Serie parasitosis en dermatología: tungiasis / Dermatology iconography: tungiasis

La tungiasis es una ectoparasitosis causada por la penetración en la piel de la pulga hembra Tunga penetrans. Esta enfermedad no es específica del hombre y se distribuye en regiones cálidas y secas alrededor del mundo. Se adquiere por contacto directo con el suelo en donde habitan los parásitos adultos. En zonas endémicas, su alta prevalencia se asocia a pobreza y falta de acceso al sistema de salud. Además es frecuente entre viajeros que visitan regiones endémicas y que regresan a sus lugares de origen. Presentamos un caso típico de tungiasis en un paciente 39 años que había realizado un viaje reciente a zona endémica. (AU)

Tungiasis is an ectoparasitosis caused by penetration into the skin of the female flea Tunga penetrans. This disease is not human-specific and is distributed worldwide in warm, dry regions. It is acquired by direct contact with the soil where the adult parasites live. In endemic areas, its high prevalence is associated with poverty and lack of access to the health system. It is also frequent among travelers visiting endemic regions and returning to their places of origin. We present a typical case of tungiasis in a 39 year old patient who had made a recent trip to an endemic area. (AU)

Tungíase atualidades clínicas / Tungiase clinical news

O objetivo deste artigo é revisar as características clínicas da tungíase. A Tunga penetrans é a menor das pulgas conhecidas, alcançando 1 milímetro de comprimento quando atinge a fase adulta. Os relatos antigos de surtos de tungíase são escassos em relação aos registros epidemiológicos. O diagnóstico da doença é realizado através da história epidemiológica e dos achados clínicos, aliados ao exame direto com visualização do parasita, após abertura da lesão com agulha estéril. A retirada da pulga é o tratamento preconizado, sendo a profilaxia a melhor alternativa para controlar o parasita. Os profissionais de saúde devem atentar para a importância de se orientar as populações de áreas endêmicas em relação à doença, a fim de reduzir o número de casos e de complicações.

The purpose of this article is to review the clinical features of tungiasis. Tunga penetrans is the smallest known flea, reaching a millimeter in length when fully grown. The earliest accounts of outbreaks of tungiasis are scarce in relation to epidemiological records. The diagnosis is made by history and clinical epidemiological findings, coupled with the direct examination with visualization of the parasite after opening the wound with a sterile needle. The removal of the flea is the recommended treatment, and prophylaxis the best way to control the parasite. Healthcare professionals should be aware as to the importance of educating the public in endemic areas for the disease in order to reduce the number of cases and complications.

Tungiasis, una enfermedad tropical emergente en Chile: Comunicación de tres casos clínicos importados / Tungiasis, an emerging tropical disease in Chile: Three imported cases reports

Tungiasis is a cutaneous ectoparasitosis caused by the sand flea Tunga penetrans whose higher prevalence occurs in South America, the Caribbean and Sub-Saharan Africa. It is clinically characterized by a papular lesion, either single or multiple, with a whitish halo and a brown-black central core, most of them localized on the feet. The lesions can be painful and itchy with the most common complication being bacterial superinfection of the skin. We report three cases of Chilean patients who presented skin lesions suggestive of tungiasis on their return from areas of high prevalence of the disease. The diagnosis is made by the clinical features of lesions in a patient from an endemic zone. Standard treatment consists of surgical extraction of the flea followed by application of a topical antibiotic and a tetanus prophylaxis. Prevention of the infestation is essential and includes the use of closed footwear and repellents.

La tungiasis es una ectoparasitosis cutánea causada por la pulga Tunga penetrans, prevalente en Sudamérica, el Caribe y África Subsahariana. Clínicamente se caracteriza por la formación de pápulas, únicas o múltiples, con un halo blanquecino translúcido y una región central pardo-negruzca, frecuentemente localizadas en los pies. Las lesiones pueden cursar con prurito o dolor leve, siendo la sobreinfección bacteriana la complicación más frecuente. Se comunican tres casos clínicos de chilenos que viajaron a zonas de alta prevalencia de tungiasis y que a su regreso presentaron lesiones dérmicas sugerentes de la enfermedad. El diagnóstico se realizó en base a las características clínicas de las lesiones en un paciente proveniente de zonas endémicas. El tratamiento de elección es la extracción quirúrgica de la pulga seguido del uso de antimicrobianos tópicos y la vacunación antitetánica. La prevención es esencial con el uso de calzado cerrado y repelentes.

Tungíase disseminada / Disseminated tungiasis

A tungíase é uma infestação zooantropofílica causada pela Tunga penetrans. É endêmica na América Latina e no Caribe. Ocorre, principalmente, em comunidades carentes e sem saneamento básico e em indivíduos que visitam áreas contaminadas. O local mais comum de penetração do ectoparasita é a região periungueal dos pés. Os autores mostram a ocorrência de uma forma disseminada num habitante da zona rural.

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.

Tungiasis: Presentación de un caso clínico / Tungiasis: a case report

La tungiasis es una parasitosis cutánea originaria de América causada por Tunga penetrans. Se caracteriza por lesiones papulares, negruzcas, únicas o múltiples, que suelen afectar los pies, principalmente en las zonas subungueales y periungueales. El diagnóstico de tungiasis se realiza por las características clínicas de las lesiones en un paciente proveniente de zonas endémicas. El tratamiento de elección es la extracción quirúrgica de la pulga y la aplicación de antibióticos tópicos. Presentamos un caso de tungiasis en una paciente de 10 años de edad con múltiples lesiones en ambos pies, que fue tratada satisfactoriamente con ivermectina y extracción quirúrgica.

Tungiasis, is a cutaneous parasitosis, native of America caused by Tunga penetrans. Infestations usually presents with black papular lesions, either single or multiple, most of them localized on the feet, mainly in the subungual and periungual areas. Diagnosis of tungiasis is based on the characteristic aspect of the lesions in a patient coming from an endemic area. Surgical removal of the fea and application of a topical antibiotic is the standard treatment. We describe a case of a 10-years-old girl, with multiple lesions localized on feet, who was succesfully treated with ivermectin and surgical removal of lesions.