Tunga penetrans causing a rapidly progressing foot ulcer in a patient with uncontrolled type 2 diabetes mellitus

Abstract

Tungiasis is a parasitic disease resulting from infestation by a female flea Tunga penetrans. The parasites are endemic in the tropics and can infect patients with diabetes mellitus (DM). Augmented by uncontrolled hyperglycemia and pre-existing neuropathy, the parasite may trigger a locally spreading inflammation, which may aggravate the trauma introduced during its extraction, leading into a rapidly progressing foot ulcer. To the best of our knowledge, no such cases in patients with type 2 diabetes have ever been published from Tanzania and likely none worldwide. This case report shows that, in diabetic patients, the wound resulting from the extraction of T. penetrans may get infected and aggravated by the ongoing inflammatory reaction, rapidly evolve into limb-threatening condition and mortality. Preventive measures are necessary and should be emphasized in patients with DM. Studies are needed to increase our understanding of the pathophysiology, proper management and sequalae of ulcers of this nature.

Beyond the acute phase: a comprehensive literature review of long-term sequelae resulting from infectious diseases

“…Meanwhile mucosal leishmaniasis can lead to partial or complete destruction of the nose and mouth mucous membranes, causing severe disability ( PAHO, 2022a ). Other parasites like Tunga penetrans and Tunga trimamillata (sand fleas), can penetrate the skin causing tungiasis, leading sequelae like difficulty walking, deformations, loss of toenails, and self-amputation of toes ( Ariza et al., 2007 ; Feldmeier et al., 2014 ; Carretero-Anibarro and Peñacoba-Masa, 2022 ; Ebrahim et al., 2022 ) ( Figure 6 ). Another notable condition is Myiasis, a skin infestation stemming from Diptera fly larvae, which can result in skin discolorations or scars ( Francesconi and Lupi, 2012 ; Calvopina et al., 2020 ).…”