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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

Abstract

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.

Keywords

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.

Notes

Acknowledgements

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.

References

  1. Ade-Serrano MA, Ejezie GC (1981) Prevalence of tungiasis in Oto-Ijanikin village, Badagry, Lagos State, Nigeria. Ann Trop Med Parasitol 75:471–472PubMedGoogle Scholar
  2. Arene FO (1984) The prevalence of sand flea (Tunga penetrans) among primary and post-primary school pupils in Choba area of the Niger Delta. Public Health 98:282–283PubMedCrossRefGoogle Scholar
  3. Bezerra SM (1994) Tungiasis—an unusual case of severe infestation. Int J Dermatol 33:725PubMedCrossRefGoogle Scholar
  4. Cardoso AEC (1990) Tunguíase. An Bras Dermatol 65:29S–33SGoogle Scholar
  5. Carvalho RW, Almeida AB, Barbosa-Silva SC, Amorim M, Ribeiro PC, Serra-Freire NM (2003) The patterns of tungiasis in Araruama township, state of Rio de Janeiro, Brazil. Mem Inst Oswaldo Cruz 98:31–36PubMedGoogle Scholar
  6. Casala AM, Copello AR, Pensa VN (1954) Sarcopsiliasis (pique o nigua). Arch Argent Dermatol 4:245–254Google Scholar
  7. Chadee DD (1998) Tungiasis among five communities in South-western Trinidad, West Indies. Ann Trop Med Parasitol 92:107–113PubMedCrossRefGoogle Scholar
  8. Cotes EC (1899) The jigger or chigoe pest. Ind Med Gaz 4:160–163Google Scholar
  9. Eisele M, Heukelbach J, van Marck E, Mehlhorn H, Meckes O, Franck S, Feldmeier H (2003) Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil: I. Natural history of tungiasis in man. Parasitol Res 90:87–99PubMedGoogle Scholar
  10. Falkenstein (1877) Über das Verhalten der Haut in den Tropen, ihe Pflege und Krankheiten. Virchows Arch Pathol Anat 71:421–440CrossRefGoogle Scholar
  11. Feldmeier H, Heukelbach J, Eisele M, Sousa AQ, Barbosa LM, Carvalho CB (2002) Bacterial superinfection in human tungiasis. Trop Med Int Health 7:559–564PubMedCrossRefGoogle Scholar
  12. Feldmeier H, Eisele M, Sabóia Moura RC, Heukelbach J (2003) Severe tungiasis in underprivileged communities: case series from Brazil. Emerg Infect Dis 9:949–955PubMedGoogle Scholar
  13. Feldmeier H, Kehr JD, Poggensee G, Heukelbach J (2006a) High exposure to Tunga penetrans (Linnaeus, 1758) correlates with intensity of infestation. Mem Inst Oswaldo Cruz 101:65–69PubMedCrossRefGoogle Scholar
  14. Feldmeier H, Kehr JD, Heukelbach J (2006b) A plant-based repellent protects against Tunga penetrans infestation and sand flea disease Acta Trop (in press)Google Scholar
  15. Geigy R, Suter P (1960) Zur Copulation der Flöhe. Rev Suisse Zool 67:206–210Google Scholar
  16. Gordon RM (1941) The jigger flea. Lancet 2:47–49CrossRefGoogle Scholar
  17. Helbok R, Dent W, Nacher M, Lackner P, Treeprasertsuk S, Krudsood S, Wilairatana S, Silachamroo U, Looareesuwan S, Schmutzhard E (2005) The use of the multi-organ-dysfunction score to discriminate different levels of severity in severe and complicated Plasmodium falciparum malaria. Am J Trop Med Hyg 72:150–154PubMedGoogle Scholar
  18. Heukelbach J, Feldmeier H (2006) Scabies. Lancet 367:1767–1774PubMedCrossRefGoogle Scholar
  19. Heukelbach J, de Oliveira FA, Hesse G, Feldmeier H (2001) Tungiasis: a neglected health problem of poor communities. Trop Med Int Health 6:267–272PubMedCrossRefGoogle Scholar
  20. Heukelbach J, Wilcke T, Eisele M, Feldmeier H (2002) Ectopic localization of tungiasis. Am J Trop Med Hyg 67:214–216PubMedGoogle Scholar
  21. Heukelbach J, van Haeff E, Rump B, Wilcke T, Moura RC, Feldmeier H (2003) Parasitic skin diseases: health care-seeking in a slum in north-east Brazil. Trop Med Int Health 8(4):368–373PubMedCrossRefGoogle Scholar
  22. Heukelbach J, Wilcke T, Feldmeier H (2004) Cutaneous larva migrans (creeping eruption) in an urban slum in Brazil. Int J Dermatol 43:511–515PubMedCrossRefGoogle Scholar
  23. Heukelbach J, Wilcke T, Harms G, Feldmeier H (2005a) Seasonal variation of tungiasis in an endemic community. Am J Trop Med Hyg 72(2):145–149PubMedGoogle Scholar
  24. Heukelbach J, Wilcke T, Winter B, Feldmeier H (2005b) The epidemiology and morbidity of scabies and pediculosis in resource-poor communities in northeast Brazil. Br J Dermatol 153(1):150–156PubMedCrossRefGoogle Scholar
  25. Jolly GG (1926) An entomological episode of the East African Campaign. Ind Med Gaz 61:164–165Google Scholar
  26. Joseph JK, Bazile J, Mutter J, Shin S, Ruddle A, Ivers L, Lyon E, Farmer P (2006) Tungiasis in rural Haiti: a community-based response. Trans R Soc Trop Med Hyg 100:970–974PubMedCrossRefGoogle Scholar
  27. Joyeux C, Sicé A (1937) Précis de médecine coloniale. Masson, Paris, p 441Google Scholar
  28. Karsten H (1865) Beitrag zur Kenntniss des Rhynchoprion penetrans. Virchows Arch Pathol Anat 32:269–292Google Scholar
  29. Linardi PM (1995) Siphonaptera. In: David Pereira Neves (Org) Parasitologia humana, 9th edn. Livraria Atheneus, Sao Paolo, pp 431–445Google Scholar
  30. Linardi PM (1998) Tungíase: uma pulga diferente que provoca um problema persistente.Vet Prag 2:19–21Google Scholar
  31. Litvoc J, Leite RM, Katz G (1991) Aspectos epidemiológicos do tétano no estado de São Paulo (Brasil). Rev Inst Med Trop São Paulo 33:477–484PubMedGoogle Scholar
  32. Muehlen M, Heukelbach J, Wilcke T, Winter B, Mehlhorn H, Feldmeier H (2003) Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil II. Prevalence, parasite load and topographic distribution of lesions in the population of a traditional fishing village. Parasitol Res 90:449–455PubMedCrossRefGoogle Scholar
  33. Robieux I, Eliopoulos C, Hwang P, Greenberg M, Blanchette V, Olivieri N, Klein N, Koren G (1992) Pain perception and effectiveness of the eutectic mixture of local anaesthetics in children undergoing venipuncture. Pediatr Res 32:520–523PubMedCrossRefGoogle Scholar
  34. Schweizer A (1952) A lórée de la foret vierge. Recits et réflexions d’un medicin en Afrique Equatoriale Francaise. Albin Michel, ParisGoogle Scholar
  35. Soria MF, Capri JJ (1953) Tetanos y “piques”. La Prensa Med Arg 40:4–11Google Scholar
  36. Ständer S, Streit M, Darsow U, Niemeier V, Vogelsang M, Ständer H, Gieler U, Gollnick H, Metze D, Weisshaar E (2006) Diagnostisches und therapeutisches Vorgehen bei chronischem Pruritus. J Dt Derm Ges 4:350CrossRefGoogle Scholar
  37. Tonge BL (1989) Tetanus from chigger flea sores. J Trop Pediatr 35:94PubMedGoogle Scholar
  38. Valença ZO, Cardoso AEC, Cardoso AS (1972) Tunguiase generalizada: relato de dois casos tratados com thiabendazol. Dermatol Ib-Lat-Am 3:375–378Google Scholar
  39. 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 83:255–258PubMedCrossRefGoogle Scholar

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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