Parasitology Research

, Volume 100, Issue 2, pp 413–421 | Cite as

Morbidity assessment in sand flea disease (tungiasis)

  • Judith Dorothea Kehr
  • Jörg Heukelbach
  • Heinz Mehlhorn
  • Hermann Feldmeier
Original Paper


Tungiasis, caused by the sand flea Tunga penetrans, is a health problem in many impoverished communities in Latin America, the Caribbean, and sub-Saharan Africa. Sand flea disease is associated with a broad spectrum of clinical and histological pathology. The factors determining the disease burden in endemic communities are not well understood, and severity of clinical pathology has never been assessed quantitatively. Thus, two severity scores were developed: one for acute disease and one for chronic sequels. These scores were evaluated in a cohort of 70 severely infested patients living in a shantytown in Fortaleza, a capital city in Northeast Brazil. Patients were examined during a period of 25 days and followed-up after a twice daily application of a plant-based repellent to prevent reinfestation. The severity score for acute disease symptoms significantly correlated with the infestation rate and the number of embedded fleas. It turned zero when reinfestation was prevented. The score for chronic disease also significantly correlated with the infestation rate. Tungiasis is associated with considerable acute and chronic morbidity. The degree of acute morbidity is directly related to the number of embedded sand fleas. When transmission is interrupted, the chronic morbidity reflects the infestation rates individuals have experienced in the past.


Severity Score Acute Disease Clinical Pathology Scabies Infestation Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We are grateful to the Associação dos Moradores do Sandra`s for supporting the study and to Antonia Valéria Assunção, Vânia Santos de Andrade Souza and Maria de Fátima Cavalcante for skilful assistance. This study was supported by the DAAD-CAPES PROBRAL program no. 152/02. Judith Dorothea Kehr received a grant from the Studienstiftung des Deutschen Volkes, Bonn, Germany. Engelhard Arzneimittel, Niederdorfelden, Germany, provided the repellent Zanzarin® free of charge. The data are part of a medical thesis by Judith Dorothea Kehr.


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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Judith Dorothea Kehr
    • 1
  • Jörg Heukelbach
    • 2
  • Heinz Mehlhorn
    • 3
  • Hermann Feldmeier
    • 1
  1. 1.Institute of Microbiology and HygieneCharité-University Medicine, Campus Benjamin FranklinBerlinGermany
  2. 2.Department of Community Health, School of MedicineFederal University of CearáFortalezaBrazil
  3. 3.Institute of Zoomorphology, Cell Biology and ParasitologyHeinrich Heine-UniversityDüsseldorfGermany

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