Epidemiology and clinical aspects of tungiasis (sand flea infestation) in Alagoas State, Brazil
2007
Jorg Heukelbach,1,2 Anne Jackson,3 Liana Ariza,4 Cláudia Maria Lins Calheiros,5 Valquíria de Lima Soares,5 and Hermann Feldmeier3
Background: Tungiasis (infestation with the sand flea Tunga penetrans) is common in resource-poor populations throughout Brazil. However, the epidemiological situation and the clinical aspects are not fully understood.Methodology: To describe the prevalence and severity of tungiasis, associated pathology, as well as the seasonal variation in rural northeast Brazil, we performed two cross-sectional surveys: one in the rainy season, another in the dry season. Individuals were examined for the presence of tungiasis, number of lesions, symptoms and signs. In the rainy season, 88.6% (1,015/1,146), and in the dry season 91.1% (990/1,087) of the respective target populations were examined.Results: The prevalence of tungiasis was 21.6% (95% confidence interval: 19.0-24.1) in the rainy season and 29.5% (26.6-32.3) in the dry season (p<0.0001). The highest prevalence was found in boys (5 – 14 years) in the dry season (48.3%; 40.6-56.0). Most lesions occurred on the feet (rainy season: 96.3%; dry season: 97.5%); a considerable number of individuals presented with lesions on the hands (6.9% and 5.1%, respectively). Common symptoms and signs were desquamation of the skin (57.5% in the rainy season; 44.5% in the dry season), hyperkeratosis (51.6% and 34.6%) and nail deformation (32.0% and 23.3%). Superinfection was present in 15.5% and 13.7% of cases, respectively. Severe pathology, such as deep fissures (10.5% and 9.3%), loss of toe-nails (5.5% and 2.4%) and difficulty walking (1.4% and 0.7%) occurred less commonly.Conclusions: Tungiasis occurs to an important degree in Alagoas State, and prevalence and morbidity varies according to the season. Children were identified as a high-risk group.
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