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Anais Brasileiros de Dermatologia

Print version ISSN 0365-0596

An. Bras. Dermatol. vol.86 no.5 Rio de Janeiro Sept./Oct. 2011 



Disseminated tungiasis*



Andrelou Fralete Ayres VallarelliI; Elemir Macedo de SouzaII

IPh.D, private clinic, São Paulo (SP), Brazil
IIAssistant Professor and Associate Senior Lecturer, Dermatology Teaching Division, Department of Clinical Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), São Paulo (SP), Brazil

Mailing address




Tungiasis is a zoophilic and anthropophilic infestation caused by Tunga penetrans. It is endemic in Latin America and in the Caribbean. It occurs mainly in impoverished communities that have no access to basic sanitation and in individuals that visit contaminated areas. The most common penetration site of this ectoparasite is the periungueal region of the feet. The authors present its disseminated form occurring in a patient inhabiting a rural area.

Keywords: Basic sanitation; Communicable diseases; Ectoparasitic infestations; Siphonaptera



Tungiasis is a zooanthropophylic infestation caused by infection by the gravid female of the Tunga penetrane flea, a hematophagous ectoparasite that inhabits dry, sandy soil and spreads principally during the dry season (Figure 1). 1-3 Maturation occurs between 8 and 12 days and the enlarged abdomen of the flea can contain as many as 200 eggs or more. It is endemic in Latin America, the Caribbean and sub-Saharan Africa. 4 Trade and military routes spread the disease and cases exist in travelers to endemic areas1.5-6 The flea's burrowing ability favors penetration of the periungual region of the feet and occasionally the hands, elbows, thighs, face, buttocks and inguinal region (Figure 2). 6-8 After penetration the site becomes inflamed and painful (Figures 3 and 4). Secondary infection may occur in the absence of treatment. Tetanus is a common complication. The disease is more prevalent in poor communities with no paved streets, where people walk barefoot.1.8-10 The diagnosis is clinical and treatment consists of removing the flea with a sterile needle.










1. Heukelbach J, de Oliveira FA, Hesse G, Feldmeier H. Tungiasis: a neglected health problem of poor communities. Trop Med Int Health. 2001;6:267-72.         [ Links ]

2. Heukelbach J, Wilcke T, Harms G, Feldmeier H. Seasonal variation of tungiasis in an endemic community. Am J Trop Med Hyg. 2005:72:145-9.         [ Links ]

3. Ugbomoiko US, Ariza L, Heukelbach J. Parasites of importance for human health in Nigerian dogs: high prevalence and limited knowledge of pet owners. BMC Vet Res. 2008;4:49.         [ Links ]

4. Gatti FR, Oliveira CM, Gatti TRSR, Sanches APG. Tungíase disseminada tratada com ivermectina. An Bras Dermatol. 2008;83:339-42.         [ Links ]

5. Hager J, Jacobs A, Orengo IF, Rosen T. Tungiasis in the United States: a travel souvenir. Dermatol Online J. 2008;14:3.         [ Links ]

6. Ferreira LA, Piazza AA, Belda W Jr, de Souza EM, Ferreira Velho PE. Tunga penetrans as a traveler's disease. Travel Med Infect Dis. 2009;7:381-2.         [ Links ]

7. Heukelbach J, Sahebali S, Van Marck E, Sabóia Moura RC, Feldmeier H. An unusual case of ectopic tungiasis with pseudoepitheliomatous hyperplasia. Braz J Infect Dis. 2004;8:465-8.         [ Links ]

8. Greco JB, Sacramento E, Tavares-Neto J. Chronic ulcers and myasis as ports of entry for Clostridium tetani. Braz J Infect Dis. 2001;5:319-23        [ Links ]

9. Feldmeier H, Eisele M, Sabóia-Moura RC, Heukelbach J. Severe tungiasis in underprivileged communities: case series from Brazil. Emerg Infect Dis. 2003;9:949-55.         [ Links ]

10. Cardoso AEC. Tungíase. An Bras Dermatol. 1990;65(Supl 1):S29-33.         [ Links ]



Mailing address:
Andrelou Fralete Ayres Vallarelli
Av. Barão de Itapura, 950 - Conjunto 44, Botafogo
13020-431 Campinas - SP, Brazil
Phone/fax: (19) 3234-2404 / 3201-6558 / 9790-8050

Received on 22.02.2010.
Approved by the Advisory Board and accepted for publication on 31.08.2010.
Conflict of interest: None
Financial funding: None



* Study conducted in the Dermatology Teaching Division, Department of Clinical Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), São Paulo (SP), Brazil.

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