Parasitology Research

, Volume 90, Issue 2, pp 87–99 | Cite as

Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil: I. Natural history of tungiasis in man

  • Margit Eisele
  • Jörg Heukelbach
  • Eric Van Marck
  • Heinz Mehlhorn
  • Oliver Meckes
  • Sabine Franck
  • Hermann Feldmeier
Original Paper

Abstract.

Tungiasis is an important health problem in poor communities in Brazil and is associated with severe morbidity, particularly in children. The causative agent, the female flea Tunga penetrans, burrows into the skin of its host, where it develops, produces eggs and eventually dies. From the beginning of the penetration to the elimination of the carcass of the ectoparasite by skin repair mechanisms, the whole process takes 4–6 weeks. The present study is based on specimens from 86 patients, for some of whom the exact time of penetration was known. Lesions were photographed, described in detail and biopsied. Biopsies were examined histologically and by means of scanning electron microscopy (SEM). Based on clinical, SEM and histological findings, the "Fortaleza classification" was elaborated. This allows the natural history of tungiasis to be divided into five stages: (1) the penetration phase, (2) the phase of beginning hypertrophy, (3) the white halo phase, (4) the involution phase and (5) residues in the host's skin. Based on morphological and functional criteria, stages 3 and 4 are divided into further substages. The proposed Fortaleza classification can be used for clinical and epidemiological purposes. It allows a more precise diagnosis, enables the assessment of chemotherapeutic approaches and helps to evaluate control measures at the community level.

References

  1. Ade-Serrano MA, Olomolehin OG, Adewunmi A (1982) Treatment of human tungiasis with niridazole (Ambilhar): a double-blind placebo-controlled trial. Ann Trop Med Parasitol 76:89–92PubMedGoogle Scholar
  2. Cardoso A (1981) Generalized tungiasis treated with thiabendazole. Arch Dermatol 117:127Google Scholar
  3. Connor DH (1976) Diseases caused by arthropods—tungiasis. In: Binford CH, Connor DH (eds) Pathology of tropical and extraordinary diseases. Armed Forces Institute of Pathology, Washington, D.C., pp 610–614Google Scholar
  4. Cooper JE (1967) An outbreak of Tunga penetrans in a pig herd. Vet Rec 80:365–366PubMedGoogle Scholar
  5. Feldmeier H, Eisele M, Heukelbach J, Saboia Moura RC (2003) Severe tungiasis—a resurgent health problem in deprived populations? A case series from Northeast Brazil (manuscript submitted)Google Scholar
  6. Feldmeier H, Heukelbach J, Eisele M, Carvalho CBM (2002b) Bacterial superinfection in human tungiasis. Trop Med Int Health 7:559–564CrossRefPubMedGoogle Scholar
  7. Franck S, Wilcke T, Feldmeier H, Heukelbach J (2003) Tungiasis bei Tropenreisenden: eine kritische Bestandsaufnahme. (in press)Google Scholar
  8. Geigy R, Herbig A (1949) Die Hypertrophie der Organe beim Weibchen von Tunga penetrans. Acta Trop 6:246–262Google Scholar
  9. Guerra F (1968) Aleixo de Abreu [1568–1630], author of the earliest book on tropical medicine describing amoebiasis, malaria, typhoid fever, scurvy, yellow fever, draconiasis, trichuriasis and tungiasis in 1623. J Trop Med Hyg 71:55–69PubMedGoogle Scholar
  10. Heukelbach J, Oliveira FAS, Hesse G, Feldmeier H (2001) Tungiasis: a neglected health problem of poor communities. Trop Med Int Health 6:267–272CrossRefPubMedGoogle Scholar
  11. Heukelbach J, Wilcke T, Eisele M, Feldmeier H (2002) Ectopic localization of tungiasis. Am J Trop Med Hyg 67:214–216PubMedGoogle Scholar
  12. Jacobs W, Renner M (1988) Biologie und Ökologie der Insekten. Fischer, StuttgartGoogle Scholar
  13. Karsten H (1865) Beitrag zur Kenntnis des Rhynchoprion penetrans. Virchows Arch Pathol Anat Physiol 32:269–292Google Scholar
  14. Lavoipierre MMJ, Radovsky FJ, Budwiser PD (1979) The feeding process of a tungid flea, Tunga monositus (Siphonaptera: Tungidae), and its relationship to the host inflammatory and repair response. J Med Entomol 15:187–217Google Scholar
  15. Linardi PM (2000) Família Tungidae. In: Linardi PM, Guimaraes LR (eds) Sifonápteros do Brasil, 1st edn. Museu de Zoologia da Universidade de São Paulo, São Paulo, pp 48–53Google Scholar
  16. Mehlhorn H (2001a) Enyclopedic references of parasitology, vol 1. Springer, Berlin Heidelberg New YorkGoogle Scholar
  17. Mehlhorn H (2001b) Enyclopedic references of parasitology, vol 2. Springer, Berlin Heidelberg New YorkGoogle Scholar
  18. Mehlhorn B, Mehlhorn M, Plötz J (2002) Light and scanning electron microscopical study on Antarctophthiosis ogmorhini-lice from the Antarctic seal Leptonychotes weddelli. Parasitol Res 88:651–660Google Scholar
  19. Rey L (1992) Bases da parasitologia médica. Guanabara Koogan, Rio de Janeiro, pp 304–310Google Scholar
  20. Rietschel W (1989) Beobachtungen zum Sandfloh (Tunga penetrans) bei Mensch und Hund in Französisch-Guayana. Tieraerztl Prax 17:189–193Google Scholar
  21. Saraceno EF, Bazarra MLG, Calviello RC et al (1999) Tungiasis: tratamiento de un caso con ivermectina. Arch Argent Dermatol 49:91–95Google Scholar
  22. Schimkewitsch W (1884) Zur Frage nach der Veränderung der Sarcopsylla penetrans unter dem Einflusse des Parasitismus. Virchows Arch Pathol Anat Physiol 52:673–676Google Scholar
  23. Vaz Z, Rocha UF (1946) Tunga penetrans (L., 1758), "bicho de pé" em gado bovino. Livro de Homenagem a R.F. Almeida 40:327–332Google Scholar
  24. Wilcke T, Heukelbach J, Cesar Saboia MR, Regina SK-P, Feldmeier H (2002) High prevalence of tungiasis in a poor neighbourhood in Fortaleza, Northeast Brazil. Acta Trop 83:255–258CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Margit Eisele
    • 1
  • Jörg Heukelbach
    • 2
  • Eric Van Marck
    • 3
  • Heinz Mehlhorn
    • 4
  • Oliver Meckes
    • 5
  • Sabine Franck
    • 1
  • Hermann Feldmeier
    • 1
  1. 1.Institute of International Health, Center for Humanities and Health SciencesFaculty of Medicine, Free University of BerlinBerlinGermany
  2. 2.Mandacaru FoundationFortalezaBrazil
  3. 3.Department of Pathology, Faculty of MedicineUniversity of AntwerpAntwerpBelgium
  4. 4.Department of Zoology and ParasitologyHeinrich-Heine-UniversityDüsseldorfGermany
  5. 5.Eye of ScienceGbRReutlingenGermany

Personalised recommendations