Typical histologic features of Tunga penetrans in skin biopsies.
BACKGROUND
Tunga penetrans is a flea that burrows into human skin, causing the disease tungiasis. Although the parasite is not endemic in the United States, patients may present with this disease upon returning from tropical locales. Histologic sections contain a variety of flea parts that may present a diagnostic dilemma for pathologists unfamiliar with this disease.


OBJECTIVE
To determine the typical histologic features of T penetrans in biopsies from patients with tungiasis.


METHODS
We reviewed biopsy specimens from 7 patients with tungiasis and sought 8 distinct structures: the exoskeleton, hypodermal layer, respiratory tract (tracheae), digestive tract, striated muscle, head, posterior end, and developing eggs.


RESULTS
The exoskeleton, hypodermal layer, tracheae, digestive tract, and developing eggs were present in all biopsy specimens reviewed. Striated muscle, the posterior end, and head, however, were present in 57%, 43%, and 0% of the biopsies, respectively. In addition, we noted a unique, pale-staining layer in the exoskeleton at the posterior end of the organism that, to the best of our knowledge, has not previously been described and that may be of diagnostic value.


CONCLUSIONS
Despite the absence of 3 key morphologic features in many (posterior end and striated muscle) or all (head) of our biopsies, the exoskeleton with a hypodermal layer, tracheae, and developing eggs were uniformly present, and together these features are sufficient for a diagnosis of tungiasis.
Smith
Marc D
MD
Division of Pathology and Laboratory Medicine, The Cleveland Clinic Foundation, Ohio 44195, USA.
Procop
Gary W
GW
D000328:Adult; D000818:Animals; D001706:Biopsy; D004478:Ectoparasitic Infestations / Q000469:parasitology* / Q000473:pathology; D006801:Humans; D008297:Male; D005423:Siphonaptera / Q000166:cytology*