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Tungiasis

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[Tunga penetrans]

Causal Agent

The chigoe flea, Tunga penetrans. The flea is also referred to as the jigger, nigua, chica, pico, pique or suthi.

Life Cycle

Lifecycle

Eggs are shed by the gravid female into the environment The number 1. Eggs hatch into larvae The number 2 in about 3-4 days and feed on organic debris in the environment. Tunga penetrans has two larval stages before forming pupae The number 3. The pupae are in cocoons that are often covered with debris from the environment (sand, pebbles, etc). The larval and pupal stages take about 3-4 weeks to complete. Afterwards, adults hatch from pupae The number 4 and seek out a warm-blooded host for blood meals. Both males and females feed intermittently on their host, but only mated females burrow into the skin (epidermis) of the host, where they cause a nodular swelling The number 5. Females do not have any specialized burrowing organs, and simply claw into the epidermis after attaching with their mouthparts. After penetrating the stratum corneum, they burrow into the stratum granulosum, with only their posterior ends exposed to the environment The number 6. The female fleas continue to feed and their abdomens extend up to about 1 cm. Females shed about 100 eggs over a two-week period, after which they die and are sloughed by the host’s skin. Secondary bacterial infections are not uncommon with tungiasis.

Geographic Distribution

Tunga penetrans is distributed in tropical and subtropical regions of the world, including Mexico to South America, the West Indies and Africa. The fleas normally occur in sandy climates, including beaches, stables and farms.

Clinical Presentation

The initial burrowing by the gravid females is usually painless; symptoms, including itching and irritation, usually start to develop as the females become fully-developed into the engorged state. Inflammation and ulceration may become severe, and multiple lesions in the feet can lead to difficulty in walking. Secondary bacterial infections, including tetanus and gangrene, are not uncommon with tungiasis.

Tunga penetrans.

 

Tunga penetrans (also known as chigoe flea, jigger, nigua, chica, pico, cique, or suthi) burrows under the skin of humans, unlike other fleas which are ectoparasitic on the surface of the skin. The females remain embedded in the host tissue during engorgement and egg-production. The fleas are usually found between the toes or under toe nails, and humans acquire the infection when walking barefoot in tropical and subtropical regions. Adults may be dissected out of lesions and are characterized by a lack of both pronotal and genal combs.
Figure A: Tunga penetrans removed from a lesion on the bottom of the foot of a patient who traveled to Africa. The bulk of the lesion and the posterior part of the flea are marked with a blue arrow. The anterior end of the flea, showing the head, mouthparts and forelegs, is marked with a green arrow. Note the lack of pronotal and genal combs. A single egg (yellow arrow), is also shown.
Figure B: Eggs of T. penetrans liberated from the lesion on the second toe of a patient who traveled to Guyana. Image courtesy of Spectrum Health, Grand Rapids, MI.
Figure C: Close-up of the eggs from the specimen in Figure B.
Tunga penetrans lesions and biopsy specimens.

 

Gross lesions and cross-sections of Tunga penetrans in tissue.
Figure A: Gross lesion on a patient's foot caused by T. penetrans. Image courtesy of Drs. Mohammed Asmal and Rocio M. Hurtado. Image first appeared at Partners' Infectious Disease Images (http://www.idimages.orgExternal Web Site Icon), whose content is copyrighted by Partners Healthcare System, Inc., and is used with permission.
Figure B: Gross lesion on a patient's foot caused by T. penetrans. Image courtesy of Drs. Mohammed Asmal and Rocio M. Hurtado. Image first appeared at Partners' Infectious Disease Images (http://www.idimages.orgExternal Web Site Icon), whose content is copyrighted by Partners Healthcare System, Inc., and is used with permission.
Figure C: Cross-sections of T. penetrans in tissue, stained with hematoxylin and eosin (H&E).
Figure D: Cross-sections of T. penetrans in tissue, stained with hematoxylin and eosin (H&E). In this image, the following structures are labeled: cuticle (CU), gut (GU), and developing eggs (EG).

Laboratory Diagnosis

Identification is made by the finding of adult fleas and their eggs in lesions.

Treatment Information

For information about treatment please contact CDC-INFO.

DPDx is an educational resource designed for health professionals and laboratory scientists. For an overview including prevention, control, and treatment visit www.cdc.gov/parasites/.