Tungiasis

# Overview
Tungiasis is a skin infestation of the Tunga penetrans  flea (also known as chigoe flea, jigger, nigua or sand flea), found in the tropical parts of Africa, Caribbean, Central and South America, and India.  This disease is endemic in Nigeria and Trinidad and Tobago where in the 1980s the prevalence of tungiasis among children approached 40%. It is rarely found outside these areas.

# History
The first reported case of tungiasis was noted in the 1500s by Gonzalez Fernandez De Oviedo y Valdes, when sailors from the  Santa Maria who sailed with Christopher Columbus were shipwrecked on Haiti and became infected.  Tungiasis also infected many of the soldiers of the Spanish conquistadores, who also reported that an entire village in Colombia was abandoned because of this disease.  The first clinical account of tungiasis was provided by the Portuguese doctor Aleixo de Abreu.

# Symptoms
The symptoms of this disease include:
- Severe pruritus
- Pain
- Inflammation and swelling
- Lesions and ulcerations, with black dots in the center
Left untreated, secondary infections such as bacteremia, tetanus, and gangrene can occur.

# Prevention
Because of their limited jumping ability, the most common sites of infection are the soles of the feet, the toe web and toenails.  Preventing infection by chigoe flea is easily achieved by wearing shoes when traveling in endemic regions and spraying insecticides on infested soil. Walking barefoot, especially in children, remains the most common reason why tungiasis remains prevalent in poor, rural populations.

# Diagnosis

## Physical Examination

### Skin
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.
- Tungiasis. Adapted from Dermatology Atlas.

# Treatment
Treatment for tungiasis include physical removal of the flea by use of forceps or needles, application of topical anti-parasitic medicine, and surgery to completely remove the nodules. If the flea is discovered in the early stages in can be easily removed, though it is slightly harder without breaking the egg sack. It appears similar to a pustule on the thick skin of the feet or hands.
Other successful reported treatment include applying a thick wax, nail polish, or petroleum solution to suffocate the flea and locally freezing the lesion by using liquid nitrogen. Local application of formaldehyde, chloroform and DDT have also been reported although their use is discouraged due to potential side effects.
Even without treatment, the burrowed fleas will die within two weeks and are naturally sloughed off as the skin sheds.