Tungiasis

Infectious diseases

Clinicals - History

Fact Explanation
Itching Tungiasis is a skin infestation caused by a burrowing flea. The causative flea is called Tunga penetrans/ chigoe flea/ jigger.
The skin is infested by the adult through a bite on the surface. Then it burrows through the skin in to the epidermis to be fed from blood vessels in the upper dermis. The most common infestation site is the feet. Most individuals may asymptomatic. Some develops an itching as the initial presenting complaint. The affected area in usually red and warm due to the inflammation.
Itching
Tungiasis is a skin infestation caused by a burrowing flea. The causative flea is called Tunga penetrans/ chigoe flea/ jigger.
The skin is infested by the adult through a bite on the surface. Then it burrows through the skin in to the epidermis to be fed from blood vessels in the upper dermis. The most common infestation site is the feet. Most individuals may asymptomatic. Some develops an itching as the initial presenting complaint. The affected area in usually red and warm due to the inflammation.
Skin lesion Some patients develop papules and nodules in the site. These papules/ nodules have sharp point or tip with a black dot on them (punctum). Usually they are extremely painful and itchy. Skin lesion
Some patients develop papules and nodules in the site. These papules/ nodules have sharp point or tip with a black dot on them (punctum). Usually they are extremely painful and itchy.
Ulcer Itching on the nodules/ papules cause ulcerations on the site. Ulcer
Itching on the nodules/ papules cause ulcerations on the site.
Complications Secondary bacterial infections, including tetanus and gangrene are common in tungiasis. Complications
Secondary bacterial infections, including tetanus and gangrene are common in tungiasis.
At risk population Tungiasis is more common in Caribbean region, Africa, India ,Pakistan and Latin America. People who walk on bare foot in dry soil and sandy beaches, stables and farms are at higher risk. At risk population
Tungiasis is more common in Caribbean region, Africa, India ,Pakistan and Latin America. People who walk on bare foot in dry soil and sandy beaches, stables and farms are at higher risk.

Clinicals - Examination

Fact Explanation
Skin lesion Patients may present with extremely itchy, erythematous skin in the parts of the feet. After that stage they may develop papules/ nodules which has a punctum. The lesion can range from 4-10mm in diameter. Some may develop ulcerations afterwards. Skin lesion
Patients may present with extremely itchy, erythematous skin in the parts of the feet. After that stage they may develop papules/ nodules which has a punctum. The lesion can range from 4-10mm in diameter. Some may develop ulcerations afterwards.
Difficulty in walking Multiple lesions in the feet can lead to difficulty in walking. Difficulty in walking
Multiple lesions in the feet can lead to difficulty in walking.
Bacterial infections This can occur over the scratch marks of the area or in the ulcer. Bacterial infections
This can occur over the scratch marks of the area or in the ulcer.

Investigations - Diagnosis

Fact Explanation
Parasitologic diagnosis Extraction of the gravid flea and/ or their eggs in the lesion using a sterile needle is diagnostic and therapeutic. Parasitologic diagnosis
Extraction of the gravid flea and/ or their eggs in the lesion using a sterile needle is diagnostic and therapeutic.
Dermoscopy A typical lesion with central, irregular, brown discoloration with a middle plugged opening or a gray-blue discoloration can be identified through dermoscopy. Dermoscopy
A typical lesion with central, irregular, brown discoloration with a middle plugged opening or a gray-blue discoloration can be identified through dermoscopy.

Management - Supportive

Fact Explanation
Tetanus toxoid Tetanus prophylaxis is indicated for patients whose tetanus vaccination status is unknown or not up-to-date. Tetanus toxoid
Tetanus prophylaxis is indicated for patients whose tetanus vaccination status is unknown or not up-to-date.
Prevention The infestation can be avoided by wearing shoes when traveling in endemic areas. Insecticide such as malathion praying on the ground is also helpful. Prevention
The infestation can be avoided by wearing shoes when traveling in endemic areas. Insecticide such as malathion praying on the ground is also helpful.

Management - Specific

Fact Explanation
Watchful waiting Most of the lesions heal themselves within 2 weeks of time. The flea dies and naturally sloughs off as the skin sheds. Watchful waiting
Most of the lesions heal themselves within 2 weeks of time. The flea dies and naturally sloughs off as the skin sheds.
Physical removal of the flea A sterile needle or forceps can be used to remove the infested flea from the lesion. This is possible in small lesions where the flea is small enough to pull out through the opening. The lesion has to be cut open in case of the flea is engorged. Physical removal of the flea
A sterile needle or forceps can be used to remove the infested flea from the lesion. This is possible in small lesions where the flea is small enough to pull out through the opening. The lesion has to be cut open in case of the flea is engorged.
Topical ivermectin Local application of anti-parasitic drugs such as ivermectin, metrifonate, and thiabendazole has been proven successful. Topical ivermectin
Local application of anti-parasitic drugs such as ivermectin, metrifonate, and thiabendazole has been proven successful.
cryotherapy Locally freezing the lesion using liquid nitrogen can be effective. cryotherapy
Locally freezing the lesion using liquid nitrogen can be effective.
Antibiotics Topical antibiotics may be instituted if secondary infection is suspected. Antibiotic treatment should be systemic if the superinfection is severe. Antibiotics
Topical antibiotics may be instituted if secondary infection is suspected. Antibiotic treatment should be systemic if the superinfection is severe.

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