Tungiasis – A major zoonotic problem only to be solved employing the One Health Concept – Hermann Feldmeier 1, Jürgen Krücken², Georg von Samson-Himmelstjerna² 1 Institute 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”

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 AugustSeptemberJulyOctober Intervention IIntervention II Group A Group B Feldmeier et al Thielecke et al. submitted

Before 4 weeks of intervention After Effect of coconut-oil based repellent Zanzarin ® -Lotion

Zanzarin ® -Lotion 2x/day on feet  reduces penetration rate %  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. rattus41% 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 ) 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?