Case #214 – October, 2007

An 18-year-old woman sought medical attention due to a painful lesion between her toes. She reported travel to Africa. The lesion was excised and sent to CDC for closer examination and identification. The tissue was noted to be fibrous and was carefully dissected to examine what was inside. Figure A shows what was revealed within the tissue; the image was taken with a hand-held digital camera mounted to a dissecting microscope. What is your diagnosis? Based on what criteria?

Image A

This was a case of tungiasis caused by the parasitic flea, Tunga penetrans. Travel history and clinical presentation were consistent with tungiasis. Diagnostic features were:

the presence of a flea in the lesion. The flea had an angular head and did not genal or pronotal combs.
large, oval egg, indicating that the flea was a gravid female. The size of T. penetrans eggs are approximately 650 micrometers in length.