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Case #275 - May, 2010

A 70-year-old female, who had recently returned from a trip to Madagascar, went to the hospital for a painful sensation on the underside of her left foot while walking. Examination of the area between the hallux and index toes revealed an ulcerative lesion. A biopsy was performed and sent to the Pathology Department for work-up. The specimen was sectioned, stained with hematoxylin and eosin (H&E) and examined by the attending pathologist. Figures A and B show what was observed at 40x magnification. Figures C and D show the same fields at 200x magnification, respectively. What is your diagnosis? Based on what criteria?
Case275_A

Figure A

Case275_B

Figure B

Case275_C

Figure C

Case275_D

Figure D

Case Answer

This was a case of tungiasis caused by the chigoe flea, Tunga penetrans. Diagnostic features included:

  • location of the parasite between the toes.
  • remnants of a sclerotized, chitinous exoskeleton (CU, Figure C).
  • remnants of the trachea (TR, Figure C).
  • developing eggs (EG, Figure D).

Figuere C

Figure D

More on: Tungiasis

Images presented in the monthly case studies are from specimens submitted for diagnosis or archiving. On rare occasions, clinical histories given may be partly fictitious.

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DPDx is an education resource designed for health professionals and laboratory scientists. For an overview including prevention and control visit www.cdc.gov/parasites/.

  • Page last reviewed: August 24, 2016
  • Page last updated: August 24, 2016
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