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New Insights into Tungiasis: Morbidity, Epidemiology, and Control
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New Insights into Tungiasis: Morbidity, Epidemiology, and Control

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366). This special issue belongs to the section "Neglected and Emerging Tropical Diseases".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 23303

Special Issue Editors

Prof. Dr. Georg von Samson-Himmelstjerna

E-Mail Website
Guest Editor
Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, 14163 Berlin, Germany
Interests: veterinary parasitology; helminth infections; antiparasitic mode of action; tungiasis; anthelmintic resistance
Prof. Dr. Ingela Krantz

E-Mail Website
Co-Guest Editor
Prof. em., Epidemiology and Global Health, Umeå University, SE-90185 Umeå, Sweden
Interests: neglected tropical diseases; epidemiology; public health; control

Special Issue Information

Dear Colleagues,

In 2021, the PAHO and WHO, for the first time, convened experts on tungiasis from South America, Africa, Europe, and Japan to summarize the existing knowledge on T. penetrans and the disease it causes. This has led to the inclusion of tungiasis in the Neglected Tropical Diseases (NTDs) roadmap of the WHO. At the same time, several research projects were initiated in Brazil, Kenya, Uganda and probably also in other countries, covering a broad spectrum of investigations from basic entomology to elimination.

The Special Issue on “New Insights into Tungiasis: Morbidity, Epidemiology, and Control” welcomes contributions from investigators who have gained new information on tungiasis in general or morbidity, epidemiology, or control in particular.

Prof. Dr. Georg von Samson-Himmelstjerna
Prof. Dr. Ingela Krantz
Guest Editors

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Keywords

  • tungiasis
  • epidemiology
  • morbidity
  • control

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Published Papers (7 papers)

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Research

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15 pages, 4398 KiB  
Article
The Effectiveness of Topical Dimethicone Together with a One Health Approach for the Control of Tungiasis in the Sanumás Communities, Yanomami Territory, Amazon Rainforest: A Real-World Study
by Yago Ranniere Teixeira Santana, Débora Dornelas Belchior Costa Andrade, Daniel Holanda Barroso, Andressa Vieira Silva, Lucas Felipe Carvalho Oliveira, Renata Velôzo Timbó, David Dias Araújo, Rafael Rocha de Andrade, Marcos Antonio Pellegrini, Fabiola Christian Almeida de Carvalho, Luciana Pereira Freire Martins and Ciro Martins Gomes
Trop. Med. Infect. Dis. 2023, 8(11), 489; https://doi.org/10.3390/tropicalmed8110489 - 30 Oct 2023
Cited by 1 | Viewed by 3131
Abstract
Background: The success of tungiasis treatment is highly dependent on adequate environmental control. Methods: This is a real-world observational cohort study designed to monitor the effectiveness of topical dimethicone together with a One Health approach for the control of tungiasis in the Sanumás [...] Read more.
Background: The success of tungiasis treatment is highly dependent on adequate environmental control. Methods: This is a real-world observational cohort study designed to monitor the effectiveness of topical dimethicone together with a One Health approach for the control of tungiasis in the Sanumás communities, Amazon rainforest, Brazil. We followed up on 562 indigenous people and 81 domestic dogs for 1.5 years in a 3-month interval. A new molecular method for large-scale soil evaluation was also tested. The control of tungiasis was independently conducted by the Brazilian Ministry of Health and comprised topical dimethicone application (NYDA®) for humans, single-dose oral afoxolaner for dogs, and in-house soil fumigation with fipronil. The main outcome was the occurrence of tungiasis after the use of topical dimethicone together with the One Health approach. Results: A total of 49 of the 562 indigenous people had active tungiasis at enrollment (8.72%). Only three cases of tungiasis resulted in active lesions after the use of topical dimethicone together with the One Health approach, with two cases of recurrence. From the 6-month follow-up and after, soil infestation was not detected. Conclusions: We conclude that the use of NYDA® together with animal and environmental interventions are effective measures for the control of tungiasis. Full article
(This article belongs to the Special Issue New Insights into Tungiasis: Morbidity, Epidemiology, and Control)
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13 pages, 4992 KiB  
Article
Tungiasis: Participation of Cats and Chickens in the Dispersion and Maintenance of the Disease in an Endemic Tourist Area in Brazil
by Jamille Bispo de Carvalho Teixeira, Katharine Costa dos Santos, Paula Elisa Brandão Guedes, Rebeca Costa Vitor, Thammy Vieira Bitar, Tatiani Vitor Harvey, Anaiá da Paixão Sevá and Renata Santiago Alberto Carlos
Trop. Med. Infect. Dis. 2023, 8(10), 456; https://doi.org/10.3390/tropicalmed8100456 - 25 Sep 2023
Cited by 2 | Viewed by 2091
Abstract
Tunga spp. are fleas commonly found in impoverished tropical regions. In Vila Juerana, a tourist community in Ilheus, Bahia, Brazil, where tungiasis is endemic, dogs are the main host of fleas during their life cycle. However, there is no information about the role [...] Read more.
Tunga spp. are fleas commonly found in impoverished tropical regions. In Vila Juerana, a tourist community in Ilheus, Bahia, Brazil, where tungiasis is endemic, dogs are the main host of fleas during their life cycle. However, there is no information about the role of cats and chickens in tungiasis in the village. Of the 272 households investigated, 112 had domestic animals, 48 had only dogs, 28 had only cats, and nine had only chickens. Of the 27 households with cohabitation among species, 16 had cats and dogs, eight had chickens and dogs, and three had dogs, cats, and chickens. The injuries due to tungiasis were ranked according to the Fortaleza classification, considering stages I, II, and III as viable lesions. The paws/feet of 71/111 (63.9%) cats and 173/439 (39.4%) chickens were inspected. Dogs that lived with positive cats and chickens also were inspected. Among the 38% (27/7; 95% IC 26.74–49.32) positive cats, 16 cohabited houses with infected dogs but none lived with positive chickens. Of the chickens, 2.3% (4/173; 95% IC 0.07–4.5) had lesions caused by tungiasis. In each household where a cat was infected, the dog was also positive. Two chickens cohabited with an infected dog and the other two did not coexist with other species. Cohabitation with infected dogs and the absence of house confinement restrictions in Vila Juerana make cats important carriers that spread tungiasis in this community. Chickens had a low frequency of tungiasis lesions despite living in proximity to infected dogs and cats. Full article
(This article belongs to the Special Issue New Insights into Tungiasis: Morbidity, Epidemiology, and Control)
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17 pages, 2372 KiB  
Article
High Level of Knowledge about Tungiasis but Little Translation into Control Practices in Karamoja, Northeastern Uganda
by Marlene Thielecke, Hannah McNeilly, Francis Mutebi, Mike B. Banalyaki, Rebecca Arono, Susanne Wiese, Felix Reichert, George Mukone and Hermann Feldmeier
Trop. Med. Infect. Dis. 2023, 8(9), 425; https://doi.org/10.3390/tropicalmed8090425 - 24 Aug 2023
Cited by 3 | Viewed by 2167
Abstract
Tungiasis is a neglected tropical disease (NTD) that can cause significant suffering and disability. Health promotion is an important pillar in NTD control programs, assuming that better knowledge contributes to reduced risk behavior and reduced risk of infection. The study objective was to [...] Read more.
Tungiasis is a neglected tropical disease (NTD) that can cause significant suffering and disability. Health promotion is an important pillar in NTD control programs, assuming that better knowledge contributes to reduced risk behavior and reduced risk of infection. The study objective was to assess tungiasis-related knowledge and its translation into control practices in a rural and highly endemic setting in Karamoja, Northeastern Uganda. We applied a mixed-methods design on household and community level. A semi-quantitative questionnaire on knowledge, practices, and attitudes (KAP) regarding tungiasis was administered to 1329 individuals with the main caring responsibilities in the household. Additionally, eight community dialogue meetings were held and analyzed. Overall, knowledge of tungiasis in humans was high but knowledge of tungiasis in animals was low. Most questionnaire respondents knew the causative agent and clinical presentations of tungiasis in humans, risk factors, and preventive measures. This tungiasis-related knowledge was translated into simple prevention measures. However, adequate tungiasis control was impeded due to a lack of resources, such as access to water and effective medical treatment. In conclusion, health promotion campaigns should be integrated with support towards adequate tungiasis control measures, such as provision of safe treatment, hardening of non-solid floors in the houses, and improved access to water. Full article
(This article belongs to the Special Issue New Insights into Tungiasis: Morbidity, Epidemiology, and Control)
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14 pages, 296 KiB  
Article
Tungiasis Stigma and Control Practices in a Hyperendemic Region in Northeastern Uganda
by Hannah McNeilly, Marlene Thielecke, Francis Mutebi, Mike Banalyaki, Felix Reichert, Susanne Wiese and Hermann Feldmeier
Trop. Med. Infect. Dis. 2023, 8(4), 206; https://doi.org/10.3390/tropicalmed8040206 - 30 Mar 2023
Cited by 5 | Viewed by 2510
Abstract
Neglected tropical diseases are known to be highly stigmatized conditions. This study investigates tungiasis-related stigma and control practices in the impoverished Napak District in rural northeastern Uganda, where tungiasis is hyperendemic and effective treatment is unavailable. We conducted a questionnaire survey with the [...] Read more.
Neglected tropical diseases are known to be highly stigmatized conditions. This study investigates tungiasis-related stigma and control practices in the impoverished Napak District in rural northeastern Uganda, where tungiasis is hyperendemic and effective treatment is unavailable. We conducted a questionnaire survey with the main household caretakers (n = 1329) in 17 villages and examined them for tungiasis. The prevalence of tungiasis among our respondents was 61.0%. Questionnaire responses showed that tungiasis was perceived as a potentially serious and debilitating condition and that tungiasis-related stigma and embarrassment were common. Among the respondents, 42.0% expressed judging attitudes, associating tungiasis with laziness, carelessness, and dirtiness, and 36.3% showed compassionate attitudes towards people with tungiasis. Questionnaire responses further indicated that people made an effort to keep their feet and house floors clean (important tungiasis prevention measures), but lack of water was a common problem in the area. The most frequent local treatment practices were hazardous manual extraction of sand fleas with sharp instruments and application of various and sometimes toxic substances. Reliable access to safe and effective treatment and water are therefore key to reducing the need for dangerous treatment attempts and breaking the vicious cycle of tungiasis stigma in this setting marked by poverty. Full article
(This article belongs to the Special Issue New Insights into Tungiasis: Morbidity, Epidemiology, and Control)
17 pages, 1894 KiB  
Article
Prevalence and Infection Intensity of Human and Animal Tungiasis in Napak District, Karamoja, Northeastern Uganda
by Francis Mutebi, Hannah McNeilly, Marlene Thielecke, Felix Reichert, Susanne Wiese, George Mukone and Hermann Feldmeier
Trop. Med. Infect. Dis. 2023, 8(2), 111; https://doi.org/10.3390/tropicalmed8020111 - 11 Feb 2023
Cited by 11 | Viewed by 3001
Abstract
Tungiasis is an important but highly neglected cause of morbidity in resource-poor communities in Latin America and sub-Saharan Africa. Data upon which implementation of control measures can be based are scarce. Before piloting an integrated tungiasis control program in three parishes of Napak [...] Read more.
Tungiasis is an important but highly neglected cause of morbidity in resource-poor communities in Latin America and sub-Saharan Africa. Data upon which implementation of control measures can be based are scarce. Before piloting an integrated tungiasis control program in three parishes of Napak district, Uganda, a cross-sectional survey involving the systematic examination of humans and domestic mammals was implemented to establish the occurrence patterns of tungiasis. The study population was 5482 residents, of which 4035 (73.6%) participated in the study. The prevalence of tungiasis in humans was 62.8% (95% CI: 61.3–64.3%), with slightly more males than females affected (p = 0.01). Age-specific prevalence and intensity of human tungiasis followed an S-curve pattern, with children of 5–14 years and the elderly (≥60 years) being the most affected. Half of all lesions (50%) had been manipulated by sharp objects. The prevalence of tungiasis in animals was lower (14.2%, 95% CI: 10.9–18.0) than that of humans (p < 0.001). Animal tungiasis occurred in decreasing order of frequency in pigs (80%), dogs (24%), goats (16.3%), cats (8.1%) and sheep (4.9%). In conclusion, human tungiasis was highly prevalent but animal infections were comparatively few in the study area. Nevertheless, effective control measures should be based on One Health principles. Full article
(This article belongs to the Special Issue New Insights into Tungiasis: Morbidity, Epidemiology, and Control)
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Review

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11 pages, 1849 KiB  
Review
Treatment of Animal Tungiasis: What’s New?
by Katharine Costa dos Santos, Paula Elisa Brandão Guedes, Jamille Bispo de Carvalho Teixeira, Tatiani Vitor Harvey and Renata Santiago Alberto Carlos
Trop. Med. Infect. Dis. 2023, 8(3), 142; https://doi.org/10.3390/tropicalmed8030142 - 27 Feb 2023
Cited by 5 | Viewed by 6280
Abstract
In tropical and subtropical countries, particularly in disadvantaged communities, tungiasis is a severe public health problem, which is often neglected by the authorities. The sand fleas Tunga penetrans, predominant in endemic areas, and Tunga trimamillata, whose cases in humans are less [...] Read more.
In tropical and subtropical countries, particularly in disadvantaged communities, tungiasis is a severe public health problem, which is often neglected by the authorities. The sand fleas Tunga penetrans, predominant in endemic areas, and Tunga trimamillata, whose cases in humans are less frequent, are the cause of this zoonosis. Domestic animals are potential reservoirs and disseminators of tungiasis, so controlling their infection would significantly advance the prevention of human cases. This literature review compiles the most recent studies and innovations in treating animal tungiasis. Studies of approaches to the treatment of animal tungiasis, as well as disease control and prevention, are described. Isoxazolines are highlighted as promising drugs to treat animal tungiasis, with high efficacy and pharmacological protection. The positive impacts of this discovery on public health are also discussed, since dogs are an essential risk factor for human tungiasis. Full article
(This article belongs to the Special Issue New Insights into Tungiasis: Morbidity, Epidemiology, and Control)
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Other

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11 pages, 22079 KiB  
Brief Report
Tungiasis in the Sanumás Amerindians in the Amazon Rainforest, Brazil: Prevalence, Intensity and Morbidity
by Yago Ranniere Teixeira Santana, Lucas Felipe Carvalho Oliveira, Gabriela Mafra Lima, Renata Velôzo Timbó, Eliane Mateus Pires, Amanda Ramos de Brito, Ana Carolina Tardin Martins, Vivyanne Santiago Magalhães, Ana Carolina Mota de Faria, Ada Amalia Ayala Urdapilleta, Isabelle Roger, Rafael Rocha de Andrade, Luciana Pereira Freire Martins, Marcos Pellegrini, Fabiola Christian Almeida de Carvalho, David Dias Araújo, Daniel Holanda Barroso, Carina Nogueira Garcia, Hermann Feldmeier and Ciro Martins Gomes
Trop. Med. Infect. Dis. 2023, 8(8), 386; https://doi.org/10.3390/tropicalmed8080386 - 28 Jul 2023
Cited by 1 | Viewed by 2886
Abstract
Background: Tungiasis is a disease associated with extreme poverty. We aimed to evaluate the prevalence of tungiasis in six different settlements of the Sanumás indigenous community in a remote area in the Auaris region, Yanomami territory, Brazil. Methods: We conducted an observational study [...] Read more.
Background: Tungiasis is a disease associated with extreme poverty. We aimed to evaluate the prevalence of tungiasis in six different settlements of the Sanumás indigenous community in a remote area in the Auaris region, Yanomami territory, Brazil. Methods: We conducted an observational study to detect clinical and epidemiological factors associated with tungiasis using a cross-sectional strategy and multivariate logistic regression. Soil analysis was performed by visual and microscopic methods. Results: We examined 555 persons, 45 of whom had active tungiasis; 18 cases were classified as mild, 16 as moderate and 11 as severe. The disease was significantly more prevalent in children than in adults (odds ratio (OR) 15.77; 95% confidence interval (CI) = 5.34–67.91; p < 0.001). Soil infestation was significantly related to the occurrence of human tungiasis (OR = 12.29; 95% CI = 3.75–45.88). The sex and GPS location of the houses were not related to the occurrence of tungiasis. Conclusions: We conclude that tungiasis is an important problem in the Sanumás community, especially for children. We suggest that interruption of the off-host transmission cycle, together with regular treatment [human and animal interventions], must be prioritized to achieve control of tungiasis in indigenous populations. Full article
(This article belongs to the Special Issue New Insights into Tungiasis: Morbidity, Epidemiology, and Control)
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