title: Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil: I. Natural history of tungiasis in man.
abstract: Tungiasis is an important health problem in poor communities in Brazil and is associated with severe morbidity, particularly in children. The causative agent, the female flea Tunga penetrans, burrows into the skin of its host, where it develops, produces eggs and eventually dies. From the beginning of the penetration to the elimination of the carcass of the ectoparasite by skin repair mechanisms, the whole process takes 4-6 weeks. The present study is based on specimens from 86 patients, for some of whom the exact time of penetration was known. Lesions were photographed, described in detail and biopsied. Biopsies were examined histologically and by means of scanning electron microscopy (SEM). Based on clinical, SEM and histological findings, the "Fortaleza classification" was elaborated. This allows the natural history of tungiasis to be divided into five stages: (1) the penetration phase, (2) the phase of beginning hypertrophy, (3) the white halo phase, (4) the involution phase and (5) residues in the host's skin. Based on morphological and functional criteria, stages 3 and 4 are divided into further substages. The proposed Fortaleza classification can be used for clinical and epidemiological purposes. It allows a more precise diagnosis, enables the assessment of chemotherapeutic approaches and helps to evaluate control measures at the community level.
authors.affiliation: Institute of International Health, Center for Humanities and Health Sciences, Faculty of Medicine, Free University of Berlin, Fabeckstrasse 60-62, 12203, Berlin, Germany.
authors.forename: Margit
authors.initials: M
authors.lastname: Eisele
authors.forename: Jörg
authors.initials: J
authors.lastname: Heukelbach
authors.forename: Eric
authors.initials: E
authors.lastname: Van Marck
authors.forename: Heinz
authors.initials: H
authors.lastname: Mehlhorn
authors.forename: Oliver
authors.initials: O
authors.lastname: Meckes
authors.forename: Sabine
authors.initials: S
authors.lastname: Franck
authors.forename: Hermann
authors.initials: H
authors.lastname: Feldmeier
mesh_terms: D000368:Aged; D000818:Animals; D001938:Brazil / Q000453:epidemiology; D004478:Ectoparasitic Infestations / Q000453:epidemiology / Q000469:parasitology / Q000473:pathology* / Q000517:prevention & control; D005260:Female; D005528:Foot / Q000469:parasitology; D005533:Foot Dermatoses / Q000469:parasitology / Q000473:pathology; D006225:Hand / Q000469:parasitology; D006801:Humans; D007223:Infant; D008018:Life Cycle Stages; D008297:Male; D005423:Siphonaptera / Q000166:cytology / Q000254:growth & development / Q000472:pathogenicity