Tungiasis (sand flea disease): a parasitic disease with particular challenges for public health

Abstract

Tungiasis (sand flea disease) is caused by the penetration of females of Tunga penetrans into the skin of the feet. Within 2 weeks of penetration the burrowed flea increases its volume by a factor of 2,000. 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. The social implications of tungiasis-associated morbidity are multifold. Children with tungiasis are teased and ridiculed, adults feel ashamed and stigmatized. There is anecdotal evidence that tungiasis negatively affects educational achievements. Impaired mobility and physical fitness will have a negative impact on household economics. Sand flea disease is common in resource-poor communities in South America and in sub-Saharan Africa with prevalence in the general population of up to 60%. In East Africa, it has re-emerged in epidemic dimensions in recent years. Hitherto, no effective drug treatment has been at hand. Traditional treatment, i.e., the manipulation of burrowed sand fleas with blunt and inappropriate instruments may facilitate the transmission of blood-derived pathogens. Prevention is feasible through regular application of a repellent based on coconut oil. Owing to its strong association with poverty, sand flea disease would be an excellent starting point for a community-based fight against rural poverty.

Answer to January 2015 Photo Quiz

“…These lesions may be asymptomatic, pruritic, or painful. The display of typical eggs and suggestive remains of the parasite confirms the diagnosis (1).…”

“…This flea presents a wide range of wild and domestic hosts, humans being an accidental host. Occasionally, tourists from developed countries are diagnosed with tungiais after becoming infected in areas where the disease is endemic (1)(2)(3)(4).…”

Pathology and diagnosis of proliferative and ulcerative dermatitis associated with Tunga penetrans infestation in cattle

“…3 Both in human beings and animals, tungiasis is mainly associated with sandy soils and dry weather, but it has also occasionally been seen in rainforests. 3 Bovine tungiasis has been described in several South American countries with most reports originating from Brazil. 10,12 The disease in cattle can be produced by 3 species of Tunga (i.e., Tunga penetrans, Tunga trimamillata, and Tunga hexalobulata), 2,10 although T. penetrans is by far the most frequently reported species of Tunga associated with bovine tungiasis.…”

Regression of Severe Tungiasis-Associated Morbidity after Prevention of Re-Infestation: A Case Series from Rural Madagascar

“…5,13 If individuals are reinfested frequently, mutilation of the feet ensues, and people can hardly walk. 3,15 There is circumstantial evidence that this causes school absenteeism in children and perpetuates poverty in affected households. 15 Because no effective drug treatment exists, the only means to prevent tungiasis-associated morbidity is to reduce the number of newly penetrating sand fleas to a negligible level.…”

“…3,15 There is circumstantial evidence that this causes school absenteeism in children and perpetuates poverty in affected households. 15 Because no effective drug treatment exists, the only means to prevent tungiasis-associated morbidity is to reduce the number of newly penetrating sand fleas to a negligible level. As the burrowed female sand flea dies in situ within 4 weeks and clinical pathology regresses when no new sand fleas penetrate, the prevention of new infestations will automatically lead to a reduction of tungiasis-associated morbidity.…”