Tungiasis

What is tungiasis?

Tungiasis is a painful, itchy skin condition that occurs when female sand fleas burrow into your skin to feed as they lay their eggs. You develop white circles with black dots in the centers. These lesions most commonly affect your feet but they can develop anywhere on your body.

The first report of tungiasis dates back to the 1500s. The crew of Christopher Columbus developed tungiasis after shipwrecking on the Caribbean island of Haiti.

What are sand fleas?

Tunga penetrans (T. penetrans) and Tunga trimamillata (T. trimamillata) are the scientific names of the sand fleas that cause tungiasis.

Other names for sand fleas include:

• Bicho del pie (bug of the foot).
• Chigoe fleas.
• Jiggers.
• Nigua.
• Pico.

Where do you find sand fleas?

The types of fleas that cause tungiasis don’t live in the United States. As their name suggests, sand fleas prefer sandy areas like beaches. They also like the warm, dry soil in livestock stables and farms. And sand fleas are able to hitch rides on animal fur.

At one time, you would only find these particular sand fleas in the West Indies and Caribbean islands. But they’re now found in these tropical and subtropical regions:

• Africa.
• India.
• Latin America.
• Pakistan.

How common is tungiasis?

More than 20 million people worldwide are at risk of tungiasis. Impoverished people who go barefoot and live in rural areas, remote villages and shanty towns in large cities are more likely to get tungiasis. The condition is more problematic among children assigned male at birth (AMAB) between the ages of 5 and 14 and the elderly. It’s estimated that 8 in 10 disadvantaged children living in areas that have sand fleas develop tungiasis.

What causes tungiasis?

You can get tungiasis from direct contact with sand fleas that live on the ground or by touching the fur of an animal that has sand fleas. Sand fleas most commonly attach to the fur of pigs, cows, dogs, cats and rats. These sand fleas are too small to see.

Only female sand fleas impregnated with eggs cause tungiasis. Male sand fleas also bite and feed on your blood. But because they don’t have eggs to nurture, they don’t burrow into your skin and cause tungiasis.

How does tungiasis occur?

The female sand fleas bite and claw the outermost layer of your skin (the epidermis), creating an opening. They burrow into the middle skin layer (the dermis) where they feed on blood from your blood vessels. Your blood provides the nutrients the female needs to produce its eggs. The sand flea gets oxygen through the bite opening in your skin. The black dot you might see in the center of the white circle on your skin is the hind end of the burrowed sand flea. This is where the eggs come out.

The sand flea can live inside your skin, growing bigger with its eggs and your blood, for up to six weeks. During this time, it may eject up to 100 eggs, which fall out of the opening in your skin and onto the ground. After laying its eggs, the sand flea dies and falls off as your skin sheds.

In about four days, the sand flea eggs hatch into larvae and begin to feed on organic material in the sand or soil. The larvae turn into pupae, which mature into adult sand fleas in about four weeks. These adults then seek people out to feed on their blood.

What are the symptoms of tungiasis?

Sand fleas can’t jump far. That’s why they most commonly burrow into the soles of your feet, in between your toes, or into your heels and outside of your foot. You probably won’t notice when the female sand flea first enters your skin. Once it burrows into your skin, you may see a white circle that looks like a ring or halo with a black dot in the center. Over time, the black dot grows as the sand flea gorges on blood and gets bigger with eggs.

The lesion may be:

• Itchy.
• Painful.
• Red.
• Swollen and inflamed.

What are the complications of tungiasis?

People with tungiasis are at risk for serious bacterial infections from the burrowed insect and from scratching at the skin. These infections can permanently disfigure the foot and affect a person’s ability to walk.

Other possible complications include:

• Bacteremia (bacteria in the blood that can lead to septicemia and sepsis).
• Cellulitis from a bug bite.
• Gangrene.
• Tetanus (a life-threatening bacterial infection that affects the nervous system).

How is tungiasis diagnosed?

Healthcare providers who provide care in regions where tungiasis is prevalent can diagnose the condition by examining the skin. Most people who live in these regions are familiar with tungiasis and know when they have it.

How do healthcare providers treat tungiasis?

Your healthcare provider can use sterilized forceps or a needle to remove a burrowed sand flea. Because the flea swells up with blood, a wide cut (excision) may be necessary to get all of the flea out.

Other methods for removing the sand flea include:

• Applying an antiparasitic medication or a thick wax or jelly to the skin lesion to kill the sand flea.
• Using cryotherapy to freeze the skin tissue and kill the sand flea.

Can you treat tungiasis at home?

No, only a healthcare provider using sterilized tools or other proven methods should attempt to remove a burrowed sand flea.

In areas where healthcare services aren’t widely accessible or affordable, people often try to remove the sand flea using unsterile methods. Sometimes, adults use the same instrument to treat multiple infected family or community members.

These unsafe methods increase the risk of:

• Rupture of the sand flea inside the skin, which causes a bacterial infection.
• Spread of hepatitis B, hepatitis C, and HIV and AIDS through unsterilized instruments.

Can you prevent tungiasis?

If you’re traveling to an area where tungiasis is prevalent, you can lower your risk of infection by wearing closed-toe shoes, socks that cover your ankles and long pants. It’s best to not go barefoot. You can also use a plant-based insecticide called Zanzarin® on your feet twice a day to lower your risk of tungiasis. Your healthcare provider can help you find this treatment. Some countries also spray a different type of insecticide on the ground to kill sand fleas.

What is the outlook for someone with tungiasis?

Many people with tungiasis improve without treatment. However, the painful, itchy symptoms can be uncomfortable until the sand flea dies. In impoverished areas that lack quality healthcare services, tungiasis can lead to infections that may threaten limbs and lives.

When should I call the doctor?

Call your healthcare provider if you have been to an area with sand fleas and you notice:

• White lesions on your foot, ankle or elsewhere on your body.
• Itchy or painful skin rash.
• Signs of infection like a fever or red streaks on the skin after tungiasis treatment.

What should I ask my provider?

You may want to ask your healthcare provider:

• What is the best treatment for tungiasis?
• What can I do to prevent tungiasis when traveling?
• What signs of tungiasis should I look out for?
• Should I look for signs of complications?

What’s the difference between tungiasis and flea bites?

Sand fleas are the only fleas that burrow into your skin to feed on blood. Other types of fleas land on the surface of your skin to temporarily feed on your blood. You may have multiple flea bites, or small red bumps on your skin. While flea bites can itch and be unsightly, they’re more of a nuisance than a health threat like tungiasis.

A note from Cleveland Clinic

If you’re visiting an area that has sand fleas, it’s wise to take precautions to lower your risk of developing tungiasis. You should wear closed-toe shoes and socks that cover your ankles. You can also spray a specific type of insecticide on your feet. Ask your healthcare provider before you travel about how to find this insect repellent. Many people with tungiasis seek treatment to remove the sand flea or kill it. It’s important to get proper medical help to remove the sand flea to lower your risk of infections and other complications.