WHAT CAUSES JIGGERS (TUNGIASIS)

WHAT CAUSES JIGGERS (TUNGIASIS)  

By Stephen Kimotho 

There are numerous rumours, misleading stories and beliefs about jiggers. So, what causes jiggers? and  how serious is this disease in Kenya? For us to clearly understand the stigma associated with jiggers it will be important to shed some light on the nature of this disease and its effects on the victim.

Neglected Tropical Diseases

Tungiasis is one of the neglected tropical diseases (NTDs) that  is common in many parts of the world. Tungiasis is prevalent in settings of extreme poverty, especially among the rural poor and some disadvantaged urban populations. Like many neglected tropical diseases, it has a serious impact on the health of the affected individuals

Tungiasis is a skin disease

Tungiasis is a skin disease caused by the impregnated female sand flea Tunga penetrans (T. penetrans). Tungiasis is characterized by the development of single or multiple, white, grey, or yellowish  nodular lesions with a brown-black coloured opening at the centre and surrounding spots  reddening. The inflammation of the  and formation of pus around the infested part, enfeebling sequelae - such as loss of nails and difficulty in walking and sitting among other symptoms - are not only indicative of the infliction caused by tungiasis, but also mark persons with tungiasis as different, rendering them susceptible to stigmatization by the unaffected members of the community.

How serious is the jigger disease in Kenya? 

It is estimated that over 2.6 million Kenyans are infested with jiggers and 70% of those are children below 12 years. In an official statement to the Kenya National Assembly in 2010 on the severity of jigger infestations in Kenya, former Minister of Public Health and Sanitation, Beth Mugo 

 alluded that nearly 10 million were at risk of infestation. Between  2008 -2010, it was estimated that over 265 tungiasis-related deaths occurred and at least 13 families in Murang’a County were reported to have contracted the HIV virus through the sharing unsterilized safety pins to extract Jiggers. In addition, it is estimated that over 800,000 individuals suffering from tungiasis were unable to take part in the voter registration exercise in  2010 because of jigger-related ailments. Statistics for the participation by tungiasis sufferers in 2013 general elections were not available by the time I was carrying out this research.

If not not controlled in time jiggers can immobilize the victim or even cause death. (See some serious cases captured in this video below)

What parts of the body does Jigger flea attack.

In most cases jigger fleas preferentially infests in the upper surface of  the toes, in between the nails (subungual folds of the toes), soles, heels, hands and knees. However, contrary to the believes of many, infestation at other parts of the body, including the genitals, groin, face, elbows, wrists, breasts, back, thighs, and gluteus region has also been reported in many parts of the country. See the pictures below 

 

Life cycle of a Jigger Flea

Jigger fleas' life cycle lasts about one month and begins after the eggs expelled by the pregnant female fall onto the ground. Larvae hatch from the eggs in suitable environments with loose and dry soil. The larvae develop into a pupa after burrowing into the soil. Adults hatch from the pupae, and both males and females feed on their warm-blooded host. The female penetrates the epidermis and thrusts its head into the superficial dermis, and punctures blood vessels for nourishment (Macías & Sashida, 2000). Within 1–2 weeks, after embedding on the skin, the flea increases its volume by a factor of roughly 2,000–3,000, frequently reaching a diameter of up to 1 cm (Eisele et al., 2003). The females expel about 100 eggs over a 2–week period and die, and are sloughed from the host’s skin. 

Manifestation of this disease 

After the flea penetrates into the skin, the lesion itches and patients normally start to scratch, and consequently, promotes the entry of bacteria through the sore epidermis. The inflammatory process is often reinforced by super infection. According to Feldmeier et al. (2002), long–lasting sequelae may result from persistent inflammation and super infection and lead to secondary morbidity such as deformation and loss of nails, suppuration, ulceration or gangrene, that may eventually lead to physical disability.

Symptoms of Tungiasis

The major symptoms of jiggers include: itching, inflammation, severe pain, a black dot at the centre of a swollen red lesion and often surrounded by what looks like a white halo. Gangrene is another common complication of severe infestation and super infection. In non-vaccinated individuals, lesions may be a port of entry for tetanus infection. Medical researchers have reported death from illnesses associated with tungiasis (Pilger et al., 2008).

Treatment and Control

Buckendahl, et al. (2010) argues that since it is almost impossible to eradicate jigger flea while the perilous living conditions commonly witnessed in impoverished communities persist, morbidity control may be the only option. Lack of effective chemotherapy to kill fleas after infestation has also been identified as a great impediment to the treatment of tungiasis by researchers. Extraction of the flea surgically with a sterile instrument is the commonly recommended treatment of tungiasis. However, extraction of jigger flea requires a skilled hand and good eyesight. 

Scholars argue that, in many resource-poor communities surgical removal of jigger flea is often inconsistently done and ends up causing more harm than good if incorrectly done.