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PLoS Negl Trop Dis. 2019 Feb 7;13(2):e0007068. doi: 10.1371/journal.pntd.0007068. eCollection 2019 Feb.

Very severe tungiasis in Amerindians in the Amazon lowland of Colombia: A case series.

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Vaupés Health Department, Mitú, Colombia.
Grupo SEP Línea de investigación-Interculturalidad, Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia.
Department of Neglected Tropical Diseases, Ministry of Health and Social Protection, Bogotá, Colombia.
Institute of Microbiology and Infection Immunology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.



Tungiasis is a parasitic skin disease caused by penetrating female sand fleas. By nature, tungiasis is a self-limiting infection. However, in endemic settings re-infection is the rule and parasite load gradually accumulates over time. Intensity of infection and degree of morbidity are closely related.


This case series describes the medical history, the clinical pathology, the socio-economic and the environmental characteristics of very severe tungiasis in five patients living in traditional Amerindian communities in the Amazon lowland of Colombia. Patients had between 400 and 1,300 penetrated sand fleas. The feet were predominantly affected, but clusters of embedded sand fleas also occurred at the ankles, the knees, the elbows, the hands, the fingers and around the anus. The patients were partially or totally immobile. Patients 1 and 3 were cachectic, patient 2 presented severe malnutrition. Patient 3 needed a blood transfusion due to severe anemia. All patients showed a characteristic pattern of pre-existing medical conditions and culture-dependent behavior facilitating continuous re-infection. In all cases intradomiciliary transmission was very likely.


Although completely ignored in the literature, very severe tungiasis occurs in settings where patients do not have access to health care and are stricken in a web of pre-existing illness, poverty and neglect. If not treated, very severe tungiasis may end in a fatal disease course.

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Conflict of interest statement

The authors have declared that no competing interests exist.

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