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| Year : 1985 | Volume
: 31
| Issue : 2 | Page : 121-2 |
Tungiasis in Maharashtra (a case report).
Sane SY, Satoskar RR
How to cite this article:
Sane S Y, Satoskar R R. Tungiasis in Maharashtra (a case report). J Postgrad Med 1985;31:121 |
Tungiasis is a disease caused by invasion of the skin by an arthropod parasite named Tunga penetrans or Chigoe flea. It produces a transient nodule with a central dark spot and commonly involves the foot and the legs. It is a common parasite in east and central Africa and South America including Brazil.[1],[2],[3] We describe here a case from Maharashtra which, to our knowledge, is the first report from India.
A 35 year old male farmer coming from the western coast of Maharashtra developed a painful nodule on the right toe for 3 months. He tried herbal medicine without any relief. The patient then came to K.E.M. Hospital, Bombay for treatment.
On examination, a firm nodule, about 1.5 cm in size, was seen on the lateral aspect of the big toe in the web space. The surrounding subcutaneous tissue was oedematous. A tiny black spot was seen on the skin over the nodule. Other toes and the lateral aspect of the foot revealed dermatitis and small boils. Inguinal lymph nodes were not palpable; the patient did not complain of any other symptoms. His general examination revealed no other abnormal findings. The nodule was diagnosed as chronic abscess, possibly a fungal granuloma. Complete excision of the nodule was done along with the surrounding skin.
The specimen, on cut section, revealed a small cavity in the nodule with a thick fibrous wall. The contents were brown and necrotic. The culture was negative for fungus but Staphylococcus aureus was grown. Histological sections showed an abscess in the subcutaneous tissue with the cavity packed by a distended parasitic flea [Fig. 1] with its dwarf head towards the deeper part and the tail pointing to the surface. There was a thick eosinophilic, P.A.S.. positive cuticle with prominent hypodermal cells. Internal organs consisted of cross sections of segments of the intestinal tract, reproductive tube with ova and antero-posterior band of thick striated muscle [Fig. 2].
Tunga penetrans or Chigoe flea is a parasite found in East and Central Africa and Central and South America extending as far as Brazil. The adult male and female fleas both suck blood from man, pig and other animals. The fertilized females, about 1.0 mm in size, burrow into the epidermis of the human or porcine skin where their presence leads to intense itching and scratching. The abdominal segment of the gravid flea enlarges with the segmentation of the ova to form a sac within the skin upto 1.0 cm in diameter. The fertilized eggs are released to the exterior and subsequently undergo both larval and pupal stages in sand, eggless flea dropping off the skin. Sometimes, many fleas may be seen in heavy infestations. The burrows in the skin extend into the stratum corneum but may reach deeply to the germinal layer of the epidermis. Secondary infection may spread alongwith them which causes chronic inflammation in the dermis. The usual sites of invasion are toes, soles of feet, web spaces and beneath the nails. Any bare surface contacting the infected soil or sand is prone to develop infection.
Various complications of tungiasis include severe itching, pain, inflammatory reaction leading to auto-amputation of digits or gangrene. Tetanus bacilli have been isolated from a case of tungiasis.[2] The infection by Chigoe flea can be prevented by avoiding bare foot walking in endemic regions. The lesion, if develops, can easily be excised surgically. Though not reported earlier from India, one should be aware of the disease since the insect and bare foot walkers both exist here.
We are thankful to the Dean, Seth G.S. Medical College and K.E.M. Hospital to permit us to publish the case.
| 1. | Brothers, W. and Heckman, R.: Tungiasis (Tunga penetrans) in Utah. J. Parasitol., 65: 782, 1979.  |
| 2. | Reiss, F.: Tungiasis in New York City. Arch. Dermatol., 93: 404-407, 1966. |
| 3. | Spencer, H. and Hutt, M. S. R.: Diseases of uncertain etiology and environmental diseases in tropics. In, "Tropical Pathology." Editors: H. Spencer, A. D. Dayan, J. B. Gibson, R. G. Huntsman, M. S. R. Hutt, G. C. Jenkins, F. Koberle, B. G. MacGraith and K. Salfelder. SpringerVerlag, New York, Heidelberg and Boston, 1973, p. 735. |
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