Severe Tungiasis in Underprivileged Communities: Case Series from Brazil

Abstract

Tungiasis is caused by infestation with the sand flea (Tunga penetrans). This ectoparasitosis is endemic in economically depressed communities in South American and African countries. Tungiasis is usually considered an entomologic nuisance and does not receive much attention from healthcare professionals. During a study on tungiasis-related disease in an economically depressed area in Fortaleza, northeast Brazil, we identified 16 persons infested with an extremely high number of parasites. These patients had >50 lesions each and showed signs of intense acute and chronic inflammation. Superinfection of the lesions had led to pustule formation, suppuration, and ulceration. Debilitating sequelae, such as loss of nails and difficulty in walking, were constant. In economically depressed urban neighborhoods characterized by a high transmission potential, poor housing conditions, social neglect, and inadequate healthcare behavior, tungiasis may develop into severe disease.

Tungiasis infestation in Tanzania

“…Since then, tungiasis continues to be an endemic health problem in countries stricken by poverty and deprivation not only on the American, but also on the African continent [1][2][3]. Tunga penetrans infestations may cause severe disease resulting in deformation of digits, chronic lymphedema, ulceration, secondary bacterial infections and tetanus [1,4,5].…”

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

“…If the pain affects particularly sensitive areas, such as the nail wall or the heel of the foot, it is incapacitating and keeps children from attending school and adults from going to work or to perform their household chores [4]. Our data show that localized intensity of pain is reflected by high temperature of the lesion.…”

“…Burrowed sand fleas exercise pressure on the surrounding tissue triggering an acute inflammatory response characterized by intense erythema, oedema, pain and pruritus [2,3]. Usually, adults try to extract penetrated sand fleas by means of needles, pins or thorns, which result, almost constantly, in bacterial superinfections [4], caused by aerobic and anaerobic bacteria, including Clostridia [5]. These infections have the potential to cause severe complications such as cellulitis and tetanus [6] or could lead to mobility restrictions [7].…”

Conhecimento dos profissionais de saúde sobre a situação da tungíase em uma área endêmica no município de Uberlândia, Minas Gerais, Brasil, 2010

“…Nestas áreas, e não muitas vezes, os indivíduos são gravemente infestados, apresentando úlceras e abscessos, deformações digitais, dificuldade de andar, entre outras condições associadas à tungíase. 5,[9][10][11][12][13][14] A doença é comumente negligenciada, tanto por pesquisadores, profissionais de saúde e autoridades de Saúde Pública como, também, pelas populações afetadas. 15 Consequentemente, medidas de controle da tungíase são raramente debatidas ou implementadas nas áreas onde ela ocorre, 16 sendo esse cenário onde a presente pesquisa foi desenvolvida, com o objetivo descrever o conhecimento dos profissionais de saúde da Atenção Básica e do Centro de Controle de Zoonoses sobre a tungíase e sua importância como problema de Saúde Pública em área endêmica do município de Uberlândia, estado de Minas Gerais, Brasil, no ano de 2010.…”