The Forgotten Neglected Tropical Diseases
The World Health Organization defines Neglected Tropical Diseases (NTDs) as communicable diseases that prevail in tropical and subtropical countries and affect more than one billion people. WHO has a 2021 – 2030 roadmap to set global targets and milestones to prevent, control, eliminate or eradicate NTDs. These Top 20 NTDs have a singular commonality: their impact on impoverished communities. Among these currently endorsed NTDs are Dengue, Echinococcosis, leprosy, Chagas disease, and Yaws. However, there is one NTD absent from this list: Tungiasis. With over a billion people at riskglobally, the parasite causing tungiasis has become recognized by its more commonname: jiggers.
OVER 1 BILLION PEOPLE ARE AT RISK FROM TUNGIASIS
HISTORY OF TUNGIASIS
Found in tropical and subtropical regions of the world, it is estimated that over 20 million people are at risk from jiggers in the WHO Region of the Americas alone.
Originally endemic in preColumbian Andean society and the West Indies, jiggers were spread via shipping routes.
The first European description of jiggers was published in 1526 by Gonsalo Fernandez de Oviedo y Valdes, where he described a skin infection and its symptoms on crew members from Columbus’s Santa Maria after they were shipwrecked on Haiti,
The spread to greater Africa occurred throughout the 17th and 19th centuries and is directly tied with the slave trade, rapidly spreading jiggers through various regions and that persist to this day.
Presently, jiggers are endemic across sub-Saharan Africa and even occasionally continues to act seafairing stowaways, showing up in North American and European travel clinics by tourists returning from tropical beach destinations. Jiggers present a serious health problem in the Caribbean, Central and South America, sub-Saharan Africa, and India.
WHAT ARE JIGGERS?
Starting as tiny larvae in sand or soil, jiggers molt to adults about 1mm in size. Adults feast on warm-blooded animals and humans with the adult female burrowing into the skin, typically being picked up by bare feet.
Once attached, a tiny black spot is the first sign that the female is burrowed in the skin. People may not even notice that she is there, but after a few days a small white bump will develop. The bump will progressively get larger and redness and inflammation will occur. The female spends two weeks continuously laying eggs. Her size expands as her abdomen swells with up to several hundred or even thousand eggs, which are released so that they fall onto the ground to repeat the jigger lifecycle. A jigger spends two weeks continuously laying eggs before dying. However, the jigger does not fall off of the host but instead remains burrowed in the skin. The body rots and black scabbing forms, leading to potentially crippling infection for the host.
Within three or four weeks, those eggs mature into adult fleas.
THE BURDEN OF TUNGIASIS
Where one jigger exists, hundreds more inevitably follow. People infested face intense inflammation as bacteria enters the skin where the jigger penetrates, often leading to abscess formation, tissue necrosis and gangrene. The pain and itching is constant while mobility becomes severely limited. Children stop attending school while adults are unable to work. Even healthy individuals can be brought to their knees by tungiasis, losing their ability to walk as the feet are the most common infection point.
In resource-poor communities, prevalence of tungiasis may be as high as 60% in the general population and up to 80% in children. The elderly and children aged 5-14 years, particularly boys, are at the highest risk. People with disabilities are also highly vulnerable to infection.
Health Impacted: Abcesses, Gangrene, Tissue Necrosis, Fissures, Ulcers, Lymphangitis, Lymphoedema, Nail Disfigurement, Ascending Neuritis, Nail Loss
As infection sets in, you find your mobility becoming limited. The pain with each step increases as the swollen wounds fester. Within a few days, you are unable to walk.
THE STIMGA OF DISEASE
In countries where tungiasis is endemic, such as Uganda, a widespread cultural stigma has become associated with jiggers. To be infested is seen as a curse or divine punishment. Children have been abandoned or face extreme isolation from their own families. Severe limitations in mobility set in as risk for bacterial infections increase, leading to a child left alone, in pain, and unable to walk.
This stigma is so severe that children have been locked in cages or cupboards by family members, only found when it was too late to save them. Even if they are not shunned by their caretakers, they are soon forced to drop out of school due to losing mobility or from social pressure.
There is no cure for tungiasis. There is no pill that can be taken or shot that can be administered to prevents jiggers once they have burrowed into your skin. Jiggers must be removed one at a time using sterilized tools, such as a scalpel, razor blade, and safety pins, to prevent the parasite from rupturing and introducing pathogenic bacteria into the wound left behind. Experienced health workers are best suited to perform the surgical extraction, applying topical antibiotic and dressing the wound once the parasite is removed.
Identifying and removing jiggers before the infestation can become severe is the most effective way to combat tungiasis. Experienced community health workers can provide onsite removal sessions and educate on hygiene and self-removal skills. Beyond learning how to safely extract jiggers, wearing closed-toe shoes can prevent the parasite from burrowing in.
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