Tungiasis--a cause of painful feet in a tropical traveller.

Tungiasis is an ectoparasitosis caused by the impregnated female sand flea Tunga penetrans. It is endemic in certain resource poor areas around the world and imported infestations in travellers can lead to considerable morbidity. With the rise in international travel and immigration, the likelihood of physicians encountering such tropical skin infestations is rising. The ability of physicians to recognise tungiasis early will be immensely beneficial to patients. We describe a case of tungiasis where a traveller presented with painful foot lesions. The patient had returned to the United Kingdom 4 days previously after spending 4 weeks in the Pantanal region in Brazil. A literature review on this subject was undertaken in this article.

Exotic human myiasis.

Human myiasis may be caused by several species of dipterous larvae. It is widespread in the tropics and subtropics particularly in Africa and the Americas and can occur in other parts of the world although less frequently. Larval infestation mostly affects the skin but can also involve wounds, bones, intestines and body cavities. Diagnosis is mainly clinical. The rule of treatment is to remove the larvae and treat any associated infection. Frequent international travel, immigration and rising global trade increase the likelihood of imported infestations. It is therefore vital that physicians in non-endemic areas are aware of clinical symptoms, exposure and presentation of this condition, as early recognition would prevent any costly, inappropriate treatments or complications. We report a case of imported human myiasis and present a literature review of human myiasis.

Eosinophilia due to multiple parasitic infection.

Eosinophilia is a common feature of many allergic and parasitic diseases. In the tropics multiple parasitic infection is often responsible for eosinophilia. The following illustrates this problem arising in the U.K. in a patient in whom tests for amoebiasis, filariasis, schistosomiasis and fascioliasis were all positive. Despite being treated for these conditions, the patient's symptoms did not resolve until he was treated for strongyloides infection which was found only after the 19th stool examination.

Pulmonary hydatid disease.

A case of pulmonary hydatid disease with myopathy, which has not previously been described as a feature of hydatidosis, is reported. The myopathy resolved during high dose mebendazole therapy.