Fig 1.
A. Fortaleza stages of embedded Tunga penetrans (stage 3, 4b, 5) and typical pathology (hyperkeratosis, desquamation, fissure, micro-abscess). B. Old and new manipulated lesions.
Fig 2.
Viability signs of Tunga penetrans.
A. Stage 3b flea expelling an egg, B. Stage 3a flea excreting a dark red/black faecal thread, C. Stage 4a flea excreting faecal liquid. Photographs taken with the digital handheld video microscope with 200x magnification.
Table 1.
Fortaleza stages of embedded sand fleas and characteristics (from Eisele et al 2006 [1]).
Fig 3.
Flow chart of patients and observed sand fleas through the trial.
NC = neem-coconut-oil mixture; KMnO4 = potassium permanganate foot bath.
Fig 4.
Changes in appearance of embedded fleas 7 days after treatment.
Photographs taken with the digital handheld video microscope with 200x magnification. (A). Viable, embedded sand flea at stage 3a with characteristic convex surface, expelling a faecal thread on Day 1 (baseline). (B). The same flea as in A but non-viable at day 7: loss of abdominal cone structure, surface now concave, desiccated appearance, Stage 4b.(C). Viable, embedded flea stage 3a with convex surface, expelling a faecal thread on day 1 (baseline). (D). Rapidly Aged: same flea as in C, still viable on day 7 with clear abdominal cone, but now stage 4a, desiccated appearance, concave surface, brown colour.
Table 2.
Treatment impact on embedded flea viability on observation day 7.
Fig 5.
Median severity score and interquartile range for acute tungiasis (SSAT) at baseline and day 7 follow up in patients treated with NC and KMnO4.
Fig 6.
Effect of KMnO4 and NC treatment on tungiasis-associated pain and itching at day 7 follow up.
Bars show modelled mean percentages including 95% confidence intervals. Statistical significance tested with binary logistic regression testing association between treatment and reduction/increase in pain/itching.
Fig 7.
Percentage of patients being pain-free and itch-free in the KMnO4 and NC treatment groups at baseline and at day 7 follow up.
Bars show modelled means including 95% confidence intervals.