodules with central black dots and indurated halos on the soles (Figs. 1 and 2). [bjid.org.br]

• Neglect

  KEYWORDS: Imported disease; Morbidity; Neglected tropical disease; Tungiasis [ncbi.nlm.nih.gov]

  Hermann Feldmeier, Jorg Heukelbach, Uade Samuel Ugbomoiko, Elizabeth Sentongo, Pamela Mbabazi, Georg von Samson-Himmelstjerna and Ingela Krantz, Tungiasis—A Neglected Disease with Many Challenges for Global Public Health, PLoS Neglected Tropical Diseases [doi.org]

• Irritability

  The initial burrowing by the gravid females is usually painless; symptoms, including itching and irritation, usually start to develop as the females become fully-developed into the engorged state. [cdc.gov]

  The three travelers with CLM complained of irritability; itching was present in two cases. Pain (58.3%) and itching (50%) were the most common symptoms in travelers with tungiasis. [ncbi.nlm.nih.gov]

  Clinical Features: The initial burrowing by the gravid females is usually painless; symptoms, including itching and irritation, usually start to develop as the females become fully-developed into the engorged state. [mcdinternational.org]

  Symptoms and signs The burrows are intensely irritating and produce an painful, inflammatory nodule. Ulcerations, with black dots in the center may occur. Extraction of the gravid flea using a sterile needle is both diagnostic and therapeutic. [privatehealth.co.uk]

In endemic areas, tungiasis is readily recognized by experienced physicians during physical examination, and further diagnostic workup is usually not required. [medical-dictionary.thefreedictionary.com]

[…] fleas infest an individual, physical debilitation and secondary infections, such as tetanus or gas gangrene, may occur.4,5 In endemic areas, tungiasis is readily recognized by experienced physicians during physical examination, and further diagnostic workup [the-medical-dictionary.com]

(See Epidemiology, Clinical, and Workup.) [2] To reproduce, the flea requires a warm-blooded host. [emedicine.medscape.com]

Mothers were almost exclusively responsible for treatment and knowledge transfer to the next generation. The health sector neither provided health education nor treatment. [ncbi.nlm.nih.gov]

Wearing shoes when walking outside and avoiding direct contact with sand and pebbles Removing sand and pebbles from inside or around homes and establishing a concrete foundation (if possible) Sleeping indoors and not on the bare ground/soil What is the Prognosis [dovemed.com]

Among females, the peak occurs in those aged 55 years and older. [40] In a village in northeastern Brazil, bimodal prevalence peaks were noted in children aged 5-9 years and in adults older than age 60 years. [32] Prognosis The prognosis of tungiasis [emedicine.medscape.com]

Knowledge about the etiological agent of tungiasis and its transmission was high in both communities: 90% knew the flea as the etiological agent of tungiasis. [ncbi.nlm.nih.gov]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Knowledge about the etiology of tungiasis and its transmission was high in surveyed communities, 97.8% of the surveyed population indicated to have experienced tungiasis at least once in their lifetime. [ajol.info]

Diseases of uncertain etiology and environmental diseases in tropics. In, "Tropical Pathology." Editors: H. Spencer, A. D. Dayan, J. B. Gibson, R. G. Huntsman, M. S. R. Hutt, G. C. Jenkins, F. Koberle, B. G. MacGraith and K. Salfelder. [jpgmonline.com]

(See Etiology.) [3, 4, 5, 6] Life cycle of Tunga penetrans - Fortaleza stages included. Compiled and designed by Fausto Bustos and Lucas Manfield. [emedicine.medscape.com]

Systematic studies are needed to increase knowledge on the epidemiological situation of tungasis in Tanzania and to identify endemic areas. [ncbi.nlm.nih.gov]

Case Overview TUNGIASIS Member Rated 0 Patient case no. 10642 Date added 04 August 2009 Patient details Age Adult Location Argentina Localisation Lower limbs / feet / toes Primary Lesions Cyst Translucent nodule Ulcer Pathophysiology infectious diseases [dermquest.com]

Future studies are needed to increase the knowledge on the biology, pathophysiology, epidemiology, therapy and control of the ectoparasite. [ncbi.nlm.nih.gov]

Using appropriate study designs, it remains imperative to increase further the knowledge on the biology, pathophysiology, epidemiology, therapy and control of the sand flea T. penetrans. [doi.org]

Thus, tetanus prophylaxis should be kept up to date in areas where tungiasis is common. [42] Pathophysiology The primary complicating factor of tungiasis infection is the bacterial superinfections that can result from loss of integrity of the skin structures [emedicine.medscape.com]

The aim of the present scrutiny was to assess the public health impact of tungiasis, associated risk factors, and emerging opportunities to prevent and control tungiasis. [ncbi.nlm.nih.gov]

It has been shown that prevention of re-infestation leads to a reduction of the morbidity associated with tungiasis.4 Author contributions Claudia J. Díaz contributed to conception of the manuscript and data acquisition. [bjid.org.br]