Chigger Research Articles

Entirely extracted Tunga penetrans in a traveller to Guinea-Bissau.

A 35-year-old traveller to West Africa returned from his trip with a sand flea embedded in his foot. The pea-sized sand flea was extracted entirely by a non-medical person, allowing an exceptional visualisation. Tungiasis, the sand flea disease, occurs sporadically in travellers. This is the second case reported from Guinea-Bissau.

A pilot study of dimeticone oils versus sodium carbonate treatment for tungiasis: A randomized cohort trial in Homa Bay County, Kenya.

Tungiasis is a cutaneous parasitosis caused by the female flea Tunga penetrans. Two-component dimeticone (NYDA) is the only treatment for tungiasis recommended by the World Health Organization; however, this topical drug is not available in Kenya. In Western Kenya, sodium carbonate is commonly used in the treatment of tungiasis. This study evaluated the 7-day cure rates for tungiasis by comparing sodium carbonate and NYDA treatments in Homa Bay County, Kenya. This was a randomized, observer-blinded, parallel-treatment cohort trial. Twenty-three eligible children with 126 flea infections were matched and randomized. All participants received both treatments, with one treatment on each foot. We recorded all health conditions/information, including inflammation scores and adverse events. Observations were performed on days 3, 5, and 7 using a digital microscope to confirm dead or live fleas based on the viability signs. Twenty-three children aged 3-13 years were analyzed. The proportion of dead fleas on day 7 was higher after NYDA treatment than after 5% sodium carbonate treatment (87% versus 64%, respectively, P = 0.01) NYDA. Median survival was 5 days for both treatments; NYDA had significantly higher trend of flea non-viability rate than 5% sodium carbonate (P<0.01). There were no significant differences in the inflammation score or pain/itchiness between the two treatments. On the last day, 14 children indicated their preference for NYDA in future treatment of tungiasis, whereas nine children preferred the 5% sodium carbonate solution. NYDA was significantly more effective than 5% sodium carbonate for tungiasis treatment. Both treatments were safe but the children preferred NYDA more. Future studies with more participants and an extended observation period are warranted to confirm our findings. The findings suggest that NYDA should be made more available in tungiasis endemic area. UMIN-CTR; UMIN 000044320.

Tungiasis among children in Kenya is associated with poor nutrition status, absenteeism, poor school performance and high impact on quality of life.

Tungiasis is a highly neglected tropical skin disease caused by the sand flea, Tunga penetrans. The flea burrows into the skin inducing a strong inflammatory response, leading to pain and mobility restrictions with potential impacts on quality of life. Few countries implement control efforts and there are few data on the impact of the disease to support policy decisions. We conducted a survey to determine the impact of tungiasis among primary school children across nine counties of Kenya. A total of 10,600 pupils aged 8 to 14 years were randomly selected from 97 primary schools and examined for tungiasis. For 81 cases and 578 randomly selected controls, anthropometric measurements were made, and school attendance and exam scores were collected from school records. Of those with tungiasis, 73 were interviewed regarding their quality of life using a tungiasis-specific instrument. Mixed effect ordered logistic and linear models were used to assess associations between disease status and impact variables. Compared to uninfected pupils, those with tungiasis had lower weight-for-age z-scores (adjusted β -0.41, 95% CI: -0.75-0.06, p = 0.020), missed more days of school the previous term (adjusted Incidence Rate Ratio: 1.49, 95% CI: 1.01-2.21, p = 0.046) and were less likely to receive a high score in mathematics (aOR 0.18, 95% CI: 0.08-0.40, p<0.001) and other subjects. Pupils with severe disease (clinical score >10) were four times more likely to experience severe pain than those with mild disease (OR 3.96, 95% CI: 1.35-11.64, p = 0.012) and a higher impact on their quality of life than those with mild disease (aOR 3.57, 95% CI: 1.17-10.8, p = 0.025) when adjusted for covariates. This study has demonstrated tungiasis has a considerable impact on children's lives and academic achievement. This indicates the need for integrated disease management for school-aged children to protect their physical and cognitive development and their future prospects.

Efficacy of monthly treatment with oral fluralaner (Bravecto® 1-Month) against Tunga penetrans in dogs in Brazil: a randomized, double-blind, controlled field study.

Tungiasis is a neglected tropical disease caused by the adult female sand flea (Tunga penetrans). Dogs are considered important reservoirs of T.penetrans in Brazil. The aim of this study was to determine the monthly insecticidal efficacy of a single oral administration of fluralaner at a dose of 10-18mg/kg (Bravecto® 1-Month, also registered as Defenza® in some countries; MSD Animal Health) in dogs naturally infested with T. penetrans. This clinical trial was conducted in a rural community located in Ilhéus, Bahia, Brazil. A total of 64 dogs were selected and distributed in a completely randomized design between a treated group (TG) that received one single dose of Bravecto® 1-Month (Defenza®) and a negative control group (CG) that received no treatment. Each group was composed of 32 dogs. The evaluations took place on days 0, 7 ± 2, 14 ± 2, 21 ± 2, 28 ± 2, 35 ± 2, and 42 ± 2 post treatment, in which the dogs were inspected to evaluate the infestation stage and classify lesions associated with tungiasis. The primary efficacy was determined from the percentage of treated dogs free of fleas (stage II and III lesions) after administration of the formulation at each evaluation time. Secondary efficacy was based on the number of active lesions (stages II and III) in each group at each evaluation time. The clinical condition of the animals was defined based on the Severity Score for Acute Dog Tungiasis (SCADT), which is related to the number and severity of lesions. The primary efficacy of the product was greater than 95.0% from days 7 to 21 and reached 100.0% between days 28 and 42, with a significant association between treatment and infestation decline (P < 0.025) between days 7 and 42. Secondary drug efficacy was greater than 99.9% from days 7 to 21, reaching 100.0% between days 28 and 42 (P < 0.05). The treated dogs also scored lower on the SCADT than the control animals did during the entire clinical evaluation period (P < 0.05). A single administration of Bravecto® 1-Month (Defenza®) was effective in eliminating Tunga penetrans infestations, as well as in preventing parasitism for at least 42days after treatment.

Detection of a neglected tropical disease: Case report of Heavy &lt;i&gt;Tunga penetrans&lt;/i&gt; lesions on the feet of a thirteen-year-old boy from a community in Lagos, Nigeria

Tungiasis is a neglected tropical disease (NTD) arising from an ectoparasitic infection of the skin of its host by the gravid female Tunga species. The prevalence can spike to about 60% in impoverished regions of South America, the Caribbean, and Sub-Saharan Africa. Instances of severe cases are rare. However, according to the consistent pattern of Tunga penetrans distribution, majority of lesions are carried by a few numbers of hosts. Limited research has been conducted in endemic areas of Nigeria, and in Badagry, wherein a prevalence rate of 21.2% was recently documented. In this report, we detail a severe case of Tungiasis in Jegeme, an endemic community within the Badagry Local Government area of Lagos, which was observed during part of an active surveillance conducted from August 2021 to November, 2021. The case involved a 13-year-old boy who reported several lesions containing embedded fleas on his limbs. Extraction and microscopic examination of the wound revealed eggs and adult forms of Tunga flea. This case highlights the persistence of severe tungiasis within this endemic community, underscoring the link between the infection and extreme poverty. Tungiasis is likely to remain endemic in such resource-poor setting where extreme poverty limits access required to prevent infestation. Appropriate response to infestation to reduce morbidity should be implemented. Improved links between locals in endemic populations and healthcare providers, coupled with increased awareness, and implementation of preventive measures is crucial.

Pathological Responses in Asian House Shrews (Suncus murinus) to the Naturally Acquired Orientia tsutsugamushi Infection.

Scrub typhus is a re-emerging disease caused by Orientia tsutsugamushi, transmitted by mites belonging to the family Trombiculidae. Humans and rodents acquire the infection by the bite of larval mites/chiggers. Suncus murinus, the Asian house shrew, has been reported to harbor the vector mites and has been naturally infected with O. tsutsugamushi. The present study aimed to localize and record O. tsutsugamushi in the tissues and the host response in shrews naturally infected with O. tsutsugamushi. Sheehan's modified May-Grunwald Giemsa staining was carried out in 365 tissues from 87 animals, and rickettsiae were documented in 87 tissues from 20 animals. Immunohistochemical (IHC) staining, using polyclonal antibodies raised against selected epitopes of the 56-kDa antigen, was carried out, and 81/87 tissue sections were tested positive for O. tsutsugamushi. By IHC, in addition to the endothelium, the pathogen was also demonstrated by IHC in cardiomyocytes, the bronchiolar epithelium, stroma of the lungs, hepatocytes, the bile duct epithelium, the epithelium and goblet cells of intestine, the tubular epithelium of the kidney, and splenic macrophages. Furthermore, the pathogen was confirmed by real-time PCR using blood (n = 20) and tissues (n = 81) of the IHC-positive animals. None of the blood samples and only 22 out of 81 IHC-positive tissues were tested positive by PCR. By nucleotide sequencing of the 56-kDa gene, Gilliam and Karp strains were found circulating among these animals. Although these bacterial strains are highly virulent and cause a wide range of pathological alterations, hence exploring their adaptive mechanisms of survival in shrews will be of significance. Given that the pathogen localizes in various organs following a transient bacteremia, we recommend the inclusion of tissues from the heart, lung, intestine, and kidney of reservoir animals, in addition to blood samples, for future molecular surveillance of scrub typhus.

The Burden of Tungiasis (Jiggers’ Infestation) and Its Impact on Rural Vulnerable Populations in Kenya: A Comprehensive Health Assessment on Muranga County, Kenya

Tungiasis, commonly known as jiggers’ infestation, poses significant health challenges within the vulnerable rural population in Kenya. This parasitic skin disease is caused by the female sand flea Tunga penetrans and primarily affects individuals living in impoverished and overcrowded conditions. The infestation leads to severe discomfort, pain, inflammation, and secondary infections, impacting the physical and mental well-being of those affected. This abstract aims to assess the health challenges brought by tungiasis in rural Kenya and especially in Muranga County, highlighting the need for effective prevention strategies, treatment interventions, and public health education to combat this neglected tropical disease. It will also aim at providing an overview of a study conducted to assess the health challenges associated with tungiasis in Muranga County, Kenya. It will also explore the significant health challenges and effects of tungiasis which is also known as jigger’s infestation on rural population in Kenya and provide recommendations on means and measures that should be taken by the department of public health within the ministry of health of Kenya and other stakeholders in improving healthcare conditions for the focus population and transform the plea of this rural population and other rural populations affected within Kenya.

PREVALENCE OF AND DEMOGRAPHIC PROFILE OF PEOPLE WITH TUNGIASIS LIVING IN DANIDA VILLAGE, JINJA DISTRICT, UGANDA.

Tungiasis, a parasitic skin condition caused by the sand flea Tunga penetrans, is characterized by the pregnant flea burrowing into the skin and toes, resulting in irritation and inflammation. This disease is prevalent in tropical regions such as America and Africa, commonly affecting areas like the feet, hands, elbows, and occasionally the buttocks. This study aims to assess the prevalence and demographic characteristics of individuals with tungiasis in Danida village, Jinja district, Uganda. A community-based cross-sectional and descriptive study design was employed, utilizing simple random sampling. A sample size of 268 was determined using Kish and Leslie’s formula. Data collection was carried out through self-administered questionnaires, and analysis was conducted using quantitative methods, including Microsoft Excel for creating charts and graphs. Additionally, analysis software was used for further processing, with results presented in tables and frequencies. The prevalence of tungiasis among participants was found to be 26.9%, with 72 out of 268 individuals affected. Among the participants, 57% had a primary level of education, and 82% of those infested were male. The age bracket most affected was 11-30 years, comprising 59.7% of cases. Furthermore, 63% of individuals with tungiasis came from families that reared animals. In conclusion, the prevalence of tungiasis in Danida village was notably high. Individuals with lower educational levels, aged between 11-30 years, males, and those from families involved in animal rearing were found to be the demographic groups with a higher incidence of Tunga penetrans infestation. Keywords: Tungiasis, Tunga penetrans, Animals, Education, Male gender.

Eutrombicula cochinocaensis infestation in llamas (Lama glama) in the Puna region of Argentina.

This paper aims to describe a case of trombiculosis in llamas from the Puna region of Argentina caused by Eutrombicula cochinocaensis. Trombiculosis is a parasitic infestation caused by the larval form of trombiculid mites, commonly known as chigger mites. Six adult llamas out of eighteen (33%) were infested and showed dermatitis, hyperemia, and crusts together with an orange-dotted pattern. The chigger mites were found mainly in the hind limbs and the abdomen. Microscopic identification of E. cochinocaensis was made by phase-contrast microscopy. Then, a histopathological study of the affected animals' skin was performed. Histological findings included dermatitis withmainly lymphocytic infiltrate, pustules, crusts, hyperkeratosis, and the mites' stylostomes in the dermis and epidermis. This is the first report of trombiculosis caused by E. cochinocaensis in llamas from Argentina. Mites of the family Trombiculidae are vectors of certain diseases to humans and animals and are therefore of sanitary and productive importance.

Developing low-cost house floors to control tungiasis in Kenya – a feasibility study

ContextTungiasis is a neglected tropical skin disease endemic in resource-poor communities. It is caused by the penetration of the female sand flea, Tunga penetrans, into the skin causing immense pain, itching, difficulty walking, sleeping and concentrating on school or work. Infection is associated with living in a house with unsealed earthen house floors.MethodsThis feasibility study used a community-based co-creation approach to develop and test simple, locally appropriate, and affordable flooring solutions to create a sealed, washable floor for the prevention of tungiasis. Locally used techniques were explored and compared in small slab trials. The floor with best strength and lowest cost was pilot trialed in 12 households with tungiasis cases to assess its durability and costs, feasibility of installation in existing local houses using local masons and explore community perceptions. Disease outcomes were measured to estimate potential impact.ResultsIt was feasible to build the capacity of a community-based organization to conduct research, develop a low-cost floor and conduct a pilot trial. The optimal low-cost floor was stabilized local subsoil with cement at a 1:9 ratio, installed as a 5 cm depth slab. A sealed floor was associated with a lower mean infection intensity among infected children than in control households (aIRR 0.53, 95%CI 0.29–0.97) when adjusted for covariates. The cost of the new floor was US$3/m2 compared to $10 for a concrete floor. Beneficiaries reported the floor made their lives much easier, enabled them to keep clean and children to do their schoolwork and eat while sitting on the floor. Challenges encountered indicate future studies would need intensive mentoring of masons to ensure the floor is properly installed and households supervised to ensure the floor is properly cured.ConclusionThis study provided promising evidence that retrofitting simple cement-stabilised soil floors with locally available materials is a feasible option for tungiasis control and can be implemented through training of community-based organisations. Disease outcome data is promising and suggests that a definitive trial is warranted. Data generated will inform the design of a fully powered randomized trial combined with behaviour change communications.Trial registrationISRCTN 62801024 (retrospective 07.07.2023).

Efficacy of an oral formulation of afoxolaner and milbemycin oxime against Tunga penetrans in naturally infected dogs

BackgroundThe sand flea Tunga penetrans is one of the agents of tungiasis, an important parasitic skin disease affecting humans and several mammalian species. Tungiasis is mainly observed in disadvantaged rural and peripheral urban communities in Latin America and sub-Saharan Africa. The dog is a major reservoir of Tunga fleas. Hematophagous adult female Tunga spp. embed and grow in their host’s epidermis and cause cutaneous inflammatory disorders. NexGard Spectra® is an orally administered endectocide for dogs, a co-formulation of the isoxazoline afoxolaner and the macrocyclic lactone milbemycin oxime. The objective of this study was to assess the efficacy of this product against canine tungiasis.MethodsA blinded, negative-controlled field trial was conducted in a Brazilian community known to be highly endemic for tungiasis. Sixty-six dogs naturally infected with live T. penetrans were randomly allocated to a treated group (44 dogs) and an untreated control group (22 dogs). In a first phase, dogs from the treated group were treated on days 0, 30, and 60. Efficacy was evaluated on the basis of the macroscopic parasitic skin lesions (Fortaleza classification) on days 7, 14, 21, 30, 45, 60, 75, and 90. In a second phase, to evaluate natural reinfections, all dogs were treated on day 90 and evaluated every 2 weeks thereafter until at least 30% of dogs were infected with live sand fleas.ResultsDuring the first phase, efficacy (reduction in live sand fleas) of 92.4% was demonstrated on day 7. From day 14 until day 90, the efficacy of NexGard Spectra® was 100%. In the second phase, all dogs were free of live T. penetrans from 15 until 45 days after the day 90 treatment; 60 days post-treatment, 11% of dogs were reinfected, and 75 days post-treatment, 40% of dogs were reinfected.ConclusionsNexGard Spectra® was demonstrated to be highly effective against canine tungiasis. In addition to an obvious beneficial effect on the health and welfare of the treated dog, the use of this product may have a one-health benefit on human cases by controlling the main reservoir of sand fleas.Graphical

Myth or truth: investigation of the jumping ability of Tunga penetrans (Siphonaptera: Tungidae).

Female sand fleas (Tunga penetrans Linnaeus, 1758, Siphonaptera: Tungidae) cause a severe parasitic skin disease known as tungiasis. T. penetrans is a small flea, measuring less than 1 mm in length. The females of this species burrow into the skin of human and animal hosts and mostly affect the feet. This has led to the anecdotal assumption that T. penetrans, unlike its relatives in the Siphonaptera family, would have a limited jumping ability potentially not reaching higher body parts. However, there is no data supporting this. This study evaluated the jumping capabilities of T. penetrans for height and distance using sticky tapes. The vertical jump of the female T. penetrans ranged from 4.5 to 100 mm with a mean of 40 mm whereas the vertical jump of the male T. penetrans ranged from 1.2 to 138 mm with a mean of 46 mm. The horizontal jump of the female T. penetrans ranged from 18 to 138 mm with a mean of 64 mm and that of the male ranged from 9 to 251 mm with a mean of 80 mm. Based on the literature, fleas of various species have been described as jumping vertically 50-100 times their size and horizontally 5-100 times their size. In this respect, sand fleas appear to have equal expert jumping abilities to their relatives. Their aggregation on people's feet is not likely a result of their poor jumping ability but might be an adaptation to the host's behavior which would require further investigations.

National prevalence and risk factors for tungiasis in Kenya

BackgroundTungiasis is a highly neglected tropical skin disease caused by the sand flea, Tunga penetrans, the female of which burrows into the skin, causing pain and itching. The disease occurs throughout South America and sub-Saharan Africa but there are few systematic data on national disease burdens. The tungiasis research community is keen to develop survey methods to fill this gap. Here we used a school-based, thorough examination method to determine the prevalence and risk factors for tungiasis in Kenya.MethodsWe conducted the first nationally representative survey of tungiasis, including nine counties covering the major ecological zones of Kenya. A stratified multistage random sampling was used to select 22 primary schools from each of the nine counties and to select up to 114 pupils aged 8 to 14 years in each school. Pupils were examined thoroughly for tungiasis. Two surveys were conducted, the first between May and July 2021 and the second between October 2021 and April 2023 when pupils were also interviewed for risk factors. Mixed effect logistic regression models were used to test associations of independent variables with tungiasis using the school as a random effect.ResultsThe overall prevalence of tungiasis in the first survey was 1.35% [95% confidence interval (CI): 1.15–1.59%], and 0.89% in the second survey. The prevalence ranged from 0.08% (95% CI: 0.01–0.59%) in Taita Taveta county to 3.24% (95% CI: 2.35–4.44%) in Kajiado county. Tungiasis infection was associated with county of residence, male sex [adjusted odds ratio (aOR) = 2.01, 95% CI: 1.52–2.67], and lower age (aOR = 0.81, 95% CI: 0.75–0.88). For the first time we demonstrate an association with attending public schools rather than private schools (aOR = 5.62, 95% CI: 1.20–26.22) and lower socioeconomic status (aOR = 0.10, 95% CI: 0.03–0.33). Using a rapid screening method of the top of feet only, would have missed 62.9% of all cases, 78.9% of mild cases and 20.0% of severe cases.ConclusionsTungiasis is widely but heterogeneously distributed across Kenya. School-based surveys offer an efficient strategy for mapping tungiasis distribution.Graphical

Tungiasis in two returning travelers in northeastern Brazil: case report

Tungiasis refers to human infection of adult fleas, specifically Tunga penetrans. Although common throughout Central America, the rural South of the U.S the Caribbean, sub-Saharan Africa and Brazil, especially in the poorer areas of the Northeastern region, it is rarely reported in travelers. In this article, we provide two case reports of Tungiasis in travelers from Brazil and United States along with a brief review of the clinical features. Case 01: An American woman, reported that after 02 days of returning from her trip, she noticed a small erythematous lesion on the outside of the first digit of the left foot, which after 04 days increased in size. The flea was then removed with sterile needle and with local antiseptic was applied. The condition evolved over 72 hours without signs of infection and the lesion healed within 6 days. Case 02: A Brazilian woman noticed a small erythematous lesion between her second and third fingers on her right hand 15 days after returning her trip. The lesion started to increase in size, developing a peripheral white area of hyperkeratosis with a central black-gray spot. It was not pruritic. The flea was removed using a sterile needle, and local antiseptic was applied. Over the course of 48 hours, there were no sings of infection, and the lesion healed within 5 days.

Tick and flea infestations in captive Tapirus terrestris and Tapirus kabomani (Perissodactyla: Tapiridae) in the Brazilian Amazon

The present study aimed to identify tick and flea species infesting captive tapirs (Tapirus terrestris and Tapirus kabomani) in the Brazilian Amazon. Ectoparasites were collected from tapirs chemically restrained in Zoo-botanical Parks, breeding facilities, conservationists and, environmental compensation areas in the states of Amapá, Amazonas, and Pará. After collection, the tick and flea specimens were placed in plastic pots containing isopropanol and identified according to dichotomous keys. Ectoparasite infestations were observed in 55% (18/33) tapirs, of which 61% (11/18) were single infestations with ticks or fleas, and 39% (7/18) were mixed infestations with different species of ticks and/or fleas. In total, 227 ticks (15 larvae, 107 nymphs, 38 females and 67 males) and 14 fleas (eight females and six males) were collected, identifying four tick species (Amblyomma cajennense sensu stricto , Amblyomma naponense, Amblyomma oblongoguttatum, and Amblyomma pacae) and three flea species and/or subspecies (Ctenocephalides felis felis, Rhopalopsyllus australis australis, and Tunga penetrans). In conclusion, infestations with Ixodidae ticks and Rhopalopsyllidae, Pulicidae and Tungidae fleas were found in captive tapirs in the Brazilian Amazon, and A. cajennense s.s. was the most frequent species. Additionally, the present study reports new associations between A. pacae and R. a. australis with T. terrestris and between A. cajennense s.s. with T. kabomani.

Efficacy of nitenpyram on the treatment of tungiasis in dogs from brazilian southern amazonic region

Tungiasis is a zoonotic skin disease caused by the penetration of the female flea of Tunga penetrans into the skin of many mammal hosts. Among the hosts, domestic, synanthropic and sylvatic animals serve as reservoirs. However, the dogs are considered the main source of human infestation in rural and endemic communities. The aim of this study was to evaluate the tungicidal efficacy of nitenpyram for the treatment of tungiasis caused by Tunga penetrans in naturally infested dogs from brazilian amazonic region. Twelve dogs presenting from three to fifty-three viable lesions received one dose of nitempyram. The animals received dosages according to the manufacture’s recommendation. The criteria used to determine the drug efficacy were the number of viable lesions after treatment. These were quantified at 3, 7- and 14-days post-treatment. According to the results, the efficacy of Nitempyram was 92,20%, 88,07% and 66,06% in the 3, 7 and 14-days post-treatment.

Reducing Prejudice against Children with Tungiasis: A Qualitative Study from Kenya on How a School Intervention May Raise Awareness and Change Attitudes towards Neglected Diseases

Tungiasis/jiggers, which is caused by the sand flea, tunga penetrans, is a ferocious but neglected disease that affects millions of people in more than 80 low-income countries. If left untreated, jiggers may not only cause pain and secondary infection, but also lead to disabilities, including difficulties grasping and walking, concentration problems, sleep disturbance, skin issues and, among children, exclusion from school due to stigma and prejudice. This study aims to shed light on how a sensitising school intervention may increase awareness and improve attitudes towards jiggers among non-affected pupils. The intervention included 11 h of teaching, involving 75 pupils. In addition to teaching and observation, a pretest and a posttest were conducted. The thematic analysis of the pretest statements resulted in the following themes: “Those affected by jiggers lack knowledge”, “Those affected by jiggers lack proper hygiene” and “Those affected by jiggers should be isolated from society”. Moreover, thematic analysis of the posttest statements resulted in the following themes: “Increased knowledge: ‘Now, I can even educate people about jiggers!’” and “Increased compassion: ‘I feel bad about those people’”. To foster a more inclusive school environment, including for children with disabilities due to jiggers, research on the long-term effects of similar school interventions is recommended.

Tungiasis in a southern tamandua (Tamandua tetradactyla) from Formosa province, Argentina

Tunga penetrans causes tungiasis, a parasitic disease of humans and domestic animals. In this work we report the presence of tungiasis in the southern tamandua (Tamandua tetradactyla) from Formosa, Argentina. An individual of southern tamandua was found dead on the roadside and it presented lesions consisted with neosomes located on its four limbs. We identified neosomes as T. penetrans. Records of T. penetrans in wild mammals acquire relevance because monitoring wildlife could help prevent possible outbreaks of tungiasis and other zoonosis.

Overview of infectious and non-infectious diseases in French Guiana in 2022

Source of many myths, French Guiana represents an exceptional territory due to the richness of its biodiversity and the variety of its communities. The only European territory in Amazonia, surrounded by the Brazilian giant and the little-known Suriname, Ariane 6 rockets are launched from Kourou while 50% of the population lives below the poverty line. This paradoxical situation is a source of health problems specific to this territory, whether they be infectious diseases with unknown germs, intoxications or chronic pathologies.Some infectious diseases such as Q fever, toxoplasmosis, cryptococcosis or HIV infection are in common with temperate countries, but present specificities leading to sometimes different management and medical reasoning. In addition to these pathologies, many tropical diseases are present in an endemic and / or epidemic mode such as malaria, leishmaniasis, Chagas disease, histoplasmosis or dengue. Besides, Amazonian dermatology is extremely varied, ranging from rare but serious pathologies (Buruli ulcer, leprosy) to others which are frequent and benign such as agouti lice (mites of the family Trombiculidae) or papillonitis. Envenomations by wild fauna are not rare, and deserve an appropriate management of the incriminated taxon. Obstetrical, cardiovascular and metabolic cosmopolitan pathologies sometimes take on a particular dimension in French Guiana that must be taken into account in the management of patients. Finally, different types of intoxication are to be known by practitioners, especially due to heavy metals.European-level resources offer diagnostic and therapeutic possibilities that do not exist in the surrounding countries and regions, thus allowing the management of diseases that are not well known elsewhere.Thanks to these same European-level resources, research in Guyana occupies a key place within the Amazon region, despite a smaller population than in the surrounding countries. Thus, certain pathologies such as histoplasmosis of the immunocompromised patient, Amazonian toxoplasmosis or Q fever are hardly described in neighboring countries, probably due to under-diagnosis linked to more limited resources. French Guiana plays a leading role in the study of these diseases.The objective of this overview is to guide health care providers coming to or practicing in French Guiana in their daily practice, but also practitioners taking care of people returning from French Guiana.

Characterization of tungiasis infection and morbidity using thermography in Kenya revealed higher disease burden during COVID-19 school closures

BackgroundTungiasis is a neglected tropical skin disease caused by the sand flea Tunga penetrans. Female fleas penetrate the skin, particularly at the feet, and cause severe inflammation. This study aimed to characterize disease burden in two highly affected regions in Kenya, to test the use of thermography to detect tungiasis-associated inflammation and to create a new two-level classification of disease severity suitable for mapping, targeting, and monitoring interventions.MethodsFrom February 2020 to April 2021, 3532 pupils age 8–14 years were quasi-randomly selected in 35 public primary schools and examined for tungiasis and associated symptoms. Of the infected pupils, 266 were quasi-randomly selected and their households visited, where an additional 1138 family members were examined. Inflammation was assessed using infra-red thermography. A Clinical score was created combining the number of locations on the feet with acute and chronic symptoms and infra-red hotspots.ResultsThe overall prevalence of tungiasis among all the school pupils who were randomly selected during survey rounds 1 and 3 was 9.3% [95% confidence interval (CI): 8.4–10.3]. Based on mixed effects logistic models, the odds of infection with tungiasis among school pupils was three times higher in Kwale (coastal Kenya) than in Siaya [western Kenya; adjusted odds ratio (aOR) = 0.36, 95% CI: 0.18–0.74]; three times higher in males than in females (aOR = 3.0, 95% CI: 2.32–3.91) and three times lower among pupils sleeping in a house with a concrete floor (aOR = 0.32, 95% CI: 0.24–0.44). The odds of finding an infected person among the household population during surveys before the COVID-19 pandemic was a third (aOR = 0.32, 95% CI: 0.19–0.53) of that when schools were closed due to COVID-19 restrictions and approximately half (aOR = 0.44, 95% CI: 0.29–0.68) in surveys done after school re-opening (round 3). Infection intensity was positively correlated with inflammation as measured by thermography (Spearman’s rho = 0.68, P < 0.001) and with the clinical score (rho = 0.86, P < 0.001). Based on the two-level classification, severe cases were associated with a threefold higher level of pain (OR = 2.99, 95% CI: 2.02–4.43) and itching (OR = 3.31, 95% CI: 2.24–4.89) than mild cases.ConclusionsThermography was a valuable addition for assessing morbidity and the proposed two-level classification of disease severity clearly separated patients with mild and severe impacts. The burden of tungiasis was considerably higher in households surveyed during COVID-19 restrictions suggesting underlying risks are found in the home environment more than in school.