domenica 9 dicembre 2012


TUNGIASIS: overview
Tungiasis is an infestation by the burrowing flea Tunga penetrans or related species.
The flea has many common names, being known in various locations as the chigger flea, sand flea, chigoe, jigger...
The flea is indigenous to the West Indies/Caribbean/Central America region, but it has spread to Africa, India, Pakistan, and South America.

TUNGIASIS: Patophysiology
The main habitat for T. penetrans is warm, dry soil and sand of beaches, stables, and stock farms.
To reproduce, the flea requires a warm-blooded host. In addition to humans, reservoir hosts include pigs, dogs, cats, cattle, sheep, horses, mules, rats, mice, and other wild animals.
Upon contact, the flea invades unprotected skin. The most common site of involvement is the feet (interdigital skin and subungual area). The flea has limited jumping ability.

TUNGIASIS: Patophysiology
The flea expands, often reaching 1 cm in diameter. The head is down into the upper dermis, feeding from blood vessels, while the caudal tip of the abdomen is at the skin surface, often forming a punctum or an ulceration. In many cases, this is described as a white patch with a black dot.
During her gestation the jigger causes a considerable amount of irritation. Pus may form around her distended abdomen, which now raises the integument into a pea-like elevation.
Very heavy infestation may cause ulceration and fibrosis that may result in secondary infections, such as bacteremia, tetanus, lymphangitis, and gas gangrene. These infections may follow attempts to extract the flea. Autoamputation of digits or other extensive soft tissue debridement is also a possibility.
Over 1-2 weeks, more than 100 eggs, which fall to the ground, are individually released from the exposed orifice.
Afterwards, the flea dies and is slowly sloughed by the host. The eggs hatch on the ground in 3-4 days, go through larval and pupal stages and become adults in 2-3 weeks. The complete life cycle lasts approximately 1 month.

TUNGIASIS: signs and symptoms
Infestation in its simplest form is manifested by the appearance of a white patch with a black dot.
More advanced infestation manifests as:
       crusted, erythematous papules;
       painful, pruritic nodules;
       crateriform lesions;
       secondary infections, including lymphangitis and septicaemia.
Lesions can range from asymptomatic, to pruritic, to extremely painful.
Pain or itching and papular or nodular eruptions, are usually on the feet, but they can occur on any area of the body to which the flea has access (no part of the body escapes especially when sleeping on the soil). 

TUNGIASIS: management
Extraction of the gravid flea using a sterile needle or dissecting forceps is diagnostic and therapeutic.
Following surgical extraction of the flea, thoroughly cleanse and cover the remaining crater with a topical antibiotic cream to prevent secondary infection.
A skin biopsy of a suspected papule or nodule may be performed.
In general, no laboratory studies are indicated other than a histologic examination of excised tissue to confirm the presence of the flea, but we normally never do it because local people know the infestation very well.
No imaging studies are indicated unless there is a secondary infection with a complication such as gas gangrene.
Conditions to consider in the differential diagnosis of tungiasis include the following:
       Cercarial dermatitis
       Creeping eruption due to Ancylostoma species
       Tick bite
       Flea bites
       Myiasis (Dermatobia hominis)
       Fire ant bites
       Ingrown toenails

TUNGIASIS: topical treatment
Topical ivermectin, metrifonate, and thiabendazole have been reported as effective.
Occlusive petrolatum suffocates the organism.
20% salicylated petroleum jelly (Vaseline) applied 12-24 hours in profound infestations caused the death of the fleas and facilitated their manual removal.
However, these treatments do not remove the flea from the skin, and they do not result in quick relief from painful lesions.
The insect repellant Zanzarin, a lotion consisting of coconut oil, jojoba oil, and aloe vera, was shown to reduce the number of newly embedded fleas and skin lesions, as well as to almost completely reverse the cutaneous pathology, when applied twice daily.
In areas with a high endemicity of sand fleas, daily application of Zanzarin was found to be very efficacious at preventing tungiasis.
Dr Giuseppe Gaido 
Dr Nadia Chiapello

Nessun commento:

Chaaria è un sogno da realizzare giorno per giorno.

Un luogo in cui vorrei che tutti i poveri e gli ammalati venissero accolti e curati.

Vorrei poter fare di più per questa gente, che non ha nulla e soffre per malattie facilmente curabili, se solo ci fossero i mezzi.

Vorrei smetterla di dire “vai altrove, perché non possiamo curarti”.

Anche perché andare altrove, qui, vuol dire aggiungere altra fatica, altro sudore, altro dolore, per uomini, donne e bambini che hanno già camminato per giorni interi.

E poi, andare dove?

Gli ospedali pubblici hanno poche medicine, quelli privati sono troppo costosi.

Ecco perché penso, ostinatamente, che il nostro ospedale sia un segno di speranza per questa gente. Non ci sarà tutto, ma facciamo il possibile. Anzi, l’impossibile.

Quello che mi muove, che ci muove, è la carità verso l’altro, verso tutti. Nessuno escluso.

Gesù ci ha detto di essere presenti nel più piccolo e nel più diseredato.

Questo è quello che facciamo, ogni giorno.

Fratel Beppe Gaido

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