Tungiasis (Jiggers)

Tungiasis, commonly known as jiggers, is a skin infestation caused by the female sand flea (Tunga penetrans), which burrows into the skin, most often on the feet. It is common in some rural and resource-limited communities and can cause significant discomfort and complications if untreated.

• A small, itchy, red-brown or black spot on the skin, usually on the feet, particularly around and under the toenails or on the soles
• The lesion gradually swells into a firm, pea-sized nodule with a dark centre as the flea grows and develops eggs
• Pain, especially with pressure or walking
• Multiple lesions can occur with heavy infestation, particularly in people who frequently walk barefoot on infested ground
• Secondary bacterial infection, ulceration, or, rarely, tetanus can occur if lesions are not properly cared for

• Caused by the female sand flea, which burrows into the skin (most often the feet) to feed and lay eggs, then dies within the skin after completing its egg-laying cycle.
• Found in sandy or dusty soil, particularly around homes, animal shelters, and areas with poor sanitation.
• Risk is greatly increased by walking barefoot on infested ground, particularly in households with dirt floors.

• Diagnosed clinically based on the characteristic appearance of the lesion, typically on the foot, together with a relevant exposure history.
• Assessment for signs of secondary bacterial infection or complications is part of the examination, particularly with multiple or longstanding lesions.

Careful removal of the embedded flea, performed with a sterile needle or similar instrument by a trained person, is the standard treatment, taking care to remove the entire flea intact to reduce the risk of infection or irritation from fragments left behind.

The wound is then cleaned and covered, and tetanus immunisation status should be checked and updated if needed, given the risk of tetanus with skin-penetrating injuries in unclean environments.

Any secondary bacterial infection is treated with an appropriate antibiotic.

Severe or widespread infestation, or lesions with significant infection or ulceration, may need assessment at a health facility for more extensive wound care.

• Wear closed shoes, particularly when walking on sandy or dusty ground in known affected areas.
• Maintain clean floors at home, ideally covering dirt floors, as fleas breed and live in dusty soil, particularly indoors near sleeping and living areas.
• Regularly inspect feet, especially in children, for early signs of infestation, allowing early removal before the flea matures and multiplies.
• Keep domestic animals, which can also carry sand fleas, away from living areas where possible, and treat infested animals.
• Ensure tetanus vaccination is up to date, given the risk of tetanus with skin-penetrating injuries in soil-contaminated environments.