Abstract
The sand flea Tunga penetrans is one of the zoonotic agents of tungiasis, a parasitic skin disease of humans and animals. The dog is one of its main reservoirs. This negatively controlled, randomized, double-masked clinical trial evaluated the therapeutic and residual efficacy of fluralaner for treatment of dogs naturally infested with T. penetrans. Sixty-two dogs from an endemically affected community in Brazil were randomly assigned to either receive oral fluralaner (Bravecto chewable tablets) at a dose of 25 to 56 mg fluralaner/kg body weight, or no treatment (31 dogs per group). Dogs were clinically examined using a severity score for acute canine tungiasis (SCADT), parasitological examinations as defined by the Fortaleza classification, and pictures of lesions on days 0 (inclusion and treatment), 7 ± 2, 14 ± 2, 21 ± 2, 28 ± 2, 60 ± 7, 90 ± 7, 120 ± 7 and 150 ± 7. The percentage of parasite-free dogs after treatment was >90% between days 14 and 90 post-treatment with 100% efficacy on study days 21, 28 and 60. Sand flea counts on fluralaner treated dogs were significantly lower (p<0.025) than control dogs on all counts from day 7 to 120. The number of live sand fleas on treated dogs was reduced by > 90% on day 7, > 95% on days 14 and 90, and 100% from day 21 to 60, and with a significant difference between groups from day 7 to 120. From day 7 to day 120, mean SCADT scores were significantly reduced in treated dogs with a mean of 0.10 compared to 1.54 on day 120 in untreated dogs. Therefore, a single oral fluralaner administration is effective for treating and achieving long lasting (> 12 weeks) prevention for tungiasis in dogs.
Highlights
Tungiasis is a parasitic skin disease caused by sand fleas of the genus Tunga, highly neglected in endemic socioeconomically vulnerable communities, where it affects a wide range of hosts, especially humans, dogs, and pigs but less often cattle, goats as well as other mammals such as rats
Reported tungiasis prevalence in Brazilian dogs ranges from 0.7% to 83.9% [13,16]. These results indicate the important role that dogs play in the disease transmission cycle in endemic and non-endemic areas because of their frequent contact with people and other animals, and because they spread the parasite in the environment [17]
This study showed that a single oral fluralaner (Bravecto chewable tablet) administration to dogs naturally infested with T. penetrans provided a high level of efficacy for the primary outcome measure, the percentage of dogs without embedded sand fleas for more than 12 weeks
Summary
Tungiasis is a parasitic skin disease caused by sand fleas of the genus Tunga, highly neglected in endemic socioeconomically vulnerable communities, where it affects a wide range of hosts, especially humans, dogs, and pigs but less often cattle, goats as well as other mammals such as rats. The disease mainly occurs in Latin America, the Caribbean and sub-Saharan Africa including Madagascar [3], with high prevalence rates in human and animal populations from slums, peripheral urban communities, fishing villages, and rural and indigenous communities, where it becomes a major public health problem [4,5]. Maintenance of tungiasis in endemic areas may occur mainly due to the lack of control and inadequate handling of T. penetrans reservoirs, including dogs, cats, pigs, and rodents, which facilitates spread of eggs of this parasite in the environment. The flea infestation causes acute and chronic injuries that trigger clinical signs including local inflammation, pain and itching [10,11]. A small number of fleas can lead to considerable morbidity presenting as local pain, ulcers, necrosis, hyperemia and edema [10,15]
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