Got the Travel Bug? A Review of Common Infections, Infestations, Bites, and Stings Among Returning Travelers

Matthew P. Vasievich; Jose Dario Martinez Villarreal; Kenneth J. Tomecki


Am J Clin Dermatol. 2016;17(5):451-462. 

In This Article



Tungiasis, caused by the sand flea Tunga penetrans, is an infestation where the female sand flea burrows into the host after mating, takes a blood meal from the superficial dermal blood vessels, and proceeds to extrude more than 100 eggs, which subsequently fall to the ground. While implanted in the host, the flea grows approximately 2000-fold in size, remains in the host for approximately 4–6 weeks, and subsequently dies and is sloughed off by the host. The parasite can also be carried by animal hosts, including dogs, pigs, cows, and rats, which can lead to persistence of the organism in rural communities despite eradication efforts.[27–29]


Tungiasis is found worldwide in both the eastern and the western hemispheres, including sub-Saharan Africa, India, Pakistan, and especially in the Caribbean, where disease prevalence is 15–50 %. In endemic areas, burden of disease can be particularly high in individuals with multiple organisms.[3,28]

Clinical Presentation

The sand flea favors acral sites, most commonly the toes and peri-ungal skin, and is often acquired when walking barefoot or with open-toed shoes in an endemic area. The disease presents with a papule or nodule, often with an overlying black dot where the flea has entered the host. The differential diagnosis includes a callus, clavus, friction blister, or traumatic hematoma. As the organism grows and becomes symptomatic, itching may result in superinfection. In communities without established vaccination programs, infection with Clostridium tetani can also occur.[30,31]


Treatment for tungiasis is physical removal of the organism; a simple shave or punch biopsy procedure is usually sufficient. Otherwise, a sterile needle may be used. Alternatively, in patients with significant disease, topical ivermectin, metrifonate, or thiabendazole may also be used.[32]