What the World Needs to Know about Tungiasis

Neglected tropical diseases (NTDs) are caused by different types of organisms including viruses, bacteria, and parasites. Diseases that are caused by parasites are known as parasitic diseases. Parasites that infect humans through infestation and or penetration from the external environment are known as ectoparasites and those that are often ingested and find their way into the internal organs are known as endoparatsites. In simple terms, endoparasites live within the host while ectoparasites live on or in the skin of the host.

Today we are going highlight one of the NTDs known as Tungiasis. Tungiasis is a parasitic disease caused by the sand flea Tunga penetrans.

Tunga penetrans is an ectoparasite which burrows and penetrates the skin of their host with its back exposed to the outside allowing it to breathe and lay eggs. The parasite grows within the host, feeding on the host’s blood and lays eggs which are released to the environment. These eggs can penetrate a new host through broken skin, usually hands or feet.

Originally from Americas, Tungiasis has spread to other regions including sub-Saharan Africa

So why should the world know about Tungiasis?

  1. It causes disability– Tungiasis is  a debilitating disease that results in discomfort, disfigurement, psychological trauma and social exclusion in infected individuals.
  2. Could develop complications through secondary infections– When the parasite infects the skin, it causes inflammation and itchiness. As such people try to remove the parasite with non-sterile crude tools which may result in bursting of the flea, and secondary infection by bacteria.
  3. Inability to perform regular tasks– Secondary infections further complicate the disease and as the infection progresses, the infected individual struggles to walk and perform other tasks due to disfigurement of fingers and toes (Fig1).
  4. Stigma and social exclusion– The changes to the skin due to infection and the disfigurement that ensues is an immense source of stigma in affected communities
Figure 1: Tungiasis infection showing embedded fleas

Tungiasis affects populations living in utter poverty and in poor living conditions. Being a zoonotic disease, Tungiasis can be passed on from animals to humans. Studies have shown that animal reservoirs could increase the prevalence and burden of the disease in humans. Several publications on the topic highlight the impact of Tungiasis in affected populations (Figure 2). Please find the publication links below for further reading.

Together We Can Stop NTDs.

Figure 2: Tungiasis, facts, impacts and our role

Further Reading

Njau, N. N., Wanzala, P., Mutugi, M., Ariza, L., & Heukelbach, J. (2012). Tungiasis (jigger infestation) in Rural Kenya, an emerging infectious disease. Retrovirology. https://doi.org/10.1186/1742-4690-9-S1-P37

Feldmeier, H., Sentongo, E., & Krantz, I. (2013). Tungiasis (sand flea disease): A parasitic disease with particular challenges for public health. European Journal of Clinical Microbiology and Infectious Diseases, Vol. 32, pp. 19–26. https://doi.org/10.1007/s10096-012-1725-4

Wiese, S., Elson, L., Reichert, F., Mambo, B., & Feldmeier, H. (2017). Prevalence, intensity and risk factors of tungiasis in Kilifi County, Kenya: I. Results from a community-based study. PLoS Neglected Tropical Diseases. https://doi.org/10.1371/journal.pntd.0005925

Feldmeier, Hermann, Eisele, M., Sabóia-Moura, R. C., & Heukelbach, J. (2003). Severe tungiasis in underprivileged communities: Case series from Brazil. Emerging Infectious Diseases, 9(8), 949–955. https://doi.org/10.3201/eid0908.030041

Girma, M., Astatkie, A., & Asnake, S. (2018). Prevalence and risk factors of tungiasis among children of Wensho district, southern Ethiopia. BMC Infectious Diseases. https://doi.org/10.1186/s12879-018-3373-5

Karunamoorthi, K. (2013). Tungiasis: A neglected epidermal parasitic skin disease of marginalized populations – A call for global science and policy. Parasitology Research. https://doi.org/10.1007/s00436-013-3551-8 Tropical Diseases. https://doi.org/10.1371/journal.pntd.0004126

Mutebi, F., Krücken, J., von Samson-Himmelstjerna, G., Waiswa, C., Mencke, N., Eneku, W., … Feldmeier, H. (2018). Animal and human tungiasis-related knowledge and treatment practices among animal keeping households in Bugiri District, South-Eastern Uganda. Acta Tropica. https://doi.org/10.1016/j.actatropica.2017.10.003

Mphande, F.A. (2020). Skin disorders in vulnerable populations, causes, impacts and challenges. Springer publications. https://www.springer.com/gp/book/9789811538780

Wafula, S. T., Ssemugabo, C., Namuhani, N., Musoke, D., Ssempebwa, J., & Halage, A. A. (2016). Prevalence and risk factors associated with tungiasis in Mayuge district, Eastern Uganda. The Pan African Medical Journal, 24. https://doi.org/10.11604/pamj.2016.24.77.8916

Published by People, Pandemics and Epidemics (PPE)

Billions around the world are affected by diseases in one way or the other, be it directly or indirectly. Both communicable and non- communicable diseases affect communities worldwide. Communicable (infectious) diseases have been associated with the environment, socioeconomic status, geographical location and access to healthcare. With various disease outbreaks affecting many parts of the world and millions of people being affected, the year 2020 has ushered in another level of an outbreak, the COVID-19 Pandemic. The disease started as an outbreak in one part of a country, soon spread to other countries and continents becoming a pandemic. People, Pandemics and Epidemics will discuss the various infectious disease outbreaks, the solutions to fighting these outbreaks, and what has been achieved so far.

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