CDC - DPDx - Tungiasis

3/7/23, 4:21 PM CDC - DPDx - Tungiasis
DPDx - Laboratory Identification of Parasites of Public Health

Concern
Tungiasis
[Tunga penetrans]
Parasite Biology Image Gallery Laboratory Diagnosis Treatment Information
Causal Agent
The chigoe flea, Tunga penetrans. The flea is also referred to as the jigger, nigua, chica, pico, pique or suthi.
Life Cycle
Eggs are shed by the gravid female into the environment . Eggs hatch into larvae in about 3-4 days and feed on organic
debris in the environment. Tunga penetrans has two larval stages before forming pupae . The pupae are in cocoons that
are often covered with debris from the environment (sand, pebbles, etc). The larval and pupal stages take about 3-4 weeks
to complete. Afterwards, adults hatch from pupae and seek out a warm-blooded host for blood meals. Both males and
females feed intermittently on their host, but only mated females burrow into the skin (epidermis) of the host, where they
cause a nodular swelling . Females do not have any specialized burrowing organs, and simply claw into the epidermis
after attaching with their mouthparts. After penetrating the stratum corneum, they burrow into the stratum granulosum,
with only their posterior ends exposed to the environment . The female fleas continue to feed and their abdomens
extend up to about 1 cm. Females shed about 100 eggs over a two-week period, after which they die and are sloughed by
the host’s skin. Secondary bacterial infections are not uncommon with tungiasis.
Geographic Distribution
Tunga penetrans is distributed in tropical and subtropical regions of the world, including Mexico to South America, the
West Indies and Africa. The fleas normally occur in sandy climates, including beaches, stables and farms.
Clinical Presentation
https://www.cdc.gov/dpdx/tungiasis/index.html 1/3
The initial burrowing by the gravid females is usually painless; symptoms, including itching and irritation, usually start to
develop as the females become fully-developed into the engorged state. Inflammation and ulceration may become severe,
and multiple lesions in the feet can lead to difficulty in walking. Secondary bacterial infections, including tetanus and
gangrene, are not uncommon with tungiasis.
Tunga penetrans.
Tunga penetrans (also known as chigoe flea, jigger, nigua, chica, pico, cique, or suthi) burrows under the skin of humans,
unlike other fleas which are ectoparasitic on the surface of the skin. The females remain embedded in the host tissue
during engorgement and egg-production. The fleas are usually found between the toes or under toe nails, and humans
acquire the infection when walking barefoot in tropical and subtropical regions. Adults may be dissected out of lesions and
are characterized by a lack of both pronotal and genal combs.
Figure A: Tunga Figure C: Close-up of

penetrans removed the eggs from the
from a lesion on the Figure B: Eggs of T. specimen in Figure B.
bottom of the foot of a penetrans liberated
patient who traveled to from the lesion on the
Africa. The bulk of the second toe of a patient
lesion and the who traveled to
posterior part of the Guyana. Image
flea are marked with a courtesy of Spectrum
blue arrow. The Health, Grand Rapids,
anterior end of the flea, MI.
showing the head,
mouthparts and
forelegs, is marked
with a green arrow.
Note the lack of
pronotal and genal
combs. A single egg
(yellow arrow), is also
shown.
Tunga penetrans lesions and biopsy specimens.
Gross lesions and cross-sections of Tunga penetrans in tissue.
Figure A: Gross lesion

on a patient's foot Figure D: Cross-
on a patient s foot
caused by T. penetrans. Figure C: Cross- sections of T.

Figure B: Gross lesion
Image courtesy of Drs. sections of T. penetrans in tissue,
on a patient's foot
Mohammed Asmal and penetrans in tissue, stained with
caused by T. penetrans.
Rocio M. Hurtado. stained with hematoxylin and eosin
Image courtesy of Drs.
Image first appeared at hematoxylin and eosin (H&E). In this image,
Mohammed Asmal and
Partners' Infectious (H&E). the following structures
Rocio M. Hurtado.
Disease Images are labeled: cuticle
Image first appeared at
(http://www.idimages.o (CU), gut (GU), and
Partners' Infectious
rgExternal Web Site developing eggs (EG).
Disease Images
Icon), whose content is
(http://www.idimages.o
copyrighted by
rgExternal Web Site
Partners Healthcare
Icon), whose content is
System, Inc., and is
copyrighted by
used with permission.
Partners Healthcare
System, Inc., and is
used with permission.
Laboratory Diagnosis
Identification is made by the finding of adult fleas and their eggs in lesions.
Treatment Information
For information about treatment please contact CDC-INFO.
Page last reviewed: December 31, 2017

CDC - DPDx - Tungiasis

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3/7/23, 4:21 PM CDC - DPDx - Tungiasis

DPDx - Laboratory Identification of Parasites of Public Health

Figure A: Tunga Figure C: Close-up of

Tunga penetrans lesions and biopsy specimens.

Gross lesions and cross-sections of Tunga penetrans in tissue.

Figure A: Gross lesion

caused by T. penetrans. Figure C: Cross- sections of T.

Page last reviewed: December 31, 2017

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