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Journal of Medical Case Reports

, 10:354

First Online: 20 December 2016Received: 15 October 2016Accepted: 17 November 2016DOI: 10.1186-s13256-016-1146-6

Cite this article as: Pallangyo, P. & Nicholaus, P. J Med Case Reports 2016 10: 354. doi:10.1186-s13256-016-1146-6


BackgroundTungiasis is one of the neglected tropical diseases; it affects up to 40% of individuals living in societies with poor housing and sanitation standards. In endemic areas, Tunga infestation, which predominantly affects the periungual areas of the lower limbs in humans, is associated with considerable morbidity and poor quality of life.

Case presentationA 78-year-old woman of African descent presented with pain, inflammation, suppuration, ulceration, and deformation of digits of all four limbs. She had a total of 1146 embedded sand fleas: 812 in lower limbs and 334 in her hands. She was febrile; her full blood count revealed pancytopenia and blood cultures were positive for Staphylococcus aureus and Streptococcus pyogenes isolates. Furthermore, she had severe hyponatremia. We applied 20% salicylated petroleum jelly followed by the manual removal of embedded sand fleas with a sterile needle. Intravenously administered piperacillin-tazobactam, topical ivermectin, ferrous sulfate, folic acid, tolvaptan, albendazole, multivitamins, and tetanus prophylaxis were instituted. She was discharged home after 16 days of hospitalization.

ConclusionsTungiasis is a neglected disease of concern in underprivileged societies that is preventable and curable. Early recognition and prompt treatment is crucial to prevent complications in this disease which may potentially mimic other conditions resulting in erroneous management.

KeywordsTungiasis Sandfly Tunga penetrans Tunga infestation Neglected tropical diseases Case report AbbreviationsALTAlanine transaminase

ASTAspartate aminotransferase


HIVHuman immunodeficiency virus

MCHMean cell hemoglobin

MCVMean corpuscular volume


RDWRed cell distribution width

VDRLVenereal Disease Research Laboratory

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Author: Pedro Pallangyo - Paulina Nicholaus

Source: https://link.springer.com/

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