Very severe tungiasis in Amerindians in the Amazon lowland of Colombia: A case series

Abstract

BackgroundTungiasis is a parasitic skin disease caused by penetrating female sand fleas. By nature, tungiasis is a self-limiting infection. However, in endemic settings re-infection is the rule and parasite load gradually accumulates over time. Intensity of infection and degree of morbidity are closely related.Methodology/principal findingsThis case series describes the medical history, the clinical pathology, the socio-economic and the environmental characteristics of very severe tungiasis in five patients living in traditional Amerindian communities in the Amazon lowland of Colombia. Patients had between 400 and 1,300 penetrated sand fleas. The feet were predominantly affected, but clusters of embedded sand fleas also occurred at the ankles, the knees, the elbows, the hands, the fingers and around the anus. The patients were partially or totally immobile. Patients 1 and 3 were cachectic, patient 2 presented severe malnutrition. Patient 3 needed a blood transfusion due to severe anemia. All patients showed a characteristic pattern of pre-existing medical conditions and culture-dependent behavior facilitating continuous re-infection. In all cases intradomiciliary transmission was very likely.Conclusion/significanceAlthough completely ignored in the literature, very severe tungiasis occurs in settings where patients do not have access to health care and are stricken in a web of pre-existing illness, poverty and neglect. If not treated, very severe tungiasis may end in a fatal disease course.

Mapping the Geographic Distribution of Tungiasis in Sub-Saharan Africa

“…Socioeconomic and geographic factors, like with so many NTDs, are paramount to the persistence of these diseases. Tungiasis is highly prevalent among people living in extreme poverty in Latin America and SSA [ 15 , 18 ]. Epidemiological hotspots develop through the combination of pervasive poverty, behavioral attributes, and environmental risk factors [ 25 ].…”

“…Severe infestations can lead to the development of fissures, disfigurement, amputation, immobilization, and chronic lymphedema, as well as secondary infections like septicemia, tetanus, and toxic shock syndrome [ 14 , 15 , 16 , 17 ]. Individuals suffering from secondary medical conditions are at an increased risk of developing life-threatening complications [ 18 ]. Tungiasis is a disease of poverty that causes significant morbidity and mortality in children, the disabled, and the elderly [ 19 ].…”

“…The utilization of sharp instruments like needles or pins and even thorns to extract the fleas has been documented [ 15 , 19 ]. This practice raises the risk of contracting human immunodeficiency virus (HIV) and other blood-borne pathogens like Hepatitis B and C [ 18 , 20 ]. Ectopic infections of the genitals [ 21 ], eyelids [ 22 ], and tongue [ 23 ] have been documented.…”

Clinical and pathological aspects of first report of Tunga penetrans infestation on southern brown howler monkey (Alouatta guariba clamitans) in Rio Grande do Sul, Brazil

“…In severe cases, tungiasis infestation can affect limbs and make locomotion difficult, serving as access to secondary infections, in addition to the possibility of limb amputation. Thus, the spread of the agent and the easy infestation make it an important widespread zoonosis in the regions of occurrence of the flea 6 …”

“…Thus, the spread of the agent and the easy infestation make it an important widespread zoonosis in the regions of occurrence of the flea. 6 Fourteen species of Tunga have been described so far, which are divided into two groups according to their morphology and host tropism: caecata, which derives from Tunga caecata and is composed of seven rodent-related species, with Neotropical distribution in China and in Japan, 7,8 and penetrans, derived from T penetrans, which has first established in the Neotropical region and later in the sub-Saharan Africa. 4,7 Furthermore, five species of this group are restricted to South America: Tunga bondari, Tunga perforans, Tunga terasma, Tunga travassoni, and Tunga trimamillata.…”