Tungiasis B88.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Sand flea infestation; Tunga penetrans infection

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Non-European epizoonosis caused by the penetration of the mated female sand flea (Tunga penetrans) into human skin. Rarely occurring as a travel disease, the parasitosis is often found in poor residential areas of the sub-Sahara (called "jiggers" there, in South America and the Caribbean.

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Tropical regions of Africa and America/Mexico/Argentina, Caribbean islands, subtropical areas of Asia. Also applies to returning travellers.

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Preferably on the feet (plantae, subungual, interdigital), other parts of the body (when lying on the ground) can also be affected.

Clinical features
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A few days after penetration of the fleas (1-100), formation of inflammatory, moderately painful to pea-sized, reddish, bulging papules or nodes. A black porus (= parasite) often appears centrally. Itching, pressure pain. Complicated are furunculoid abscesses.

The parasite reaches a size of up to 0.5 cm within 7-14 days. The rear end of the flea with the respiratory and genital openings protrudes from the skin. After ejection of the eggs (up to 300 eggs) and the dead flea, a dimple-like depression remains.

More rare are clinical pictures with disseminated strongly itchy papules on the contact surfaces.

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General therapy
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First kill the sand flea with a swab soaked in ether, turpentine oil or paraffin, then remove the sand flea with a needle or fine tweezers. Occasionally an excision is necessary.

In case of multiple infestation: therapy with ivermectin, metrifonate, thiabendazole

External therapy
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The flea body can be removed with a scalpel and tweezers. Further antiseptic therapy e.g. with Clioquinol (e.g. Linola-Sept) once/day in the evening or fusidic acid (e.g. Fucidine ointment).

Internal therapy
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In cases of purulent secondary infection, systemic antibiotics after antibiogram, in severe cases internal antiparasitic therapy with Tiabendazole (Mintezol) 25-50 mg/kg bw/day for 2-4 days.

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Travellers should be informed about the occurrence of the disease in rural areas. It is recommended to wear stockings and closed shoes in places with high parasite load (poor residential areas).

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The sand flea goes through its development from egg, larva, pupa to adult flea in the ground. The infection occurs when the flea penetrates the skin. It can jump up to 40 cm high.

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  9. v. Stebut E et al (2015) Rice dermatoses. Nude Dermatol 41: 433-439

Incoming links (2)

Fleas; Sand flea infestation;


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Last updated on: 29.10.2020