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Key Words and Related Terms: lymphedema, leg lymphedema, lymphatic filariasis, Elephantiasis, Wuchereria bancrofti, Brugia malayi , B. timori, parasites.

We most commonly think of lymphatic filariasis as caused by a mosquito bite where one of three microscopic parasitic worms are literally injected into your body. These parasitic worms are: Wuchereria bancrofti , Brugia malayi , and B. timor

There is however, another parasite that is not much discussed and therefore very often missed in attempting to diagnose lymphedema in a person from a sub tropical or tropical climate.

Tungiasis is an infestation by the burrowing flea Tunga penetrans or related species. The flea has many common names as listed above. Tungiasis was first reported in crewmen who sailed with Christopher Columbus. The flea is indigenous to the West Indies/Caribbean/Central America region, but it has spread to Africa, India, Pakistan, and South America. Travelers to endemic areas may import cases to other countries, including the United States. These painful infections can cause significant morbidity in groups, such as soldiers. It was first reported by Gonzales Fernandes De Oviedo at the turn of the 16th century when crews of the Spanish ship Santa Maria were shipwrecked in Haiti and became infested with the disease. In the 17th century, Aleixo de Abreau, a Portugese physician working in the Brazilian government provided the first scientific description of Tunga penetrans. To reproduce, the flea requires a warm-blooded host. In addition to humans, reservoir hosts include pigs, dogs, cats, cattle, sheep, horses, mules, rats, mice, and other wild animals and of course we humans. The flea prefers a warm dry soil such as is found on sandy beaches, stables and stock farms. The fleas invade the unprotected skin, most commonly the feet.

“Both the male and the nonfertilized female flea feed intermittently on warm-blooded hosts. Once impregnated, however, the female flea anchors herself to the skin by using biting mouthparts and burrows into the epidermis. Because the process is painless, a keratolytic enzyme may be involved. The flea expands, often reaching 1 cm in diameter. The head is down into the upper dermis feeding from blood vessels, while the caudal tip of the abdomen is at the skin surface, often forming a punctum or an ulceration. The flea breathes through this opening. In many cases, this is described as a white patch with a black dot.

Over 1-2 weeks, more than 100 eggs, which fall to the ground, are individually released from this exposed orifice. Afterwards, the flea dies and is slowly sloughed by the host. The eggs hatch on the ground in 3-4 days, go through larval and pupal stages and become adults in 2-3 weeks. The complete life cycle lasts approximately 1 month.” “Treatment for this includes cryotherapy or electrodesiccation of the nodules caused by the infecton. Topical ivermectin, metrifonate, and thiabendazole have also been reported as effective. Occlusive petrolatum suffocates the organism. Twenty-percent salicylated petroleum jelly (Vaseline) applied 12-24 h in profound infestations caused the death of the fleas and facilitated their manual removal.” (1)

It is also possible to actually removed the flea from the body cavity it forms, but this can be problematic if the flea is engorged.

Antiparasitic medicine may also be used. Though it is not available in the United States, the drug Niridazole (Ambilhar) has been reported to be complete effective.

Any secondary infection must be treated immediately and aggressively to prevent even further complications.

Tungaiasis can be controlled through the use of shoes, treting infested areas and by treating infected reservoir hosts. Malathion has been shown to be effective when sprayed on the ground.

Complications are similar to any form of lymphedema and these include cellulitis, lymphangitis, gangrene and ainhum. Death from related tetanus has even been reported.

(1) eMedicine

Abstracts and Studies

Tungiasis. Report of one case.

Sep 2011

[Article in Spanish] Tapia E O, Kam C S, Naranjo L M, Villaseca H M. Source Departamento de Anatomía Patológica, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile.


We report a 54-year-old male that, after working in a rural zone of Rio de Janeiro, Brazil, presented with an itching cutaneous lesion in the wrist with a black small central zone. The patient extracted from the lesion a on of 0.5 mm diameter. The pathological study of the insect recognized its body segments. The epidemiological background and the characteristics of the lesion led to the diagnosis of tungiasis.


Tungiasis in a free-ranging jaguar (Panthera onca) population in Brazil.

Mar 2012

Widmer CE, Azevedo FC. Source Inter-unit Program in Applied Ecology, Universidade de São Paulo, PO Box 09, CEP 13418-900, Piracicaba, São Paulo, Brazil.


Tungiasis is an ectoparasitic disease caused by fleas of the genus Tunga. The disease is reported to occur mostly in human populations. In wildlife, however, the occurrence and impact of this disease remains uncertain. We captured and examined 12 free-ranging jaguars for the presence of Tunga penetrans in the Pantanal region of Mato Grosso do Sul state, Brazil. Tungiasis prevalence was 100% in the population; lesions were confined to the jaguar's paws. T. penetrans was identified based on the characteristics of the embedded fleas and the morphological identification of a collected free-living flea. The intensity and stage of infestation varied between individual animals. However, in general, all captured jaguars were in good health. The 100% prevalence of tungiasis may be related to the fact that all captures were performed during the dry season. Their high ecological requirements for space make jaguars potential disseminators of T. penetrans in the Pantanal region. Because cattle ranching and ecotourism are the main economic activities in the Pantanal, further studies should evaluate the risks of tungiasis to human and animal health. To the best of our knowledge, this is the first report of tungiasisin jaguars.


Evidence of tungiasis in pre-Hispanic America.

May 2011

Maco V, Tantaleán M, Gotuzzo E. Source Albert Einstein College of Medicine, New York, New York, USA.


Ancient parasites of the genus Tunga originated in America and, during the first half of the 19th century, were transported to the Eastern Hemisphere on transatlantic voyages. Although they were first documented by Spanish chroniclers after the arrival of Columbus, little is known about their presence in pre-Hispanic America. To evaluate the antiquity of tungiasis in America, we assessed several kinds of early documentation, including written evidence and pre-Incan earthenware reproductions. We identified 17 written documents and 4 anthropomorphic figures, of which 3 originated from the Chimu culture and 1 from the Maranga culture. Tungiasis has been endemic to Peru for at least 14 centuries. We also identified a pottery fragment during this study. This fragment is the fourth representation of tungiasis in pre-Hispanic America identified and provides explicit evidence of disease endemicity in ancient Peru.


External Links

Chiqoe flea transmitter

Kingdom: Animalia

Phylum: Arthropoda

Class: Insecta

Order: Siphonaptera

Family: Hectopsyllidae

Genus: Tunga

Species: penetrans

Binomial name

Tunga penetrans

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tungiasis.txt · Last modified: 2012/10/16 14:40 (external edit)