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Jiggers Control in Kenya
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Jiggers: A painful Infestation
Many people living in tropical or sub-tropical regions are exposed to the risk of a debilitating infestation of these tiny sand-fleas, yet little is known of their epidemiology. New study from Kenya shows how common they can be.
Jiggers Control Nairobi Kenya
A jigger infestation, known as tungiasis, can be very painful; I speak from personal experience. This tiny sand-flea has a variety of other colloquial names including nigua, chigoe and bicho de pé (Portugues for foot-bug). The last one, and its scientific name, Tunga penetrans, giving clues to its habit, as the adult female burrows into the skin, usually of the foot.
Originally endemic in pre-Columbian Andean society and the West Indies jiggers were spread to other tropical and sub-tropical regions via shipping routes. They are now present in the Caribbean, Central and South America, sub-Saharan Africa, and India, but not in Europe or North America.
The jigger life cycle
The lifecycle of the jigger flea occurs in sandy environments. After the jigger flea develops into adult form, male and female fleas will forage on warm-blooded animals or humans for a tasty banquet of blood. Although males and females feed on blood, only the females burrow into the skin which primarily causes the symptoms associated with tungiasis. Since the fleas cannot jump very far, the most common areas of involvement are the feet where direct contact with fleas occurs. Specifically, the skin part of the toe surrounding the nail is the most common site. However, the webs of the toes or soles of the feet can also be involved.
Initially, a little black spot appears where the female burrows into the skin. At this point, infected individuals don’t usually notice any symptoms or other signs that they are infected. After a short time, perhaps a few days, a small white bump will develop in the spot where the female invaded the skin. The bump will progressively get larger, and an area of redness and inflammation will occur around the white bump. During this stage, the patient usually develops some itching and pain. As the female resides in the skin, she continues to lay eggs over about a two-week period and then dies. The death of the female flea is marked by a black scab or crust covering the initial point of entry into the skin. Due to the invasive nature of the flea, infection with bacteria or other microbes can occur and result in complications. The worst and most dreaded complication is rampant infection requiring amputation.
Although most people can recover from the infestation and heal without having any treatment, the signs and symptoms can mimic other ailments.
The life cycle of jiggers include:
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
4 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.
Jiggers, What You Should Know about Jiggers
A jigger is a small parasitic flea that burrows into the skin of a warm-blooded host before laying eggs. They generally attack feet or hands. At first, the jigger appears as a small black dot on the skin. As the female’s abdomen fills with blood and eggs, a bump forms underneath the skin, which is often painful and itchy and makes walking incredibly difficult.
With her back end still sticking out of the host’s body, the female releases her eggs then eventually dies. But did you know? Only female jiggers burrow into the skin. If left untreated, jiggers can lead to deadly secondary infections or even amputation. People suffering with jiggers usually attempt to remove them with safety pins, thorns, or other sharp, and often unsanitary, objects.
Jiggers, Signs of Jiggers Infestation in Kenya
Jigger Infestation Signs in Kenya Include:
Live Flea Burrows
Pain in joints
Black pin head dot
Deformed lower limbs and coldness
Jigger larvae live a few centimeters under sand or soil, feeding on organic matter. They are often found inside dwellings with mud floors. The larvae molt to adults about 1mm in size and move to the skin of a variety of mammals including rats, domestic animals and humans. (jiggers control Nairobi Kenya)
Unlike males, the females burrow into the skin leaving just the tip of their abdomen exposed, thus enabling them to exchange gasses, defecate and mate. The females feed on blood by inserting their proboscis into dermal capillaries. They quickly swell as they become full of eggs which are shed into the environment, after which the females die.
Penetration of the skin causes intense itching and is followed by inflammation and acute pain. The jigger is evident as a small swollen lesion, with a black dot at the center, which can grow to the size of a pea.
Severe pathology following an infestation is caused by bacteria entering the skin when the jigger penetrates. These infections can lead to abscess formation, tissue necrosis and gangrene. Tungiasis has also been associated with tetanus, possible due to the entry of the soil pathogen, Clostridium tetani into the wound. In addition, bacteria, present in the jigger, release inflammation-inducing lipopolysaccharides into the surrounding tissue when the females die.
The risk of acute pathology can be prevented by removal of the jigger with a sterile needle and disinfection of the affected area. However, in poor rural or shanty-town settings non-sterile objects are often used to winkle the jigger out, including thorns or non-sterile pins, thereby introducing more bacteria.
Jiggers are endemic in many tropical and sub-tropical countries, but the epidemiology of the disease is poorly understood. In common with most neglected tropical diseases, the children and the elderly are the most likely to be affected by tungiasis. A recent study by our team aimed to asses risk factors and the health burden associated with this disease.
Tungiasis in Kenya
The study was based in 21 villages in Vihiga County, Kenya, and assessed 437 participants aged over 5 years for the presence of a jigger infestation. Socio-economic factors were assessed via a questionnaire. The area is densely populated and almost 80% of people live in houses with earthen floors. The soil in all study village was a sandy clay.
Just over 20% of participants were found to be infested. Five of the villages had no cases of tungiasis and three represented hot spots for infestation. Village altitude did not affect distribution of infestations in the study area, however factors associated with low economic status factors were significant, including:
Going barefoot or wearing open toed footwear
Lack of toilet facilities or electricity
Washing without soap
Houses with earthen floors
Having a common resting place in the house
Having rats around the house
Importantly, 45% of the participants in the study did not know how tungiasis is transmitted. It was associated with witchcraft, being cursed or, in the elderly, impending death.
The study also showed that 5-14-year-olds were particularly vulnerable, probably as they play barefooted around their houses and are also exposed to infestation when attending schools with earthen floors.
The authors recognize the modest scale of their study and point out several factors that could be important in future studies such as the inclusion of under-fives, topography and soil type studies and the conduction of longitudinal studies that may identify cause and effect, looking at one variable at a time.
These findings reinforce previous studies performed in other areas and point to the likelihood of transmission occurring where people gather to rest or sit for long periods, as jigger eggs could be shed there, and the whole lifecycle take place in that location. In particular, the finger points to poor rural schools which do not usually have concrete floors in the classrooms. (jiggers control Nairobi Kenya)
The report highlights preventative measures such as the need for education regarding transmission and hygiene, the importance of wearing protective footwear and the possibility of spraying the floor of areas were transmission could occur with insecticides.
The World Health Organization does not officially recognize tungiasis as a neglected tropical disease and no systematic data on disease occurrence is available. Perhaps it is time this is remedied. Meanwhile avoid wearing open toed footwear if visiting areas where transmission could be occurring. (jiggers control Nairobi Kenya)
Jiggers, How to Get Rid of Jigger Flea & Tungiasis in Kenya
The following strategies have been identified for elimination of jiggers and jigger flea infestations.
Jiggers, Getting Rid of Jigger Flea & Tungiasis in Kenya Include:
Clean the area by soaking in a basin filled with soap and water.