Suppuration (pus formation), tissue death, auto-amputation of digits (via ainhum), and chronic lymphedema may also be seen.If the patient is not vaccinated, tetanus is often a complication due to secondary infection. Necrosis and gangrene are other common complications of severe infestation and superinfection. Staphylococcus aureus and Wolbachia endobacteria can be transmitted by the chigoe flea, as well as nearly 150 other different pathogens. For these reasons, the chigoe flea should be removed as soon as possible. Incubation
Because of the relatively rapid onset of tungiasis, the incubation period tends to be short. Although some reddening around the site of penetration occurs, the first symptoms are perceived in stage 2 as itching and severe pain, usually a day after penetration. Cause
Tungiasis is strictly caused by chigoe fleas (the term transmission does not apply because Tunga penetrans is itself responsible for the disease.) The preponderance of tungiasis lesions on the toes may be because chigoe flea is a poor jumper, attaining only a high of 20 cm. But the reality is more complex; for example, the jumping ability cannot explain why hands are the second-most affected body part. Lesions on the hands are better explained by playing in the sand and noting that hands are often used to remove sand from other parts of the body. The occurrence of tungiasis lesions on the toes, between them, and on the soles can be easily explained because most of the victims are poor, walk barefoot, and live in places where the sand (home to chigoe fleas) constitutes the floor.
Since the chigoe flea technically has no reservoir species and the female will cause tungiasis to any mammalian organism it can penetrate, this means the flea will have a relatively large number of hosts and victims. Epidemiologically, this is important as tungiasis often causes secondary infections. History
Tungiasis had been endemic in pre-Columbian Andean society for centuries before discovery of  T. penetrans as native to the West Indies. The first case of tungiasis was described in 1526 by Gonzalo Fernández de Oviedo y Valdés, where he discussed the skin infection and its symptoms on crew members from Columbuss Santa Maria after they were shipwrecked on Haiti. Through ship routes and further expeditions, the chigoe flea was spread to the rest of the world, particularly to the rest of Latin America and Africa. The spread to greater Africa occurred throughout the 17th and 19th centuries, specifically in 1872 when the infected crewmen of the ship Thomas Mitchell introduced it into Angola by illegal dumping of sand ballast, having sailed from Brazil. References
External links

Muehlstaedt, Michael (2008). "Periungual Tungiasis". New England Journal of Medicine. 359 (24): e30. doi:10.1056/NEJMicm074290. PMID 19073971.