Periungual Tungiasis

Abstract

images in clinical medicineT h e ne w e ngl a nd jou r na l o f m e dic i ne n engl j med 359;24 www.nejm.org december 11, 2008 e30 A healthy 35-year-old man presented with small eggs and a brownish lesion on the medial edge of his right big toe (Panel A). Two weeks before presentation, he had returned from a holiday trip to Brazil, where he had been barefoot. The patient was afebrile and without malaise. The brownish part (the decomposing adult sand flea) was excised, and multiple eggs appeared after the application of lateral pressure (Panel B). After disinfection, a sterile dressing was applied. The patient had a complete recovery with no additional symptoms. Tungiasis is an ectoparasitosis in which the fertilized female sand flea (Tunga penetrans) burrows into the skin, with a predilec tion for periungual regions. However, any part of the skin can be affected. In the skin, the flea lays hundreds of eggs and then dies, leaving an open sore containing its hindquarters, which can be an entry point for superinfection. The parasite is endemic in tropical Africa and South America, as well as in subtropical regions of Asia.

Current status of the knowledge on the epidemiology of tungiasis in the Americas

“…Between 2003 and 2021 a total of 135 cases were reported for which the geographical origin of tungiasis was known. Ninety-six out of the 135 cases (71%) were reported from Brazil (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). In Brazil, cases were reported from Amazonas and Roraima States in the North of the country to Rio Grande do Sul State in the extreme South.…”