The Pan American Health Organization (PAHO) has released the first evidence-based guide for tungiasis, a neglected tropical disease caused by the sand flea Tunga penetrans. The parasite embeds in the skin and produces marked inflammation, pain, burning and severe itching, particularly on the feet. Millions are affected in Latin America, the Caribbean and Sub-Saharan Africa; children and older adults bear the greatest burden and the disease can cause chronic complications, deformities and social stigma.
PAHO’s regional advisor Ana Luciañez said tungiasis is mainly linked to communities living in poverty and marginalisation. The guidelines recommend low-viscosity dimethicone as the preferred treatment because it kills fleas when applied to lesions and is easier and less costly than surgical removal. If dimethicone is not available, the guide suggests ivermectin. The guide warns strongly against manual extraction without aseptic measures or trained personnel, noting common use of needles, scissors and hairpins. It also discourages potassium permanganate and hydrogen peroxide due to burns, pigmentation and irritation risks. Specialists warn that unsafe removal can lead to infections, tetanus and even death; dermatologist Cynthia Rossi reported patients unable to walk because of many lesions.
PAHO describes tungiasis as neglected, with limited research, low investment, few international protocols and little pharmaceutical interest, and it is not included in most national public health plans. Manuel Calvopiña of PAHO’s Guidelines Development Group said incidence has decreased over the last 20 years but some people remain incapacitated. The agency calls for combined clinical, community and environmental measures, better epidemiological data and policies to make dimethicone available. The World Health Organization recommends simple prevention: daily foot washing with soap, sealing or spraying floors with insecticide, and using coconut oil repellents.
In Latin America and the Caribbean infections are concentrated in ten countries. More than 70 per cent of reported cases between 2010 and 2022 were in Brazil, mainly in Amazonian villages. Colombia has reported serious cases among indigenous populations in the Amazon, and cases have been reported in Ecuador, Guatemala, French Guiana, Haiti, Mexico, Bolivia and Argentina. PAHO estimates 450 million people live in at-risk areas, but many cases go unreported because of stigma and lack of access to healthcare. Experts say education of health staff, officials and communities and policies to make dimethicone available are critical next steps.
Difficult words
- tungiasis — Parasitic skin disease caused by a sand flea
- dimethicone — Silicone oil used to kill or suffocate fleas
- ivermectin — Medicine used to treat parasitic infections in humans
- aseptic — Free from bacteria or infection; sterile practice
- marginalisation — Social and economic exclusion of certain communities
- stigma — Negative social judgement that causes shame or isolation
- extraction — Removal of something, often by manual or surgical means
- epidemiological — Relating to the study of disease patterns in populations
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Discussion questions
- What are the advantages and risks of using dimethicone compared with manual extraction in communities with limited health services?
- How might stigma and lack of access to healthcare affect reporting and control of tungiasis in at-risk areas?
- What combined clinical, community and environmental measures could help reduce tungiasis where you live or in similar communities?
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