Clinical Picture

Tungiasis: diagnosis at a glance Takashi Matono, Yasuyuki Kato, Rie Yotsu, Norio Ohmagari

A 22-year-old Japanese woman presented to our hospital with a 10-day history of pain and a rash on her right first toe 10 days after a 2-week trip to Uganda, where she had stayed within Manafwa district. Although she had worn shoes and socks during student fieldwork she reported wearing sandals with no socks around the suburban guesthouse. On examination she had a yellowish-white nodule, 5 mm diameter, with a central black spot at the rim of her right first toenail (figure). We suspected stage 3 tungiasis and excised the nodule under local anaesthesia, during which we saw several eggs (figure), and also gave a tetanus toxoid booster. Stereomicroscopy showed Tunga penetrans, body length 0·5 mm, with mature eggs (figure). At follow-up examination 7 days later the lesion was completely healed with no signs of secondary bacterial infection. Tungiasis is an ectoparasitic skin disease caused by the female sand flea T penetrans, which is endemic to Central and South America, the Caribbean, and sub-Saharan Africa. The principal reservoirs of the flea are animals. Once inside the person, a tiny flea can grow up to a diameter of 10 mm within 1–3 weeks and leave hundreds of eggs. Tungiasis is an important health hazard in endemic areas, associated with long-term physical disability, immobility, and chronic pain, and self-excision can lead to life-threatening secondary bacterial superinfections such as tetanus and the transmission of blood-borne infections. Although surgical excision has been established as an effective treatment, another option is topical dimethicone to reduce the potential for adverse events. Tungiasis is a dynamic zoonotic disease that can be classified under various stages, making diagnosis challenging as signs and symptoms change during the developmental stages of the embedded female sand flea. Travellers should be educated about the importance of wearing closed shoes and socks at all times during their visits to endemic areas.

Published Online February 12, 2016 S0140-6736(15)01239-8


Disease Control and Prevention Center (T Matono MD, Y Kato MD, N Ohmagari MD), and Department of Dermatology (R Yotsu MD), National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan Correspondence to: Dr Yasuyuki Kato, Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo 162-8655, Japan [email protected]



Contributors All authors contributed equally to patient management and writing of the report. Written consent to publication was obtained. Acknowledgments This report was supported in part by the Emerging/Re-emerging Infectious Diseases Project from the Japan Agency for Medical Research and Development, AMED.

Figure: Tungiasis in a returning traveller from Uganda (A) A periungual yellowish-white nodule with a central black spot on the patient’s right toe. (B) Eggs laid by the Tunga penetrans the female sand flea. (C) Tunga penetrans with mature eggs confirmed using a stereomicroscope.

1000 µm Published online February 12, 2016


Tungiasis: diagnosis at a glance.

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