Clinical and epidemiological survey of tungiasis in Madagascar.

BACKGROUND: Tungiasis is a dermal parasitic infection, classified as a neglected tropical disease. Madagascar is one of endemic countries which have been committed for decades to control the tungiasis as a public health issue. Despite this medical importance, little is known about the prevalence and epidemiology of the disease in this country. METHODS: A descriptive cross-sectional survey was performed in two endemic foci of Antananarivo and Toamasina. RESULTS: In total, 2971 suspected individuals were surveyed. Of them, 643 individuals were excluded due to absence or refusing clinical examinations. Therefore, 2328 individuals with aforementioned criteria were clinically examined, 320 cases (13.7%) were found infected by Tunga penetrans. Of these 320 infected cases, 241 individuals came from rural regions against 79 from urban areas. The sex ratio of infected cases was 1.15 with an age average of 34.7 years old. Most of them were illiterate (185/320, 57.8%) with no habit of feet washing (210/320, 65.6%). The majority (198/320, 61.9%) inhabited in the houses constructed by falafa providing a suitable breeding location for Tunga ectoparasites. Based on clinical examination, most of the patients (298/320, 93.1%) had the lesions on their toes followed by those possessed the lesions on the plantar (140/320, 43.7%). The lesion stages of IV and V were observed in 49.1% (157/320) of visited patients which were more common in rural regions (86%) than in urban areas (14%). For treatment, removing the fleas using needle (122/320, 38.1%), followed by the application of petroleum (100/320, 31.2%) were among the most traditional remedies used by our patients. CONCLUSION: This investigation highlights a high burden of tungiasis in studied endemic foci in particular in rural regions. These results can be helpful in control management strategies against this parasitosis in Madagascar.

Morphological and Molecular Identification of Cimex hemipterus Fabricius, 1803 (Hemiptera: Cimicidae) and First Report of C. lectularius Linnaeus, 1758, in Madagascar.

Bed bugs are hematophagous insects with a long history of presence in human communities. Over the last three decades, infestations by bed bugs in human dwellings have drastically increased, leading to a rise in bed bug concerns. This study was conducted in May 2019 in the Miarinarivo district of Madagascar. Eight locations with suspected infestations were inspected. Of these, five locations were found with active bed bug infestations. Overall, 23 (19 adults and four nymphs) specimens with numbers per apartment ranging from 2 to 6 were collected and analyzed using morphological and molecular approaches. Of 19 adults collected, 18 were morphologically identified as Cimex hemipterus (Hemiptera: Cimicidae), with the final adult identified as C. lectularius. Morphological identification of adults was confirmed by sequencing 450 bp fragment of COI gene. All four nymphs were also identified molecularly as C. hemipterus. Maximum likelihood phylogenetic tree of COI gene and sequence alignment of C. hemipterus specimens revealed the presence of two groups (first group clustered with previously reported haplotype from Asian and African countries and the second group encompassed a lesser known haplotype exclusively from Africa (Kenya and Senegal). This study presents low genetic diversity among C. hemipterus specimens and, for the first time, reports the occurrence of C. lectularius, known as temperate species, in Madagascar. These results can be helpful in control management strategies against these ectoparasites in this country.

Autochthonous Gnathostomiasis in Madagascar.

We used molecular tools to identify an autochthonous case of gnathostomiasis in Madagascar. This severe ocular infection, caused by Gnathostoma spinigerum nematodes, led to vision loss in the patient's left eye. Clinicians should be aware of this parasitosis in Madagascar and other countries in Africa.