Organism
Tungiasis is an infestation with a female flea, Tunga penetrans (jigger flea or chigoe flea) that burrows into skin, feeds on tissue fluids and grows from 1 mm to around 1 cm within 2 weeks as the contained eggs develop. Within the skin, the flea lies head down with the posterior end at the skin surface, through which eggs are extruded. After the flea eggs have been laid, the flea dies and the body is gradually lost with overlying skin. Eggs hatch after being laid and larvae develop to adult fleas in around 3 weeks. After copulation, female fleas develop a pattern of jumping which persists until they die or find a warm blooded mammal in which to develop further.

Mode of Transmission
Humans become infested when walking in sandy soil in which female fleas are present. Infestation tends to involve the feet and ankles, particularly between the toes and along the instep. Infestation can occur anywhere in the body however, for example on the head if the individual lies on the ground. Patients with reduced sensation in their feet may have more severe infestations.

Regions Affected
Tungiasis occurs throughout tropical Africa, tropical and subtropical America and more recently the Indian subcontinent. Pigs are the natural host for the jigger flea, and infections in humans are more common in areas where there is close contact with pigs. The fleas prefer sandy soil.

Prevention
Tungiasis can be prevented by wearing solid shoes and avoiding contact with the ground. Pigs should be kept away from areas where humans live.

Symptoms and Signs
Tungiasis causes a small spot which gradually enlarges over the course of 2 weeks. It is generally not painful, and once the flea eggs have been passed, the swelling settles with some scarring. People living in areas where tungiasis is common can develop very heavy infections with large amounts of scar tissue. Cavities containing female fleas can become secondarily infected with bacteria, including tetanus and gas gangrene, and occasionally patients die following infestation with jigger fleas.

Tests
The diagnosis is made on the characteristic appearance and a history of travel.

Treatment
The treatment is to remove the female flea intact using a sterile needle to widen the cavity and poke out the flea. Once this has been done it is important to keep the area clean and dressed to avoid secondary infection.

Complications and Outcome
As mentioned above, rare complications include tetanus and gas gangrene. Heavy infestations can be unsightly but are generally not life threatening.

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