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    Canine tungiasis: High prevalence in a tourist region in Bahia state, Brazil.
    Prev Vet Med 2017 Apr 20;139(Pt A):76-81. Epub 2017 Feb 20.
    UESC, Universidade Estadual de Santa Cruz, Departamento de Ciências Agrárias e Ambientais, Programa de Pós-Graduação em Ciência Animal, Ilhéus, Bahia, Brazil. Electronic address:
    Tungiasis is a parasitic skin disease neglected by authorities, health professionals, and the general population. Its occurrence is significantly associated with poverty. A cross-sectional study was conducted to describe the prevalence of tungiasis, associated clinical signs and risk factors of the canine population at a tourist site in the city of Ilhéus, Bahia (northeast Brazil). Read More

    Treatment of tungiasis with a two-component dimeticone: a comparison between moistening the whole foot and directly targeting the embedded sand fleas.
    Trop Med Health 2017 10;45. Epub 2017 Mar 10.
    Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany.
    Background: Tungiasis (sand flea disease) is caused by the penetration of female sand fleas (Tunga penetrans, Siphonaptera) into the skin. It belongs to the neglected tropical diseases and is prevalent in South America, the Caribbean and sub-Saharan Africa. Tungiasis predominantly affects marginalized populations and resource-poor communities in both urban and rural areas. Read More

    Disseminated tungiasis in a 78-year-old woman from Tanzania: a case report.
    J Med Case Rep 2016 Dec 20;10(1):354. Epub 2016 Dec 20.
    Unit of Research, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania.
    Background: Tungiasis is one of the neglected tropical diseases; it affects up to 40% of individuals living in societies with poor housing and sanitation standards. In endemic areas, Tunga infestation, which predominantly affects the periungual areas of the lower limbs in humans, is associated with considerable morbidity and poor quality of life.

    Case Presentation: A 78-year-old woman of African descent presented with pain, inflammation, suppuration, ulceration, and deformation of digits of all four limbs. Read More

    Successful Treatment of Severe Tungiasis in Pigs Using a Topical Aerosol Containing Chlorfenvinphos, Dichlorphos and Gentian Violet.
    PLoS Negl Trop Dis 2016 Oct 11;10(10):e0005056. Epub 2016 Oct 11.
    Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany.
    Background: In endemic communities, zoonotic tungiasis, a severe skin disease caused by penetrating female sand fleas, is a public health hazard causing significant human and animal morbidity. No validated drugs are currently available for treatment of animal tungiasis. Due to the reservoir in domestic animals, integrated management of human and animal tungiasis is required to avert its negative effects. Read More

    Prevalence and risk factors associated with tungiasis in Mayuge district, Eastern Uganda.
    Pan Afr Med J 2016 24;24:77. Epub 2016 May 24.
    Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
    Introduction: Tungiasis is an endemic but neglected health problem in Uganda especially in resource poor communities. It is largely affecting rural communities in the Eastern, West Nile and Central regions. This study assessed prevalence and risk factors associated with tungiasis in Mayuge district, Eastern Uganda. Read More

    Prevalence and clinical aspects of tungiasis in south-west Nigerian schoolchildren.
    Trop Doct 2017 Jan 8;47(1):34-38. Epub 2016 Jul 8.
    Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
    Tungiasis is highly prevalent in resource-poor communities in sub-Saharan Africa, but studies among schoolchildren are scanty. We assessed prevalence, parasite load and clinical aspects of tungiasis in schoolchildren in south-western Nigeria. A total of 545 schoolchildren was examined. Read More

    Got the Travel Bug? A Review of Common Infections, Infestations, Bites, and Stings Among Returning Travelers.
    Am J Clin Dermatol 2016 Oct;17(5):451-462
    Department of Dermatology, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA.
    The popularity of international travel continues to increase among Americans, even though they often experience subsequent illness on return from their journey. The pathogens responsible are not necessarily endemic to the destination itself but are often the result of poor sanitary conditions or activities engaged in while away. Skin disease ranks third among all medical concerns in returning travelers. Read More

    Two Severe Cases of Tungiasis in Goat Kids in Uganda.
    J Insect Sci 2016 24;16. Epub 2016 Mar 24.
    College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda
    Tungiasis ensues from the penetration and burrowing of female sand fleas (Tunga spp.; Siphonaptera: Tungidae) in the skin of mammals. There are few case reports of severe tungiasis in goats and in these cases the Tunga species were not in most cases clearly identified. Read More

    Tungiasis in Italy: An imported case of Tunga penetrans and review of the literature.
    Pathol Res Pract 2016 May 2;212(5):475-83. Epub 2016 Feb 2.
    Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena 41124, Italy.
    Tungiasis is an animal and human parasitic disease caused by fleas of the genus Tunga (Siphonaptera, Tungidae), endemic in equatorial and subtropical regions and rarely described in European countries, where clinicians and general pathologists could be not aware of this parasitic disease. To our knowledge, only 75 cases of human tungiasis (not all described in detail) were previously reported in Italy. We described a new case in a 34-year-old Italian flight attendant who developed a granuloma-like, ulcerated nodule in the subungual region of his left 5th toe, partially detaching the nail, about 20-30 days after his return from Brazil. Read More

    Tungiasis-associated morbidity in pigs and dogs in endemic villages of Uganda.
    Parasit Vectors 2016 Jan 27;9:44. Epub 2016 Jan 27.
    Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, 14163, Berlin, Germany.
    Background: Tunga penetrans (Insecta, Siphonaptera, Tungidae) causes severe morbidity among heavily infected humans and animals in Latin America and sub-Saharan Africa. The clinical pathology of tungiasis in animals has never been studied systematically.

    Methods: This was a cross-sectional study conducted between January to March 2015, aimed at describing tungiasis-associated clinical pathology in 121 and 20 T. Read More

    Animal Reservoirs of Zoonotic Tungiasis in Endemic Rural Villages of Uganda.
    PLoS Negl Trop Dis 2015 16;9(10):e0004126. Epub 2015 Oct 16.
    Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany.
    Background: Animal tungiasis is believed to increase the prevalence and parasite burden in humans. Animal reservoirs of Tunga penetrans differ among endemic areas and their role in the epidemiology of tungiasis had never been investigated in Uganda.

    Methods And Findings: To identify the major animal reservoirs of Tunga penetrans and their relative importance in the transmission of tungiasis in Uganda, a cross sectional study was conducted in animal rearing households in 10 endemic villages in Bugiri District. Read More

    [Two travellers returning from the tropics with persistent wounds on their feet].
    Ned Tijdschr Geneeskd 2015 ;159:A9278
    Koninklijk Instituut voor de Tropen, Amsterdam.
    Two young tropical medicine residents returned from Zanzibar with multiple aching wounds on their toes that did not heal within 6 weeks. The clinical picture fit 'tungiasis', which is caused by Tunga penetrans, also known as jigger or sandflea. The ectoparasites were surgically removed and the status of tetanus vaccination was checked. Read More

    Skin lesions in returning travellers.
    Int Marit Health 2015 ;66(3):173-80
    Department of Epidemiology and Tropical Medicine, Military Institute of Medicine, Warsaw, Poland.
    Skin lesions, apart from diarrhoeas, fever of unknown origin, and respiratory tract infections belong to the most frequent medical problems in travellers returned from tropical and subtropical destinations, accounting more than 10% of reported cases. Most dermatoses have their clinical onset during travel, although some of them can occur after return. Travel-related dermatological problems can have a wide spectrum of clinical picture, from macular, popular or nodular rash, linear and migratory lesions, to plaques, vesicles, bullae, erosions or ulcers. Read More

    Dermatoscopy in inflammatory and infectious skin disorders.
    G Ital Dermatol Venereol 2015 Oct;150(5):521-31
    Dermatology Clinic, University of Catania, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy -
    Dermatoscopy is a non-invasive technique that allows a rapid and magnified in vivo observation of the skin surface. By definition, it is performed with handheld devices (dermatoscopes) allowing X10 magnification. More expensive, computer-assisted digital systems (videodermatoscopes) may be equipped with lenses that ensure magnifications up to X1000; in this case the term videodermatoscopy is generally used. Read More

    Tungiasis Outbreak in Travelers From Madagascar.
    J Travel Med 2015 Jul-Aug;22(4):263-6. Epub 2015 Jun 2.
    Laboratoire de Parasitologie et Zoologie appliquée, Faculté de Médecine, et Institut de Parasitologie de l'Ouest, Rennes, France.
    Seven patients from a group of 16 travelers were diagnosed at our institution with one or more sand fleas on their toes, 1 day to 3 weeks after returning from Madagascar. A questionnaire was sent to the whole group to collect clinical and epidemiological information, which showed that 9 of 13 (69%) had received pre-travel medical advice, but none were aware of sand flea; thus prevention measures were rarely applied. Five of seven (71%) patients wore open sandals throughout the trip. Read More

    Skin infections in returned travelers: an update.
    Curr Infect Dis Rep 2015 Mar;17(3):467
    Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
    Dermatologic manifestations of travel-related illness are particularly vexing due to the broad differential diagnosis and clinicians' unfamiliarity with uncommonly seen diseases. This paper aims to educate and update the reader on selected infectious diseases in the returned traveler whose disease manifestations are primarily dermatologic. First, the evolving epidemiology of these infections is examined; understanding the geographic distribution of infectious etiologies helps refine and narrow the differential diagnosis. Read More

    Characterization of Tunga penetrans antigens in selected epidemic areas in Murang'a county in Kenya.
    PLoS Negl Trop Dis 2015 Mar 20;9(3):e0003517. Epub 2015 Mar 20.
    Department of Zoological sciences, Kenyatta University, Nairobi, Kenya.
    Tunga penetrans are fleas that cause tungiasis, a condition characterized by high transmission rate due to poor housing conditions, social neglect and inadequate health care in economically disadvantaged communities in developing countries. This study therefore aimed at characterizing jiggers antigens to identify immunodominant ones to help understand immunological behavior of the parasite that would otherwise be important in future control of the parasite. Samples were gravid fleas and blood samples from infested individuals in Kahuro and Murang'a East district in Murang'a County. Read More

    Pathology and diagnosis of proliferative and ulcerative dermatitis associated with Tunga penetrans infestation in cattle.
    J Vet Diagn Invest 2015 Jan;27(1):80-5
    private practice, Jujuy, Argentina (Marin)Veterinary Medical Teaching Hospital (Houston), School of Veterinary Medicine, University of California-Davis, Davis, CADepartment of Medicine and Epidemiology (Omanska-Klusek), School of Veterinary Medicine, University of California-Davis, Davis, CACalifornia Animal Health & Food Safety Laboratory, San Bernardino branch (Garcia, Uzal), School of Veterinary Medicine, University of California-Davis, Davis, CACollege of Veterinary Medicine, Western University of Health Sciences, Pomona, CA (Alcaraz)
    Tunga penetrans is the smallest biting flea known. In cattle, infestation by T. penetrans (tungiasis) typically affects the skin of the distal legs, udder, prepuce, and perianal area. Read More

    Notes on the genus Tunga (Siphonaptera: Tungidae) II--neosomes, morphology, classification, and other taxonomic notes.
    Parasite 2014 17;21:68. Epub 2014 Dec 17.
    Laboratoire de Parasitologie et Zoologie appliquée, Faculté de Médecine 2, avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France - Laboratoire de Parasitologie, Mycologie et Immunologie parasitaire, Centre Hospitalier Régional Universitaire, 2 rue Henri Le Guilloux, 32033 Rennes Cedex, France.
    This review focuses on the neosomes, morphology, and taxonomy of adult species of the genus Tunga, complementing the previously published data on the phylogeny, ecology, and pathogenic role. Neosomes are structures formed after penetration of adult females into the skin of hosts resulting in significant enlargement, being the most characteristic and most frequently observed form in hosts. Neosomes can be differentiated by shape, measurements, and sites of attachment to principal hosts. Read More

    Treatment of parasitic skin diseases with dimeticones a new family of compounds with a purely physical mode of action.
    Trop Med Health 2014 Jun;42(2 Suppl):15-20
    Institute of Microbiology and Hygiene, Charité University Medicine , Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
    Epidermal parasitic skin diseases (EPSD) are common in the tropics and sub-tropics. They are caused by mites, lice and other blood-sucking insects. In resource-poor countries they are associated with considerable morbidity. Read More

    Association between footwear use and neglected tropical diseases: a systematic review and meta-analysis.
    PLoS Negl Trop Dis 2014 13;8(11):e3285. Epub 2014 Nov 13.
    Brighton & Sussex Medical School, Brighton, United Kingdom.
    Background: The control of neglected tropical diseases (NTDs) has primarily focused on preventive chemotherapy and case management. Less attention has been placed on the role of ensuring access to adequate water, sanitation, and hygiene and personal preventive measures in reducing exposure to infection. Our aim was to assess whether footwear use was associated with a lower risk of selected NTDs. Read More

    Tungiasis in Northern Tanzania: a clinical report from Qameyu village, Babati District, Manyara Region.
    J Infect Dev Ctries 2014 Nov 13;8(11):1456-60. Epub 2014 Nov 13.
    University of Milan, I.R.C.C.S. Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
    Introduction: Tungiasis is an infestation caused by the penetration in the skin of the gravid female of the flea Tunga penetrans (T. penetrans). The current epidemiological situation of tungiasis in Eastern Africa is poorly known. Read More

    Tungiasis presenting as a soft tissue oral lesion.
    BMC Oral Health 2014 Sep 3;14:112. Epub 2014 Sep 3.
    Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences Makerere University, P, O, Box 7072, Kampala, Uganda.
    Background: The sand flea Tunga penetrans usually infects the feet and affects primary school-age children and elderly persons in rural Uganda. Tungiasis occurs nationwide but disease outbreaks have been reported in the Busoga sub-Region of eastern Uganda, associated with poor sanitation and proximity between humans and domestic animals. Ectopic tungiasis, usually seen with extensive infection and at weight-bearing body surfaces often follows exposure in highly infested environments. Read More

    Neosomes of tungid fleas on wild and domestic animals.
    Parasitol Res 2014 Oct 21;113(10):3517-33. Epub 2014 Aug 21.
    Departamento de Parasitologia, Instituto de Ciências Biológicas da Universidade Federal de Minas Gerais, Caixa Postal 486, Avenida Antônio Carlos, 6627, Campus UFMG, Belo Horizonte, Minas Gerais, 31270-901, Brazil,
    Tunga is the most specialized genus among the Siphonaptera because adult females penetrate into the skin of their hosts and, after mating and fertilization, undergo hypertrophy, forming an enlarged structure known as the neosome. In humans and other warm-blooded animals, neosomes cause tungiasis, which arises due to the action of opportunistic agents. Although its effects on humans and domestic animals are well described in the literature, little is known about the impact of tungiasis on wild animals. Read More

    Treatment of Tungiasis with dimeticone: a proof-of-principle study in rural Kenya.
    PLoS Negl Trop Dis 2014 31;8(7):e3058. Epub 2014 Jul 31.
    Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany.
    Tungiasis (sand flea disease) is a neglected tropical disease, prevalent in resource-poor communities in South America and sub-Saharan Africa. It is caused by an inflammatory response against penetrated female sand fleas (Tunga penetrans) embedded in the skin of the host. Although associated with debilitating acute and chronic morbidity, there is no proven effective drug treatment. Read More

    Tungiasis in Haiti: a case series of 383 patients.
    Int J Dermatol 2014 Aug 6;53(8):999-1004. Epub 2014 Mar 6.
    Department of Dermatology, Hôpital Universitaire la Paix (State University Hospital la Paix), Port-au-Prince, Haiti.
    Background: Tungiasis is endemic in poverty-stricken communities of South and Central America, Africa, Asia, and the Caribbean. This ectoparasitosis, caused by the female sand flea Tunga penetrans, is associated with considerable longterm morbidity in severely affected patients, including toe deformation and limited mobility. In Haiti, tungiasis is poorly documented but is known to occur. Read More

    Illness in travelers returned from Brazil: the GeoSentinel experience and implications for the 2014 FIFA World Cup and the 2016 Summer Olympics.
    Clin Infect Dis 2014 May 28;58(10):1347-56. Epub 2014 Feb 28.
    Global Health and Population, Harvard School of Public Health, Boston.
    Background: Brazil will host the 2014 FIFA World Cup and the 2016 Olympic and Paralympic Games, events that are expected to attract hundreds of thousands of international travelers. Travelers to Brazil will encounter locally endemic infections as well as mass event-specific risks.

    Methods: We describe 1586 ill returned travelers who had visited Brazil and were seen at a GeoSentinel Clinic from July 1997 through May 2013. Read More

    [Tungiasis, an emerging tropical disease in Chile: three imported cases reports].
    Rev Chilena Infectol 2013 Dec;30(6):676-9
    Tungiasis is a cutaneous ectoparasitosis caused by the sand flea Tunga penetrans whose higher prevalence occurs in South America, the Caribbean and Sub-Saharan Africa. It is clinically characterized by a papular lesion, either single or multiple, with a whitish halo and a brown-black central core, most of them localized on the feet. The lesions can be painful and itchy with the most common complication being bacterial superinfection of the skin. Read More

    Infestation of Tunga penetrans in villages near Zomba Central Hospital.
    Malawi Med J 2013 Sep;25(3):88-9
    Zomba Central Hospital/Medical Department, Ministry of Health, Malawi.
    An outbreak of Tunga Penetrans (Jigger Flea) infestation affecting a number of villages near to a Central Hospital in Malawi is described. Due to the large number of affected individuals, high parasitic load, and extended duration of infection an alternative to the recommended approach of surgical removal of the flea was required. Benzyl benzoate paint and liquid paraffin had been used in local Primary Healthcare settings previously and topical treatment with antiparasitic agents has been advocated in the literature, particularly for severe infestation. Read More

    The fate of the embedded virgin sand flea Tunga penetrans: hypothesis, self-experimentation and photographic sequence.
    Travel Med Infect Dis 2013 Nov-Dec;11(6):440-3. Epub 2013 Nov 1.
    Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Hindenburgdamm 27, D-12203 Berlin, Germany.
    We describe the morphological development of a single penetrated female sand flea (Tunga penetrans) in a medical expatriate working in Madagascar. The embedded parasite developed abnormally in two aspects. First, it lived twice as long as usually. Read More

    Tungiasis - A Janus-faced parasitic skin disease.
    Travel Med Infect Dis 2013 Nov-Dec;11(6):357-65. Epub 2013 Oct 18.
    Institute of Microbiology and Hygiene, Charité Medical School, Campus Benjamin Franklin, Hindenburgdamm 27, D-12203 Berlin, Germany. Electronic address:
    Tungiasis is a parasitic skin disease caused by the penetration of female sand fleas (Tunga penetrans). It is acquired when people walk barefoot or rest on soil, where sand fleas have completed the off-host cycle. Tungiasis is a classic poverty-associated disease which belongs to the family of neglected tropical diseases (NTD). Read More

    Prevention of tungiasis and tungiasis-associated morbidity using the plant-based repellent Zanzarin: a randomized, controlled field study in rural Madagascar.
    PLoS Negl Trop Dis 2013 19;7(9):e2426. Epub 2013 Sep 19.
    Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany.
    Background: Tungiasis, a parasitic skin disease caused by the female sand flea Tunga penetrans, is a prevalent condition in impoverished communities in the tropics. In this setting, the ectoparasitosis is associated with important morbidity. It causes disfigurement and mutilation of the feet. Read More

    Tungiasis under dermoscopy: in vivo and ex vivo examination of the cutaneous infestation due to Tunga penetrans.
    An Bras Dermatol 2013 Jul-Aug;88(4):649-51
    Dermatology Department, University of São Paulo, Medical School, Clinics Hospital, São Paulo(SP), Brazil.
    The female flea Tunga penetrans is responsible for a cutaneous parasitosis known as Tungiasis. We report the clinical case of a 12 year-old Caucasian boy who sought treatment in a dermatological private office due to a painful lesion in the plantar area and whose dermoscopic examination, without skin contact, allowed the visualization of parasite's movement inside the skin. The diagnosis of tungiasis is clinical, but it can be aided by in vivo and ex vivo dermoscopic examination of the lesion. Read More

    Regression of severe tungiasis-associated morbidity after prevention of re-infestation: a case series from rural Madagascar.
    Am J Trop Med Hyg 2013 Nov 16;89(5):932-6. Epub 2013 Sep 16.
    Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany; Institut Pasteur de Madagascar, Antananarivo, Madagascar; Faculty of Medicine, Mainz University, Mainz, Germany.
    Tungiasis (sand flea disease) is a neglected tropical disease. Heavy infestation results in mutilation of the feet and difficulty in walking. We identified eight individuals with extremely severe tungiasis in rural Madagascar. Read More

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