title: Disseminated tungiasis in a 78-year-old woman from Tanzania: a case report.
abstract: BACKGROUND
  Tungiasis is one of the neglected tropical diseases; it affects up to 40% of individuals living in societies with poor housing and sanitation standards. In endemic areas, Tunga infestation, which predominantly affects the periungual areas of the lower limbs in humans, is associated with considerable morbidity and poor quality of life.
  
  
  METHODS
  A 78-year-old woman of African descent presented with pain, inflammation, suppuration, ulceration, and deformation of digits of all four limbs. She had a total of 1146 embedded sand fleas: 812 in lower limbs and 334 in her hands. She was febrile; her full blood count revealed pancytopenia and blood cultures were positive for Staphylococcus aureus and Streptococcus pyogenes isolates. Furthermore, she had severe hyponatremia. We applied 20% salicylated petroleum jelly followed by the manual removal of embedded sand fleas with a sterile needle. Intravenously administered piperacillin-tazobactam, topical ivermectin, ferrous sulfate, folic acid, tolvaptan, albendazole, multivitamins, and tetanus prophylaxis were instituted. She was discharged home after 16 days of hospitalization.
  
  
  CONCLUSIONS
  Tungiasis is a neglected disease of concern in underprivileged societies that is preventable and curable. Early recognition and prompt treatment is crucial to prevent complications in this disease which may potentially mimic other conditions resulting in erroneous management.
authors.affiliation: Unit of Research, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania. pedro.pallangyo@gmail.com.
authors.forename: Pedro
authors.initials: P
authors.lastname: Pallangyo
authors.affiliation: Unit of Research, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania.
authors.forename: Paulina
authors.initials: P
authors.lastname: Nicholaus
mesh_terms: D000368:Aged; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D065092:Antidiuretic Hormone Receptor Antagonists / Q000008:administration & dosage; D001552:Benzazepines / Q000008:administration & dosage; D004478:Ectoparasitic Infestations / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D005121:Extremities / Q000469:parasitology* / Q000473:pathology; D005260:Female; D005296:Ferrous Compounds / Q000008:administration & dosage; D005492:Folic Acid / Q000008:administration & dosage; D006801:Humans; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D010878:Piperacillin / Q000008:administration & dosage; D000077725:Piperacillin, Tazobactam Drug Combination; D011204:Poverty Areas; D011788:Quality of Life; D018805:Sepsis / Q000188:drug therapy / Q000469:parasitology* / Q000473:pathology; D012720:Severity of Illness Index; D013636:Tanzania; D013745:Tetanus Toxoid / Q000008:administration & dosage; D000077602:Tolvaptan; D016896:Treatment Outcome; D058253:Tunga / Q000187:drug effects*; D058285:Tungiasis / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D014815:Vitamins / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D005296:Ferrous Compounds; D013745:Tetanus Toxoid; D014815:Vitamins; D000077725:Piperacillin, Tazobactam Drug Combination; D000077602:Tolvaptan; C020748:ferrous sulfate; D010397:Penicillanic Acid; D005492:Folic Acid; D010878:Piperacillin
keywords: Case report; Neglected tropical diseases; Sandfly; Tunga infestation; Tunga penetrans; Tungiasis