Regression of Severe Tungiasis-Associated Morbidity after Prevention of Re-Infestation: A Case Series from Rural Madagascar

 http://www.ajtmh.org/content/89/5/932.short

Regression of Severe Tungiasis-Associated Morbidity after Prevention of Re-Infestation: A Case Series from Rural Madagascar

1. Marlene Thielecke*,
2. Vaomalala Raharimanga,
3. Manuela Stauss-Grabo,
4. Christophe Rogier,
5. Vincent Richard and
6. Hermann Feldmeier

+ Author Affiliations

1. Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany; Institut Pasteur de Madagascar, Antananarivo, Madagascar; Faculty of Medicine, Mainz University, Mainz, Germany

+ Author Notes

• Authors' addresses: Marlene Thielecke and Hermann Feldmeier, Institute of Microbiology and Hygiene, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany, E-mails: marlene.thielecke@googlemail.com and hermann.feldmeier@charite.de. Vaomalala Raharimanga, Christophe Rogier, and Vincent Richard, Institut Pasteur de Madagascar, Antananarivo, Madagascar, E-mails: rvmalala@pasteur.mg, crogier@pasteur.mg, and vrichard@pasteur.sn. Manuela Stauss-Grabo, Faculty of Medicine, Mainz University, Mainz, Germany, E-mail: m.staussgrabo@gmail.com.

1. ↵* Address correspondence to Marlene Thielecke, Institute of Microbiology and Hygiene, Charité University Medicine, Campus Benjamin Franklin, Hindenburgdamm 27, 12203 Berlin, Germany. E-mail: marlene.thielecke@googlemail.com

Abstract.

Tungiasis (sand flea disease) is a neglected tropical disease. Heavy infestation results in mutilation of the feet and difficulty in walking. We identified eight individuals with extremely severe tungiasis in rural Madagascar. To prevent reinfestation, four individuals received solid shoes and four received a daily application of an herbal repellent effective against Tunga penetrans. Over a period of 10 weeks the feet were examined and the severity of tungiasis-associated morbidity was measured. Within this period, the severity score for acute tungiasis decreased 41% in the shoe group and 89% in the repellent group. The four major inflammation-related symptoms disappeared in the four patients of the repellent group, but only in two patients of the shoe group. Those observations indicate that cases with extremely severe tungiasis, associated morbidity almost totally disappears within 10 weeks if the feet are protected by a repellent. Wearing shoes reduced acute morbidity only marginally.

Footnotes

• Financial support: This study was supported in parts by Ärzte für die Dritte Welt, Frankfurt, Germany, and Engelhard Arzneimittel, Niederdorfelden, Germany, and by an international research project of the Institut Pasteur de Madagascar. Marlene Thielecke received a travel grant from the German Academic Exchange Agency, Bonn/Berlin, Germany, and from the Charité University Medicine Berlin, Germany.
• Reprint requests: Hermann Feldmeier, Institute of Microbiology and Hygiene, Charité University Medicine, Campus Benjamin Franklin, Hindenburgdamm 27, 12203 Berlin, Germany, E-mail: hermann.feldmeier@charite.de.

• Received May 7, 2013.
• Accepted August 15, 2013.

• © The American Society of Tropical Medicine and Hygiene