@entity15903 is an important health problem in poor communities in Brazil and is associated with severe morbidity, particularly in @entity1 . The causative agent, the female flea Tunga penetrans, burrows into the skin of its host, where it develops, produces eggs and eventually dies. From the beginning of the penetration to the elimination of the carcass of the ectoparasite by skin repair mechanisms, the whole process takes 4-6 weeks. The present study is based on specimens from 86 @entity1 , for some of whom the exact time of penetration was known. Lesions were photographed, described in detail and biopsied. Biopsies were examined histologically and by means of @entity4653 ( @entity4653 ). Based on clinical, @entity4653 and histological findings, the "Fortaleza classification" was elaborated. This allows the natural history of @entity15903 to be divided into five stages: (1) the penetration phase, (2) the phase of beginning @entity1184 , (3) the white halo phase, (4) the involution phase and (5) residues in the host's skin. Based on morphological and functional criteria, stages 3 and 4 are divided into further substages. The proposed Fortaleza classification can be used for clinical and epidemiological purposes. It allows a more precise diagnosis, enables the assessment of chemotherapeutic approaches and helps to evaluate control measures at the community level.

Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil: I. Natural history of XXXX in @entity1 .

@entity1 :: ('9606', 'Species') :: ['children', 'patients'] @entity1184 :: ('MESH:D006984', 'Disease') :: ['hypertrophy'] @entity15903 :: ('MESH:D058285', 'Disease') :: ['tungiasis', 'Tungiasis'] @entity4653 :: ('MESH:D004401', 'Disease') :: ['SEM', 'scanning electron microscopy']
@entity15903 :: (MESH:D058285,Disease) :: ['tungiasis']
