Abstract
Tungiasis is a parasitic skin disease caused by infection of the flea called Tunga penetrans is distributed in tropical and subtropical regions of the world, including Africa, South America and the West Indies. Adult females penetrate into the skin of their hosts, forming an enlarged structure known as the neosome, which cause tungiasis. These may occur around foot nails and interdigital. The lesions become painful and itching sensation. Treatment is excision of the flea. Secondary bacterial infections are not uncommon with tungiasis. Antibiotics should be used for the secondary bacterial infections. Diagnosis is usually based on the history of travel to epidemic areas, macroscopic inspiration of the lesions due to its characteristic appearance and isolation of the flea and eggs from the lesion.
We report a case of tungiasis diagnosed by using Direct KOH examination to find out flea body and eggs from the lesion. A 67 year-old man returned from a working trip to United Republic of Tanzania with an infection of Tunga penetrans located on his left second toe around the nail. When a patient is first seen, the part of left second toenail came off the nail bed and around the nail was purple and edematous. The tip of the toenail was composed of elevated yellowish papule with central darkening. We suspected tungiasis and removed the affected region including nail. In our case, clinically the flea was unapparent because the lesion was degenerated and necrotic. So we did Direct KOH examination and we could find the part of flea body and many eggs. The Flea body structure was also found through a pathological examination. The wound healed by removing the affected lesion and using ointment for ulceration and antibiotics.
When the flea and eggs were unapparent from the lesion, Direct KOH examination is helpful to diagnosis of tungiasis.
