RESUMEN
BACKGROUND: Tungiasis, an ectoparasitosis caused by the female sand flea Tunga penetrans, is an important health problem in many impoverished communities in the tropics. Sand flea disease is associated with a broad spectrum of clinical pathology and severe sequels are frequent. Treatment options are limited. METHODOLOGY/PRINCIPAL FINDINGS: We assessed the effectiveness of the intermittent application of the plant-based repellent Zanzarin to reduce infestation intensity and tungiasis-associated morbidity in a resource-poor community in Brazil, characterized by a very high attack rate. The study population was randomized into three cohorts. Initially, during a period of four weeks, the repellent was applied twice daily to the feet of all cohort members. This reduced the number of embedded sandfleas to 0 in 98% of the participants. Thereafter members of cohort A applied the repellent every second week twice daily for one week, members of cohort B every fourth week for one week, and members of cohort C served as controls. Infestation intensity and tungiasis-associated morbidity were monitored during five months. The intermittent application of Zanzarin for one week every second week significantly reduced infestation intensity from a median 4 lesions (IQR 1-9) during the whole transmission season. In contrast, in cohort B (application of the repellent every fourth week) the infestation intensity remained twice as high (median 8 lesions, IQR 9-16; pâ=â0.0035), and in the control cohort C 3.5 times as high (median 14 lesions; IQR 7-26; pâ=â0.004 during the transmission season). Tungiasis-related acute pathology remained very low in cohort A (median severity score 2; IQR 1-4) as compared to cohort B (median severity score 5; IQR 3-7; p<0.001), and control cohort C (median severity score 6.5; IQR 4-8; p<0.001). CONCLUSIONS/SIGNIFICANCE: Our study shows that in a setting with intense transmission, tungiasis-associated morbidity can be minimized through the intermittent application of a plant-based repellent.
Asunto(s)
Control de Enfermedades Transmisibles , Repelentes de Insectos/administración & dosificación , Preparaciones de Plantas/administración & dosificación , Tunga/efectos de los fármacos , Tungiasis/prevención & control , Adolescente , Adulto , Aloe/química , Animales , Brasil/epidemiología , Niño , Preescolar , Cocos/química , Estudios de Cohortes , Infestaciones Ectoparasitarias/epidemiología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Aceites de Plantas/administración & dosificación , Pobreza , Tungiasis/tratamiento farmacológico , Tungiasis/economía , Tungiasis/parasitología , Adulto JovenRESUMEN
The parasitic skin disease tungiasis, caused by the jigger flea Tunga penetrans, is endemic in low-income communities in Brazil. In this study, inhabitants of a shantytown in Fortaleza, northeastern Brazil, who had an elevated parasite load, were identified. The number of lesions, localization, staging and associated diseases were recorded. The 142 individuals identified were living in extremely precarious housing conditions. A total of 3,445 lesions located on the feet were counted (median = 17 lesions; maximum = 98 lesions). Almost without exception, the individuals had nail deformation and edema, and more than 70% presented with pain and fissures. There was nail loss in 46%; deformation of the digits in 25%; abscesses in 42%; and complaints of walking difficulty in 59%. Our data show that tungiasis in this low-income urban community typical of northeastern Brazil was associated with severe morbidity. Tungiasis needs to be recognized as a public health problem in this study area and other similar endemic areas.
Asunto(s)
Infestaciones Ectoparasitarias/epidemiología , Dermatosis del Pie/parasitología , Siphonaptera , Enfermedad Aguda , Adolescente , Adulto , Anciano , Animales , Brasil/epidemiología , Niño , Preescolar , Enfermedad Crónica , Infestaciones Ectoparasitarias/complicaciones , Femenino , Dermatosis del Pie/epidemiología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Áreas de Pobreza , Índice de Severidad de la Enfermedad , Población UrbanaRESUMEN
A tungíase, ectoparasitose causada pela pulga Tunga penetrans, é endêmica em comunidades brasileiras de baixo poder aquisitivo. Neste estudo foram identificados habitantes de uma favela urbana em Fortaleza com carga parasitária elevada. Número de lesões, localização, estadiamento e patologias associadas foram registrados. Os 142 indivíduos identificados apresentaram condições de moradia extremamente precárias. Contou-se no total 3.445 lesões localizadas nos pés (mediana = 17 lesões; máximo = 98 lesões). Quase sem exceção, os indivíduos apresentaram deformações ungueais e edema e mais de 70 por cento dor e fissuras. Perda de unha foi observada em 46 por cento dos casos e deformação de dígitos em 25 por cento; 42 por cento apresentaram abscessos e 59 por cento queixaram-se de dificuldade de andar. Nossos dados mostram que a tungíase em comunidade urbana de baixa renda típica no nordeste brasileiro está associada a patologia grave. A doença precisa ser reconhecida como problema de saúde pública na região estudada e em outras áreas endêmicas semelhantes.
The parasitic skin disease tungiasis, caused by the jigger flea Tunga penetrans, is endemic in low-income communities in Brazil. In this study, inhabitants of a shantytown in Fortaleza, northeastern Brazil, who had an elevated parasite load, were identified. The number of lesions, localization, staging and associated diseases were recorded. The 142 individuals identified were living in extremely precarious housing conditions. A total of 3,445 lesions located on the feet were counted (median = 17 lesions; maximum = 98 lesions). Almost without exception, the individuals had nail deformation and edema, and more than 70 percent presented with pain and fissures. There was nail loss in 46 percent; deformation of the digits in 25 percent; abscesses in 42 percent; and complaints of walking difficulty in 59 percent. Our data show that tungiasis in this low-income urban community typical of northeastern Brazil was associated with severe morbidity. Tungiasis needs to be recognized as a public health problem in this study area and other similar endemic areas.