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Background In Brazil, tungiasis is endemic in some resource-poor communities where various domestic and sylvatic animals act as reservoirs for this zoonosis. To determine the effect of control measures on the prevalence and intensity of infestation of human and animal tungiasis, a repeated cross-sectional survey with intervention was carried out. Methodology/Principal Findings In a traditional fishing community in Northeast Brazil, humans and reservoir animals were treated, and premise-spraying using an insecticide was done, while a second fishing community served as a control. Both communities were followed up 10 times during a 12-month period. At baseline, prevalence of tungiasis was 43% (95% confidence interval [CI]: 35%–51%) and 37% (95% CI: 31%–43%) in control and intervention villages, respectively. During the study, prevalence of tungiasis dropped to 10% (95% CI: 8%–13%; p, Author Summary Tungiasis is a disease caused by the sand flea Tunga penetrans, a parasite prevalent in many impoverished communities in developing countries. The female sand flea penetrates into the skin of animals and humans where it grows rapidly in size, feeds on the host's blood, produces eggs which are expelled into the environment, and eventually dies in situ. The lesions become frequently superinfected and the infestation is associated with considerable morbidity. Clearly, tungiasis is a neglected disease of neglected populations. We investigated the impact of a package of intervention measures targeted against on-host and off-host stages of T. penetrans in a fishing community in Northeast Brazil. These measures decreased disease occurrence only temporarily, but had a sustained effect on the intensity of the infestation. Since infestation intensity and morbidity are correlated, presumably the intervention also lowered tungiasis-associated morbidity. Control measures similar to the ones used in this study may help to effectively control tungiasis in impoverished communities.

In Brazil tungiasis is endemic in many resource-poor communities, where various domestic and sylvatic animals act as reservoirs for this zoonosis. To determine the role of animal reservoirs in human tungiasis, a cross-sectional study was performed in a traditional fishing community in northeast Brazil. The human and the animal populations were examined for the presence of embedded sand fleas and the prevalence and the intensity of infestation were correlated. The overall prevalence of tungiasis in humans was 39% (95% CI 34-43%). Of six mammal species present in the village, only cats and dogs were found infested. The prevalence in these animals was 59% (95% CI 50-68%). In households, where infested pet animals were present, a higher percentage of household members had tungiasis (42% [95% CI 30-53%] versus 27% [20-33%], p=0.02), and the intensity of the infestation was higher (six lesions versus two lesions, p=0.01). The intensity of infestation in animals correlated with the intensity of infestation in humans (rho=0.3, p=0.02). Living in a household with an infested dog or cat led to a 1.6-fold (95% CI 1.1-2.3, p=0.015) increase in the odds for the presence of tungiasis in household members in the bivariate analysis and remained a significant risk factor in the multivariate regression analysis. The study shows that in this impoverished community tungiasis is highly prevalent in humans and domestic animals. In particular, it underlines the importance to include animals in control operation aiming at the reduction of disease occurrence in the human population.

Tungiasis is endemic in many countries in Latin America, the Caribbean and sub-Saharan Africa, and it is associated with severe morbidity. The pathophysiological and immunological characteristics of the ectoparasitosis are not well understood, and no effective therapy is currently available. The aim of this study was to describe the natural history of tungiasis in laboratory-raised Wistar rats. The rats were exposed in the laboratory to the parasite or were kept in a natural environment with an intense transmission of Tunga penetrans. The time course of the infestation was determined, and lesions were photographed, described clinically in detail and biopsied. Biopsies were examined histopathologically and by light and scanning electron microscopy. Based on these findings, the natural history of tungiasis in Wistar rats was described and divided in five stages. Our data show that the natural history of tungiasis in Wistar rats and humans is almost identical, except that in the animals, the basement membrane disrupts 5 days after penetration and provokes an intense infiltration of the dermis, while in humans, the basement membrane remains intact. The study indicates that the Wistar rat is an appropriate model for the study of clinical and pathological aspects of tungiasis. Using this model should enable a better understanding of the pathophysiology and immunology of the ectoparasitosis.

Tungiasis is a zoonotic ectoparasitosis that causes considerable morbidity in affected populations. The type of microenvironment that facilitates infestation of hosts by Tunga penetrans has not been investigated. In this study, we exposed 30 laboratory-raised Wistar rats, a suitable model for the infestation, at six different places characterized by different microenvironments in a hyperendemic fishing village in northeastern Brazil. During a period of two weeks, the animals were monitored and the number of embedded fleas was documented. The number of lesions varied considerably according to the microenvironment and was highest in a cage placed at the far end of a compound of a household affected by tungiasis. No penetration was observed inside houses. Results indicate that in this endemic area transmission of T. penetrans seems to occur mainly outdoors.

The jigger Tunga penetrans (Linnaeus, 1758: type-species of the family Tungidae) is the smallest known species of flea (Siphonaptera), causing serious ectoparasitosis of humans and domestic animals. The adult female Tunga lodges in the epidermis of the mammalian host, grows by neosomy, becomes gravid and expels eggs. Relatively little is known about the free-living male Tunga adults. Among impoverished communities of Fortaleza in north-east Brazil, we observed T. penetrans males as well as females penetrating the skin of human hosts. After penetrating the epidermis for a few hours, evidently for capillary feeding from the dermis, males withdrew their mouthparts and crawled away, whereas the females remained completely embedded, hypertrophying to become gravid, eventually dying in situ after oviposition. Caged rats were placed on the sandy soil and examined periodically for Tunga infestation. On five rats we obtained 140 females embedded and we detected 75 males biting, with rat erythrocytes observed in the proventriculus and midgut of all five males dissected and examined microscopically. This confirms that T. penetrans males are hamatophagous ectoparasites of mammals.

Tungiasis is caused by the penetration of the female sand flea Tunga penetrans into the skin of its host. This parasitic skin disease is almost invariably associated with an intense inflammation around embedded fleas, the underlying mechanisms being unknown. A study was undertaken to determine whether Wistar rats can be used as an animal model to assess cytokine kinetics during the natural course of the infection. Laboratory-raised Wistar rats were exposed in cages put on the soil in an area with high human attack rates. Rats were examined daily and blood samples were taken before exposure and at 2, 6, 10, 13, 16 and 20 days after flea penetration. TNF-alpha, IL-1 beta, IFN-gamma, IL-4, IL-10 and CINC (a rat cytokine- induced neutrophil chemoattractant and member of the IL-8 family) were determined by enzyme immunoassay. The results showed an increasing serum concentration of TNF-alpha and IL-1 beta 10-13 days after penetration and a rapid increase in IL-4 2 days after fleas became embedded. During the natural course of the infection, the ratio of the serum concentration of TNF-alpha to that of IL-10 decreased, indicating a relative increase in the secretion of the anti-inflammatory cytokine. The treatment of lesions with silicone oil abrogated the natural disease course and changed the pattern of cytokine secretion. We conclude that the Wistar rat is an appropriate model to study immune responses in tungiasis.