Images in Clinical Medicine
Periungual Tungiasis
N Engl J Med 2008; 359:e30December 11, 2008
- Article
A healthy 35-year-old man presented with small eggs and a brownish lesion on the medial edge of his right big toe (Panel A). Two weeks before presentation, he had returned from a holiday trip to Brazil, where he had been barefoot. The patient was afebrile and without malaise. The brownish part (the decomposing adult sand flea) was excised, and multiple eggs appeared after the application of lateral pressure (Panel B). After disinfection, a sterile dressing was applied. The patient had a complete recovery with no additional symptoms. Tungiasis is an ectoparasitosis in which the fertilized female sand flea (Tunga penetrans) burrows into the skin, with a predilection for periungual regions. However, any part of the skin can be affected. In the skin, the flea lays hundreds of eggs and then dies, leaving an open sore containing its hindquarters, which can be an entry point for superinfection. The parasite is endemic in tropical Africa and South America, as well as in subtropical regions of Asia.
Michael Muehlstaedt, M.D.
Ludwig Maximilian University of Munich, D-80377 Munich, Germany
mmuehlst@med.lmu. de
