1. Tungiasis
SRU

2. Tungiasis
Tungiasis is an infestation of the skin by a burrowing flea called Tunga penetrans (also known as Sarcopsylla penetrans or Pulex penetrans, or more commonly as the chigoe flea, bicho de pie (bug of the foot), jigger, nigua, pico, pigue, and sand flea. Chigoe flea is sometimes confused with chigger or harvest mite.

3. Tungiasis
Acute inflammation with intense erythema and a slight edema is shown.
Lesions are located at the lateral side of the finger and another lesion is lifting up the nail.

4. Tunga penetrans (jigger or sand flea)

5. Life Cycle of the Chigoe Flea
The parasitic chigoe flea lives in warm, dry soil and sand, and is found commonly in beaches, farms, and wooded areas.
Both the male and female fleas feed on warm-blooded host, but only the impregnated female flea anchors herself and burrows into the host's skin.
The chigoe flea burrows head first into the upper dermis, with the tail-end of its abdomen forming an orifice at the skin surface (often causing white patch with a dark tip, bump or ulceration), which the flea uses to breathe.

6. Tungiasis lesion

7. In about 1 to 2 weeks, the chigoe flea becomes enlarged (about the size of a pea) when it becomes full with eggs. It then lays about 100 eggs through the skin orifice, which fall to the ground. The flea then dies and is slowly shed by the host. In approximately 3 to 4 days, the eggs then hatch and become adult fleas in 2 to 3 weeks.
Flea eggs shed from the lesion.

8. Host of the Chigoe Flea
To reproduce, the chigoe flea requires a warm-blooded host, such as human, cattle, sheep, horse, pig, rat, and dog.

9. Symptoms of Tungiasis The symptoms of chigoe flea infestation include:
Extreme itching
Pain
Inflammation
Fibrous cyst
Bumps, lesions or nodules (in form of white or red patches with dark spots)
Ulceration, especially in heavy infestation
Discharge from the ulcer or bump
In heavy infestation, ulceration and fibrosis can occur. Left untreated, secondary infection such as bacteremia, tetanus and gas gangrene can occur.

10. Because the flea has limited jumping ability, the most common site of infection in human is the feet, especialy in the areas between the toes and around the toenails.
Severe tungiasis of the toes.

11. Prevalence of Tungiasis
Tungiasis is found mainly in the Africa, especially in Nigeria, the Caribbean, especially in Trinidad, Central and South America, and India.

12. Prevention of Tungiasis
Infection by chigoe flea can be effectively prevented by wearing shoes and spraying insecticides in affected areas.

13. Tungiasis Treatment
The treatment options for chigoe flea infestation include:
Cryotherapy Similar to cryotherapy for wart, a freezing solution of liquid nitrogen is applied to "freeze" the tungiasis nodule.
Topical medicine Topical anti-parasitic medicine, such as ivermectin (stromectol) can be used.
Anti-parasitic drugs Drugs such as niridazole has been successfully used to kill embedded fleas in adults and children.
Petrolatum solution Another option is to put a thick layer of petrolatum (liquid paraffin or mineral oil) to suffocate the flea.

14. Removal by forcep When the flea is close enough to the surface, a forcep or a needle can be used to gently remove it from the skin.
Surgery If the flea is engorged with blood, it may be difficult to remove with a forcep. Here, a minor surgery using a curette to excise the nodule may be necessary. After removal of the chigoe flea, topical antibiotics are applied to the wound. Broad spectrum antibiotics and tetanus shot may also be given to prevent secondary infections.