title: Regression of severe tungiasis-associated morbidity after prevention of re-infestation: a case series from rural Madagascar.
abstract: Tungiasis (sand flea disease) is a neglected tropical disease. Heavy infestation results in mutilation of the feet and difficulty in walking. We identified eight individuals with extremely severe tungiasis in rural Madagascar. To prevent reinfestation, four individuals received solid shoes and four received a daily application of an herbal repellent effective against Tunga penetrans. Over a period of 10 weeks the feet were examined and the severity of tungiasis-associated morbidity was measured. Within this period, the severity score for acute tungiasis decreased 41% in the shoe group and 89% in the repellent group. The four major inflammation-related symptoms disappeared in the four patients of the repellent group, but only in two patients of the shoe group. Those observations indicate that cases with extremely severe tungiasis, associated morbidity almost totally disappears within 10 weeks if the feet are protected by a repellent. Wearing shoes reduced acute morbidity only marginally.
authors.affiliation: Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany; Institut Pasteur de Madagascar, Antananarivo, Madagascar; Faculty of Medicine, Mainz University, Mainz, Germany.
authors.forename: Marlene
authors.initials: M
authors.lastname: Thielecke
authors.forename: Vaomalala
authors.initials: V
authors.lastname: Raharimanga
authors.forename: Manuela
authors.initials: M
authors.lastname: Stauss-Grabo
authors.forename: Christophe
authors.initials: C
authors.lastname: Rogier
authors.forename: Vincent
authors.initials: V
authors.lastname: Richard
authors.forename: Hermann
authors.initials: H
authors.lastname: Feldmeier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002648:Child; D005260:Female; D005528:Foot / Q000469:parasitology* / Q000503:physiopathology; D006801:Humans; D007302:Insect Repellents / Q000494:pharmacology; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012424:Rural Population; D055502:Secondary Prevention; D012775:Shoes; D058253:Tunga / Q000187:drug effects* / Q000502:physiology; D058285:Tungiasis / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control*
chemical_list: D007302:Insect Repellents
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