Tungiasis

Tungiasis is a dermatological parasitic disease caused by two of the 13 known species of female sand flea (Tunga penetrans and Tunga trimammillata). Tungiasis is endemic in tropical and subtropical regions of the Caribbean, South America and sub-Saharan Africa, especially in areas with sandy soil and is an emerging pathology in patients travelling from non-endemic areas. After skin penetration, the parasite’s abdomen protrudes from the surface, visible as a white enlarging dot. Due to inflammation at the penetration site, lesions are prone to complications such as infection and sepsis, occasionally leading to minor amputation. In diabetic patients with underlying vasculopathy, tungiasis may lead to manifest critical limb ischemia, with necrosis, sepsis and death. In settings that are endemic for tungiasis, the mismanagement of diabetes (under-diagnosis and treatment) is frequently reported, which can lead to the increased prevalence of many associated complications of this metabolic condition, including microvascular challenges, with microangiopathy or macrovascular diseases in the form of chronic limb ischemia. The co-occurrence of two neglected conditions (metabolic and parasitic) in the case of tungiasis in diabetic patients could potentially favour catastrophic clinical scenarios. The skin lesion caused by the parasite embedment, in a patient with impaired vasculature and immunity due to diabetes, could start a domino of clinical conditions that could potentialy lead to gangrene, limb amputation, sepsis and death. Further research is needed to better understand and define this co-occurrence in terms of prevalence, clinical features and outcomes.