Skip to main content

Advertisement

SpringerLink
Log in

Morbidity assessment in sand flea disease (tungiasis)

  • Original Paper
  • Published:
Parasitology Research Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  • Ade-Serrano MA, Ejezie GC (1981) Prevalence of tungiasis in Oto-Ijanikin village, Badagry, Lagos State, Nigeria. Ann Trop Med Parasitol 75:471–472

    PubMed  CAS  Google Scholar 

  • 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 98:282–283

    Article  PubMed  CAS  Google Scholar 

  • Bezerra SM (1994) Tungiasis—an unusual case of severe infestation. Int J Dermatol 33:725

    Article  PubMed  CAS  Google Scholar 

  • Cardoso AEC (1990) Tunguíase. An Bras Dermatol 65:29S–33S

    Google Scholar 

  • 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 98:31–36

    PubMed  Google Scholar 

  • Casala AM, Copello AR, Pensa VN (1954) Sarcopsiliasis (pique o nigua). Arch Argent Dermatol 4:245–254

    Google Scholar 

  • Chadee DD (1998) Tungiasis among five communities in South-western Trinidad, West Indies. Ann Trop Med Parasitol 92:107–113

    Article  PubMed  CAS  Google Scholar 

  • Cotes EC (1899) The jigger or chigoe pest. Ind Med Gaz 4:160–163

    Google Scholar 

  • 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 90:87–99

    PubMed  Google Scholar 

  • Falkenstein (1877) Über das Verhalten der Haut in den Tropen, ihe Pflege und Krankheiten. Virchows Arch Pathol Anat 71:421–440

    Article  Google Scholar 

  • Feldmeier H, Heukelbach J, Eisele M, Sousa AQ, Barbosa LM, Carvalho CB (2002) Bacterial superinfection in human tungiasis. Trop Med Int Health 7:559–564

    Article  PubMed  CAS  Google Scholar 

  • Feldmeier H, Eisele M, Sabóia Moura RC, Heukelbach J (2003) Severe tungiasis in underprivileged communities: case series from Brazil. Emerg Infect Dis 9:949–955

    PubMed  Google Scholar 

  • 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 101:65–69

    Article  PubMed  Google Scholar 

  • Feldmeier H, Kehr JD, Heukelbach J (2006b) A plant-based repellent protects against Tunga penetrans infestation and sand flea disease Acta Trop (in press)

  • Geigy R, Suter P (1960) Zur Copulation der Flöhe. Rev Suisse Zool 67:206–210

    Google Scholar 

  • Gordon RM (1941) The jigger flea. Lancet 2:47–49

    Article  Google Scholar 

  • 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 72:150–154

    PubMed  CAS  Google Scholar 

  • Heukelbach J, Feldmeier H (2006) Scabies. Lancet 367:1767–1774

    Article  PubMed  Google Scholar 

  • Heukelbach J, de Oliveira FA, Hesse G, Feldmeier H (2001) Tungiasis: a neglected health problem of poor communities. Trop Med Int Health 6:267–272

    Article  PubMed  CAS  Google Scholar 

  • Heukelbach J, Wilcke T, Eisele M, Feldmeier H (2002) Ectopic localization of tungiasis. Am J Trop Med Hyg 67:214–216

    PubMed  Google Scholar 

  • 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):368–373

    Article  PubMed  Google Scholar 

  • Heukelbach J, Wilcke T, Feldmeier H (2004) Cutaneous larva migrans (creeping eruption) in an urban slum in Brazil. Int J Dermatol 43:511–515

    Article  PubMed  Google Scholar 

  • Heukelbach J, Wilcke T, Harms G, Feldmeier H (2005a) Seasonal variation of tungiasis in an endemic community. Am J Trop Med Hyg 72(2):145–149

    PubMed  Google Scholar 

  • 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):150–156

    Article  PubMed  CAS  Google Scholar 

  • Jolly GG (1926) An entomological episode of the East African Campaign. Ind Med Gaz 61:164–165

    Google Scholar 

  • 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 100:970–974

    Article  PubMed  Google Scholar 

  • Joyeux C, Sicé A (1937) Précis de médecine coloniale. Masson, Paris, p 441

    Google Scholar 

  • Karsten H (1865) Beitrag zur Kenntniss des Rhynchoprion penetrans. Virchows Arch Pathol Anat 32:269–292

    Google Scholar 

  • Linardi PM (1995) Siphonaptera. In: David Pereira Neves (Org) Parasitologia humana, 9th edn. Livraria Atheneus, Sao Paolo, pp 431–445

    Google Scholar 

  • Linardi PM (1998) Tungíase: uma pulga diferente que provoca um problema persistente.Vet Prag 2:19–21

    Google Scholar 

  • Litvoc J, Leite RM, Katz G (1991) Aspectos epidemiológicos do tétano no estado de São Paulo (Brasil). Rev Inst Med Trop São Paulo 33:477–484

    PubMed  CAS  Google Scholar 

  • 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 90:449–455

    Article  PubMed  Google Scholar 

  • 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 32:520–523

    Article  PubMed  CAS  Google Scholar 

  • Schweizer A (1952) A lórée de la foret vierge. Recits et réflexions d’un medicin en Afrique Equatoriale Francaise. Albin Michel, Paris

    Google Scholar 

  • Soria MF, Capri JJ (1953) Tetanos y “piques”. La Prensa Med Arg 40:4–11

    CAS  Google Scholar 

  • 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 4:350

    Article  Google Scholar 

  • Tonge BL (1989) Tetanus from chigger flea sores. J Trop Pediatr 35:94

    PubMed  CAS  Google Scholar 

  • Valença ZO, Cardoso AEC, Cardoso AS (1972) Tunguiase generalizada: relato de dois casos tratados com thiabendazol. Dermatol Ib-Lat-Am 3:375–378

    Google Scholar 

  • 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 83:255–258

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Institute of Microbiology and Hygiene, Charité-University Medicine, Campus Benjamin Franklin, Hindenburgdamm 27, 12203, Berlin, Germany

    Judith Dorothea Kehr & Hermann Feldmeier

  2. Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil

    Jörg Heukelbach

  3. Institute of Zoomorphology, Cell Biology and Parasitology, Heinrich Heine-University, Düsseldorf, Germany

    Heinz Mehlhorn

Authors
  1. Judith Dorothea Kehr
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jörg Heukelbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heinz Mehlhorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hermann Feldmeier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hermann Feldmeier.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kehr, J.D., Heukelbach, J., Mehlhorn, H. et al. Morbidity assessment in sand flea disease (tungiasis). Parasitol Res 100, 413–421 (2007). https://doi.org/10.1007/s00436-006-0348-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00436-006-0348-z

Keywords

Search

Navigation