Jiggers (Tunga penetrans)

Notes

## Basic introduction

  • Jiggers hide in the crevices and hairy cracks found on the floors, walls of dwellings and items like furniture.
  • They feed on warm-blooded hosts such as man, cats, dogs, rats, pigs, cattle and sheep.
  • The female flea feeds by burrowing into the skin of its host and its abdomen becomes enormously enlarged between the second and third segments so that the flea forms a round sac with the shape and size of a pea. The impregnated female Tunga embeds itself in the skin under the toenails and fingernails of man - where the resultant sores may fill with pus due to bacterial infection.

## Statistics

  • An estimated 2 million Kenyans in 24 counties continue to suffer the debilitating effects and social stigma associated with jiggers
  • Prevalence of tungiasis in Murang’a South district (Kenya) during high transmission season in 2009 was 57%
Symptoms
  • A tiny black dot on the skin at the point of penetration
  • Most lesions occur on the feet, often on the soles, the toe webs, and around or under the toenails (as the flea is a poor jumper)
  • A small, inflammatory papule with a central black dot forms early.
  • The papule enlarges into a white, pea-sized nodule with well-defined borders between 4-10mm in diameter.
  • Asymptomatic to pruritic and painful lesion.
  • Multiple/severe infestations may result in a cluster of nodules with a honeycomb appearance.
  • With heavy infestations there can be severe inflammation
  • Ulceration
  •  
  • Lymphangitis
  • Gangrene
  • Sepsis
  • The loss of toenails
  • Autoamputation of the digits
  • Risk of secondary infection
  • Tetanus is a common secondary infection that has reported associations with death.
Diagnosis
  • Clinical evaluation
Differential
  • Cercarial dermatitis
  • Creeping eruption due to Ancylostoma species
  • Fire ant bites
  • Flea bites
  • Myiasis
  • Scabies Tick bite
Prevention
  • Maintaining good personal hygiene
  • Dusting the earthen floor with insecticide powder
  • Smoothening of the mud walls (with cow dung or mud)
Reference
  1. Ahadi Kenya. http://www.jigger-ahadi.org/jiggers.html
  2. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf
  3. Njau N, Wanzala P, Mutugi M, Ariza L, Heukelback J (2012) Tungiasis (jigger infestation) in rural Kenya, an emerging infectious disease. Retrovirology 9: P37.
  4. Government of Kenya. http://www.president.go.ke/2015/03/03/two-million-kenyans-in-24-counties-affected-by-jiggers-says-first-lady/
  5. Ministry of Health, Kenya. Kenya Essential Medicine List (2016). http://publications.universalhealth2030.org/uploads/KEML-2016Final-1.pdf
Management
  • Treatment

_Wash affected areas with clean water and soap

_Dry the cleaned areas

_Soak affected area in a potassium permanganate or Lysol for 15 minutes

_Apply petroleum jelly or other oil to soften the skin (to suffocate them)

_Repeat the above procedure three times a day for two weeks.

  • Counsel the public to extract jiggers with a clean pin
  • Tetanus toxoid vaccination (Tetanus is the major cause of death)
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