Tungiasis is an important health problem in poor communities in Brazil and is associated with severe morbidity, particularly in children. The causative agent, the female flea Tunga penetrans, burrows into the skin of its host, where it develops, produces eggs and eventually dies. From the beginning of the penetration to the elimination of the carcass of the ectoparasite by skin repair mechanisms, the whole process takes 4-6 weeks. The present study is based on specimens from 86 patients, for some of whom the exact time of penetration was known. Lesions were photographed, described in detail and biopsied. Biopsies were examined histologically and by means of scanning electron microscopy (SEM). Based on clinical, SEM and histological findings, the ''Fortaleza classification'' was elaborated. This allows the natural history of tungiasis to be divided into five stages: (1) the penetration phase, (2) the phase of beginning hypertrophy, (3) the white halo phase, (4) the involution phase and (5) residues in the host's skin. Based on morphological and functional criteria, stages 3 and 4 are divided into further substages. The proposed Fortaleza classification can be used for clinical and epidemiological purposes. It allows a more precise diagnosis, enables the assessment of chemotherapeutic approaches and helps to evaluate control measures at the community level.

Background. We assessed community knowledge, attitudes, and practices on malaria as well as acceptability to indoor residual spraying. Material and Methods. A cross-sectional survey was done in a community in Geita district (northwest Tanzania). Household heads (n = 366) were interviewed Results. Knowledge on malaria transmission, prevention, and treatment was reasonable; 56% of respondents associated the disease with mosquito bites, with a significant difference between education level and knowledge on transmission (P < .001). Knowledge of mosquito breeding areas was also associated with education (illiterate: 22%; literate: 59% (P < .001). Bed nets were used by 236 (64.5%), and usage was significantly associated with education level (P < .01). The level of bed net ownership was 77.3%. Most respondents (86.3%) agreed with indoor residual spraying of insecticides. Health facilities were the first option for malaria treatment by 47.3%. Artemether-lumefantrine was the most common antimalarial therapy used. Conclusions. Despite reasonable knowledge on malaria and its preventive measures, there is a need to improve availability of information through proper community channels. Special attention should be given to illiterate community members. High acceptance of indoor residual spraying and high level of bed net ownership should be taken as an advantage to improve malaria control.

Chronic sequelae and disabilities are one of the main problems in leprosy. The current study aimed to estimate the prevalence of disabilities in leprosy patients after successfully completing multidrug therapy in Araguaína, Tocantins State, Brazil. This was a cross-sectional study including 282 cases diagnosed from 2004 to 2009. The degrees of disability at diagnosis and at discharge from treatment were collected from medical records and the National Information System for Notifiable Diseases (SINAN). A simplified neurological workup was performed after discharge from treatment. The prevalence of disabilities at diagnosis was 29.4%, and 8.9% of then was grade II. Between diagnosis and discharge, the degree of physical disability worsened in 25% of cases. At diagnosis, the proportion of deformities was significantly higher in men (RR = 1.7; 95%CI: 1.23-2.37). There was a significant association between disability and multibacillary disease (p < 0.001) and occurrence of reactions (p < 0.001). The data show that after discharge from multidrug therapy, in order to prevent chronic sequelae and functional limitations, continuous monitoring is still needed for individuals that have been recorded as cured and thus deleted from the records.

SummaryTungiasis is caused by penetration of the female sand flea Tunga penetrans into the epidermis of its host. It is endemic in many countries in Latin America, the Caribbean and sub-Saharan Africa. Although superinfection is a common clinical observation, the frequency and the pattern of bacterial pathogens associated with tungiasis have never been investigated systematically. We conducted a prospective clinico-bacteriological study with patients living in a shantytown in Fortaleza, capital of Ceará State (Northeast Brazil), where tungiasis is hyperendemic. Swabs were taken from 78 patients with multiple lesions after surgical extraction of the parasite, and the specimens were cultured for aerobic and anaerobic microorganisms. Ninety-nine specimens were investigated for aerobic bacteria, from which 146 pathogens were identified. The most common species were Staphyloccous aureus (35.5%) and various enterobacteriaceae (29.5%). Bacillus sp., Enteroccous faecalis, Streptococcus pyogenes and Pseudomonas sp. were also isolated. Eighty-four anaerobic cultures yielded 20 pathogens: in eight cases we detected Peptostreptococcus sp., in seven cases Clostridium sp., and in five cases non-identifiable gram-negative bacilli. These results show that secondary infection is very common in tungiasis, and caused by a variety of highly pathogenic microorganisms. It is proposed that T. penetrans acts as a foreign body facilitating biofilm formation within the epidermis. To prevent spreading of pathogens to the surrounding tissue and/or the systemic circulation, sand fleas should be surgically extracted immediately after penetration.keywords tungiasis, clinico-bacteriological study, superinfection, aerobic pathogens, anaerobic pathogens, biofilm formation correspondence Prof.

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Tungiasis (caused by the sand flea Tunga penetrans) is hyperendemic in many resource-poor communities in Brazil. To understand transmission dynamics of this parasitic skin disease in a typical endemic area, a longitudinal study was carried out in a slum in Fortaleza in northeastern Brazil. In a door-to-door survey, the population of a randomly selected area (n = 1,460) was examined on four occasions for the presence of embedded sand fleas. Prevalence rates were 33.6% in March (rainy season), 23.8% in June (end of the rainy season), 54.4% in September (peak of the dry season), and 16.8% in January (begin of the rainy season). Tungiasis was more common in males than in females. The intensity of infestation was correlated with the prevalence. The study shows that prevalence of tungiasis and parasite burden vary significantly during the year with a peak in the dry season. These findings have important consequences for the design of control measures.

ObjectiveTo describe mortality from neglected tropical diseases (NTDs) in Brazil, 2000–2011.MethodsWe extracted information on cause of death, age, sex, ethnicity and place of residence from the nationwide mortality information system at the Brazilian Ministry of Health. We selected deaths in which the underlying cause of death was a neglected tropical disease (NTD), as defined by the World Health Organization (WHO) and based on its International statistical classification of diseases and related health problems, 10th revision (ICD-10) codes. For specific NTDs, we estimated crude and age-adjusted mortality rates and 95% confidence intervals (CI). We calculated crude and age-adjusted mortality rates and mortality rate ratios by age, sex, ethnicity and geographic area.FindingsOver the 12-year study period, 12 491 280 deaths were recorded; 76 847 deaths (0.62%) were caused by NTDs. Chagas disease was the most common cause of death (58 928 deaths; 76.7%), followed by schistosomiasis (6319 deaths; 8.2%) and leishmaniasis (3466 deaths; 4.5%). The average annual age-adjusted mortality from all NTDs combined was 4.30 deaths per 100 000 population (95% CI: 4.21–4.40). Rates were higher in males: 4.98 deaths per 100 000; people older than 69 years: 33.12 deaths per 100 000; Afro-Brazilians: 5.25 deaths per 100 000; and residents in the central-west region: 14.71 deaths per 100 000.ConclusionNTDs are important causes of death and are a significant public health problem in Brazil. There is a need for intensive integrated control measures in areas of high morbidity and mortality.

CLM is a common parasitic skin disease in this rural community, with different topographic patterns of lesions in children and adults. CLM is associated with considerable morbidity. The length of the track can be used to estimate the duration of infestation.