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Tungiasis Symptoms and Diagnosis

By Deborah Fields, BSc (Hons), PgDip, MCIPR

Symptoms

Tungiasis, the skin condition caused by the parasitic Tungapenetrans flea, can cause several different symptoms in a patient who has been bitten.

The tunga flea is found on sandy beaches, rainforests, or around stables. It tends to stay close to the ground and so most commonly bites the feet of people, as well as the feet of other warm-blooded animals.

The bites are mostly concentrated around the lower area, nearer to the ground. This can include bites between the toes. The individual is unlikely to feel the interaction with the flea but will see the effects later. If the person is bitten by the female version of the flea, she will penetrate the skin and burrow inside the epidermis to reach the blood vessels and feed. Her abdomen will be positioned at the surface of the skin and contribute to the discomfort the patient feels. The female flea can remain under the skin for two weeks and during this time it will steadily increase in volume by up to 2000 its original size. She will also be producing more than 100 eggs that will fall out of the cavity it has produced.

Some people have tried to remove the parasite without the help of a doctor because of the combination of irritating and painful symptoms described below:

  • Itchiness – this will be concentrated in the area where the burrowing has occurred. The tunga flea produces a white nodule with a black center where the patient will experience much of the itching
  • Pain – patients can also feel lots of pain in their feet which can lead to an altered way of walking. The patient finds the feet too tender to place them on the ground firmly
  • Ulcers – the burrowing of the flea may result in ulceration of the foot
  • Inflammation – there may be some swelling of the foot where the flea has entered the flesh and some patients’ feet also become pus-filled in the area affected by the parasite
  • Loss of toenails –the fleas can burrow below the toenails and cause them to fall off
  • Deformed toes –these can be the result of a severe attack of the parasites. In some cases, people have reportedly wanted to cut off their toes as a result of the condition because of the pain and discomfort it causes them.

In addition to the symptoms described, there can also be further complications from bacteria and viruses that the fleas might introduce to the body. Here are some of them:

  • Tetanus – this is a condition that can result in muscle spasms, lockjaw, sweating, a high temperature, and fast heartbeat. It can be life-threatening at times
  • Gangrene – this can cause swelling, pain, sores, and blisters. The worst cases can result in amputation
  • Tissue necrosis – tissues in the foot can die and resemble mummified layers
  • Clostridial infection – clostridium bacteria can be found in soil. Patients with this tungiasis may have exposed their open sores to the bacteria if they have walked around without shoes to protect their feet. Clostridium can cause all sorts of gastrointestinal diseases.

Diagnosis

If tungiasis is suspected, doctors will look for signs that eggs from the burrowing female flea, are being expelled from the affected area on the feet. A doctor can massage the foot in the suspected area to encourage the production of the eggs from a cavity. Another visible sign is brown strands of feces produced by the flea hanging out of the sores.

A biopsy can also be carried out on the lesions to determine whether a parasite is present. The doctor will be looking for signs of ectoparasite or chitinous fragments.

Local people are also very good at recognizing the signs of the disease in others within their community.

Reviewed by Susha Cheriyedath, MSc

References

Further Reading

Last Updated: Aug 12, 2016

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