Infection with tungiasis through interhost movement of adult female sand fleas, Tunga penetrans

Extract

Tungiasis is a highly neglected tropical skin disease caused by the parasitic adult female sand flea, Tunga penetrans. More than 80% of tungiasis patients are found in the age group <15 y, in the elderly population and in people with disabilities. Tungiasis is a public health threat in the most marginalized, resource-poor communities of sub-Saharan Africa, South America and the Caribbean.¹ Patients struggle to walk, and their sleep is disturbed due to itching and pain. Children avoid going to school and hesitate to play with their friends because walking is painful. Their quality of life is significantly impaired,² especially when constant re-infection leads to chronic clinical manifestations including desquamation, hyperkeratosis, fissures, ulcers, lymphoedema and loss of nails and deformation of toes.¹ Bacterial superinfection is common, exacerbating the inflammation and pain.¹

The cause for all this suffering is the unique lifestyle of the adult female sand flea that burrows into the epidermis and once fully embedded after approximately 6–8 h, starts to grow over a period of 7 d until it reaches the size of a pea. This process is known as neosomy and serves in the development of hundreds of eggs in the flea's expanded abdomen.³ It is this growth of the parasite that causes the intense inflammation, pain and itching.¹