Morbidity assessment in sand flea disease (tungiasis)

Abstract

Tungiasis, caused by the sand flea Tunga penetrans, is a health problem in many impoverished communities in Latin America, the Caribbean, and sub-Saharan Africa. Sand flea disease is associated with a broad spectrum of clinical and histological pathology. The factors determining the disease burden in endemic communities are not well understood, and severity of clinical pathology has never been assessed quantitatively. Thus, two severity scores were developed: one for acute disease and one for chronic sequels. These scores were evaluated in a cohort of 70 severely infested patients living in a shantytown in Fortaleza, a capital city in Northeast Brazil. Patients were examined during a period of 25 days and followed-up after a twice daily application of a plant-based repellent to prevent reinfestation. The severity score for acute disease symptoms significantly correlated with the infestation rate and the number of embedded fleas. It turned zero when reinfestation was prevented. The score for chronic disease also significantly correlated with the infestation rate. Tungiasis is associated with considerable acute and chronic morbidity. The degree of acute morbidity is directly related to the number of embedded sand fleas. When transmission is interrupted, the chronic morbidity reflects the infestation rates individuals have experienced in the past.

Tungiasis in Northern Tanzania: a clinical report from Qameyu village, Babati District, Manyara Region

“…Tungiasis associated morbidity, such as pain, difficulty in walking and deformity of toenails, was commonly reported (Table 2). These clinical manifestations have been reported in different studies [8,10,13,14]. One of the most common symptoms reported in our study was itching (62.9% of patients), which is believed to facilitate the leakage of eggs.…”

“…Clusters of embedded fleas usually located at the heels or at the first or the fifth toe, with necrosis of the surrounding tissue known as "honeycomb-like lesions", were observed. [13]. In these patients it was impossible to determine the exact number of the lesions.…”

High-resolution infrared thermography: a new tool to assess tungiasis-associated inflammation of the skin

“…Thereby, HRIT offers the possibility to assess inflammation in a quantitative and objective manner, a progress compared to current methods to detect inflammation in parasitic skin diseases [14,[21][22][23]. Our findings corroborate previous observations showing that the area of inflamed skin due to a bacterial infection is much more precisely determined by HRIT than by visual inspection alone [24].…”

“…The localization of each lesion was noted on a visual scheme. Clinical pathology was assessed adapting the previously validated severity scores for acute and chronic tungiasis, but the assessment was limited to the index lesion [14]. This resulted in a modified severity score for acute tungiasis (mSSAT) and a modified severity score for chronic tungiasis (mSSCT).…”

Tungiasis, una enfermedad tropical emergente en Chile: Comunicación de tres casos clínicos importados

“…Cuando las lesiones son muy numerosas o hay pústulas, puede ser necesario el empleo de antimicrobianos sisté-micos 13 . Un ensayo clínico aleatorio (ECA) efectuado en 108 pacientes, demostró que el uso tópico de ivermectina (loción), tiabendazol (ungüento y loción) o metrifonato (loción) tiene cierta eficacia en disminuir el número de lesiones en comparación con placebo 14 .…”