To the Editor: Infestation with the sandflea Tunga penetrans, or “chigoe flea”, is rarely encountered in Australia, but has been noted in children recently arrived from Central–East Africa. There have been only two previous Australian case reports of this parasitic infection, both in adult travellers returning from Africa.1,2

Several families who had been living in crowded refugee camps in Tanzania underwent routine screening for infection within 2 weeks of arrival in Australia. Four of 14 children examined had cutaneous lesions on their feet — mainly on the toes, nail beds and interdigital spaces (Box). These lesions were papular, less than 1 cm in diameter, pale yellow with dark centres, and were variably painful and/or itchy. Chronic, adjacent skin and nail bed changes were evident, as were small, loosely attached seed-like objects. Papules could be lifted with a sterile needle, leaving a small, non-bleeding cavity. Tunga penetrans, with numerous attached eggs, was identified by microscopy.

Tungiasis occurs when an impregnated female sandflea burrows into the unprotected skin of a warm-blooded host. There is a predilection for the feet, although the perineum, buttocks and arms may also be infected.3 The head of the sandflea breaches the upper dermis to feed on blood vessels, while the abdomen traverses the epidermis, with its posterior components (anus, genital opening and respiratory spiracle) reaching the surface, forming a papule. Over several weeks, the flea releases hundreds of eggs before dying. After hatching, the larvae thrive in dust, soil and sand; they are found on beaches and in animal stockyards of tropical countries.3,4 Infection of pigs and other livestock, the usual host reservoirs, has led to significant problems in the livestock industry.1,4

Apart from pruritis and pain caused by local inflammation, morbidity results from ulceration and secondary bacterial infection, including tetanus and gas gangrene.1,2,4

Fleas can be removed using a sterile needle and forceps, and secondary complications prevented with tetanus prophylaxis, and antibiotics as appropriate. Successful outcomes with antiparasitic agents, such as ivermectin and thiabendazole, have also been recently reported.5

Tungiasis is indigenous to Latin America and the Caribbean, but was introduced to Africa, where it is now endemic, and to parts of South Asia.4 Given the current influx of African refugees into Australia, including the tropical north, the obvious concern is whether Tunga penetrans could establish itself here.

We encourage medical practitioners dealing with newly arrived African refugees to examine for tungiasis in their screening evaluation. If, as suspected, this condition is prevalent, national infection control guidelines aimed at preventing establishment of the disease in Australia may be needed.

Lesions caused by Tunga penetrans, the “chigoe” sandflea

A characteristic Tunga penetrans lesion (thick arrow), with pale-yellow papule and dark centre, and a less obvious lesion (thin arrow) with surrounding chronic skin changes and multiple, loosely attached eggs.