Case #328 - July, 2012
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A 25-year-old woman traveled to Kenya and Uganda for three months of field work in public health entomology. Upon returning to the United States, she noticed a painful lesion on her left big toe, just at the intersection with the nail (Figure A). She visited her primary care physician. While applying pressure to the region during examination, eggs appeared to exude from the lesion (Figure B). Eggs were sent to Microbiology for diagnostic assistance. The eggs measured on average 600 micrometers in length. What is your diagnosis? Based on what criteria?
Figure A
Figure B
Case Answer
This was a case of tungiasis caused by the chigoe flea, Tunga penetrans. Diagnostic features included the presence of eggs within the size range for Tunga, as well as the location on the host. People are typically infested when walking bare-foot or in sandals in sandy areas of endemic regions for the disease.
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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