TUNGIASIS
Dr. Noor Zarina Bt Abd Wahab
Faculty of Health Sciences
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Scientific Classification
Kingdom: Animalia
Phylum: Arthropoda
Class: Insecta
Order: Siphonaptera
Family: Hectopsyllidae
Genus: Tunga
Species: [Link]
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Intro…Tungiasis
• Tungiasis is an inflammatory skin disease caused by infection
of the female ectoparasitic Tunga penetrans flea.
• Tunga penetrans is the smallest flea in the world - measuring
1mm in length.
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History
• From the existing literature, it seems T. penetrans is native to
the West Indies.
• The first case of tungiasis was described in 1526 by Gonzalo
Fernández de Valdés where he discussed the skin infection
and its symptoms on crew members from Columbus’s Santa
Maria after they were shipwrecked on Haiti.
• Through ship routes and further expeditions, the chigoe flea
was spread to the rest of the world, particularly to the rest of
Latin America and Africa.
• The spread to greater Africa occurred throughout the 17th to
19th centuries.
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Causal Agent
• The chigoe flea, Tunga penetrans.
• The flea is also referred to as the jigger, nigua, chica, pico,
pique or suthi.
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Epidemiology
• Tunga penetrans is distributed in tropical and subtropical
regions of the world, including Mexico to South America, the
West Indies and Africa.
• The fleas normally occur in sandy climates, including beaches
and farms.
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LIFE CYCLE OF Tunga penetrans
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Life Cycle
• Eggs are shed by the gravid female into the environment.
• Eggs hatch into larvae in about 3-4 days and feed on organic
debris in the environment.
• Tunga penetrans has two larval stages before forming pupae.
• The pupae are in cocoons that are often covered with debris
from the environment (sand, pebbles, etc).
• The larval and pupal stages take about 3-4 weeks to
complete.
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• Adults hatch from pupae and seek out a warm-blooded
host for blood meals.
• Both males and females feed intermittently on their host,
but only mated females burrow into the skin (epidermis) of
the host, where they cause a nodular swelling.
• Females do not have any specialized burrowing organs, and
simply claw into the epidermis after attaching with their
mouthparts.
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• After penetrating the stratum corneum, they burrow
deeper into the stratum granulosum, with only their
posterior ends exposed to the environment.
• The female fleas continue to feed and their abdomens
extend up to about 1 cm.
• Females shed about 100-200 eggs over a 2 weeks period,
after which they die and are sloughed by the host’s skin.
• Secondary bacterial infections are uncommon with
Tungiasis.
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Gender differentiation of T. penetrans
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Transmission
• Transmission of tungiasis is strictly by infection of Tunga
penetrans.
• The flea is able to jump only 20 cm, which explains why
tungiasis lesions are most commonly found on the periungal
region of the toes.
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Clinical features
• The initial burrowing by the gravid females is usually painless;
symptoms, including itching and irritation, usually start to
develop as the females become fully-developed into the
engorged state.
• Inflammation and ulceration may become severe, and
multiple lesions in the feet can lead to difficulty in walking.
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Gross lesions on a patient's foot caused by T. penetrans
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Laboratory Diagnosis
• Identification is made by the finding of adult fleas and
their eggs in lesions.
• Tunga penetrans burrows under the skin of humans, unlike
other fleas which are ectoparasitic on the surface of the
skin.
• The females remain embedded in the host tissue during
engorgement and egg-production.
• The fleas are usually found between the toes or under toe
nails, and humans acquire the infection when walking
barefoot in tropical and subtropical regions.
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Tunga penetrans removed from a lesion on the bottom of the foot of a patient
who traveled to Africa
Close-up of eggs of T. penetrans.
Image courtesy of Spectrum Health, Grand Rapids, MI.
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NEXT TOPICS:
SCABIES &
PEDICULOSIS
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THE END…
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