Tungiasis – A major zoonotic problem only to be solved employing the One Health Concept –

Hermann Feldmeier1, Jürgen Krücken², Georg von Samson-Himmelstjerna²1Institute of Microbiology and Hygiene, Charité Medical School

²Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin

“THE JIGGER OR CHIGOE PEST“

“most dreadful sores ever seen“

“causes serious trouble to men“

“The greatest curse that has ever afflicted Africa“

“The Jigger Evil“

“one of the most serious torments of the tropics of

America“

“distressing sores, awful ulcers”“pestiferous insect which causes

terrible sufferings”

0-4 5-9 10-14 15-19 20-39 40-59 >=600%

20%

40%

60%

80%

100%

Age groups (years)

Pre

vala

nce

Human tungiasis in endemic region

• Aerobic = 100% (S. aureus > streptococci > enterobacteriaceae)

• Anaerobic = 19% (Peptostreptococci > clostridiae > gram-neg. bacteriae)

Bacterial super infection

Feldmeier et al. 2002

Successful prevention of infestation based on repellent

0,0

0,5

1,0

1,5

2,0

2,5

3,0

3,5

Infe

stat

ion

rate

Gruppe A

Gruppe B

August SeptemberJuly October

Intervention I Intervention II

Group A

Group B

Feldmeier et al. 2006 Thielecke et al. submitted

Before4 weeks of intervention

After

Effect of coconut-oil based repellent Zanzarin®-Lotion

Zanzarin®-Lotion 2x/day on feet

reduces penetration rate 92 -100%

prevents clinical pathology

Prophylaxis

Control

Continued prophylaxis in human population

Complementary treatment and surveillance in animal reservoirs (e.g. dogs, cats, pigs)

Tunga penetrans is a zoonotic parasite

Animal host/reservoirs include:

• Dogs, cats

• Pigs, sheeps, goats, cattle

• Rats

• Monkeys

• Armadillos

Pampiglione et al., Med Vet Entomol, 2009

Prevalence of tungiasis in animals

TUNGIASIS

Slum, Brazil: dogs 67%

cats 50%

R. rattus 41%

Fishing village, Brazil: dogs 69%

cats 50%

Village, Nigeria: pigs 52%

Multiple lesions caused by Tunga penetrans on the lower extremity, swine Pampiglione et al., Med Vet Entomol, 2009

Multiple lesions caused by Tunga penetrans on the udder, swine Pampiglione et al., Med Vet Entomol, 2009

Lesions caused by Tunga penetrans on the tail, swine Pampiglione et al., Med Vet Entomol, 2009

Lesions caused by Tunga trimamillata with formation of conspicuous cavities in the soft and hard tissues of the hoof, bovine Pampiglione et al., Med Vet Entomol, 2009

Lesions caused by Tunga trimamillata with formation of conspicuous cavities in the soft and hard tissues of the hoof, goat Pampiglione et al., Med Vet Entomol, 2009

Multiple lesions due to Tunga penetrans infection with ulceration, secondary infections and scars, paw region, dog

Zoonotic relevance due to reservoir host function

In Nigeria highest odds ratios (i.e. 17.98) identified for presence of pigs re zoonotic infection (Ugbomoiko et al. 2007, Ugbomoiko et al. 2008)

In Brasil soil samples from indoor resting places of dogs significantly more often positive than other sites (Linardi et al. ATMP 2010)

In Brasil high prevalence rates between 30 and approx. 70% in cats and dogs, respectively, as well as rats in slum and rural villages (Heukelbach et al. MVE 2004)

In Brasil presence of animals on compound associated with OR of 1.9 (Muehlen et al. 2005)

In Brasil intensity of infection in pet animals correlated with that in humans (Pilger et al. 2007) and insecticidal treatment could reduce infection in humans (Klimpel et al. 2005)

Planned field study in T. penetrans endemic Ugandian villages

Objectives:• Evaluation of Tunga spp. prevalence in household or household

associated animals (e.g. pigs, dogs, cats, small ruminants, chicken) using parasitological and clinical score systems

• Characterization of seasonal patterns of Tunga spp. epidemiology

• Description of clinical and pathological characteristics of Tunga spp. infections in above mentioned animals

• Evaluation of novel treatment and control approaches using innovative parasiticides in different animal species

• Systematic collection of fleas recovered from animals for potential analysis of pathogens

Planned field study in T. penetrans endemic Ugandian villages

General study outline:

Bi-weekly monitoring of all types of domestic animals in 3 endemic villages to assess infection intensity and morbidity for a period of three months

Controlled intervention phase using monthly topical pyrethroid treatment in livestock and once per season imidacloprid/flumethrin collar (Seresto) treatment in dogs/cats; monitoring of intensity of infection and morbidity

Assessment of economic damage caused by Tungiasis in animals

Thank you for your attention

Two friends – ONE HEALTH

What are key research questions re T. penetrans in animal hosts?

What are the characteristics for spatial/societal differences re veterinary risk factors for human infections?

How can infections in pet animals best be treated/controlled?

How can infections in livestock animals best be treated/controlled?

What is the actual economic relevance of T. penetrans infection in livestock?