Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil
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Tungiasis is hyperendemic in many poor communities in Brazil and is associated with considerable morbidity. In order to understand the factors that determine the distribution of this ectoparasitosis in a rural community, an epidemiological study was carried out in a traditional fishing village in Ceará State, north-eastern Brazil. Based on active case detection and voluntary participation, 91% of the population (belonging to 95% of all families) was examined. Embedded fleas were looked for over all parts of the body, counted, and the lesions were staged. The overall prevalence of infestation was 51.3% (95% CI: 47.0–55.5). More males than females were infested (54.8% vs 48.3%); however, this difference was not statistically significant. Age-specific prevalence rates followed an S-shaped curve with peaks in children aged 5–9 years and people elder than 60 years. The parasite burden was high (range 1–145 lesions; arithmetic mean: 8.9) and particularly elevated in males, children <15 years and the elderly. The distribution of the parasite burden was uneven within the population with the majority of the lesions in a few individuals: the 23 subjects (8% of all infested) with severe infestation (>30 lesions) accounted for 1,366 of the 2,493 lesions (54.8%) documented. The study shows that tungiasis is a highly prevalent ectoparasitosis in this deprived community with a peculiar distribution of prevalence and parasite burden.
KeywordsParasite Load Parasite Burden Family Leader Tungiasis Severe Infestation
This study was supported by the Ärztekomittee für die Dritte Welt, Frankfurt (Germany), DAAD/CAPES PROBRAL academic exchange program, World Health Organization grant CPE/PVC B''/181/195, Geneva (Switzerland), Bayer Environmental Science, Leverkusen, Germany and Solvay Farma São Paulo (Brazil). The skilful assistance of Antonia Valéria Assunção Santos and the cooperation of the community leaders of Balbino are gratefully acknowledged. M.M., J.H and T.W agree that they have contributed equally to this work. Due to editorial policy this statement cannot appear on the title page. The data are part of a medical thesis by T. Wilcke. We are indebted to Michi Feldmeier for excellent secretarial assistance.
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