TUNGIASIS IN NEW-YORK

A 33-year-old African woman was evaluated for tender nodules on her fe et. Accompanied by her four children, she had recently immigrated from Somalia. Before her immigration, she resided in a Kenyan refugee camp for approximately 1 year, where she walked barefoot in sand and dirt. The patient stated that she and her four children, as well as many pe ople living in the same compound, had similar, tender lesions on their feet. Her children were ''treated'' by their grandmother, who removed the contents of their lesions with a safety pin. On physical examinat ion the patient had numerous tender, isolated, and clustered hyperkera totic, crusted papules, measuring 4-6 mm, on the plantar and periungua l surfaces. Several lesions were ulcerated (Figs 1 and 2). The hyperke ratotic masses were debrided with a surgical blade. An intact, white, coiled structure was curetted from each papule, leaving numerous empty crater-like lesions (Fig. 3), which were identified on histologic sec tions as Tunga penetrans. Microscopic examination of unstained specime ns showed branching, thin, translucent tubular structures with numerou s eggs. Ring-shaped cross-sections of the organism's respiratory and d igestive tracts were seen on hematoxylin and eosin stain (Fig. 4). The patient received a 10-day course of dicloxacillin and topical bacitra cin ointment. All lesions were healed within 1 week of therapy.