Oral niridazole was once considered a therapeutic drug, but well-designed studies are lacking and, given the severe adverse effects, this is one drug that is likely to cause more harm than good. However, it has some anecdotal evidence of lysing the fleas altogether. Oral ivermectin is considered by some in endemic areas to be a panacea against the fleas but studies using high doses have failed to validate this hypothesis. Other drugs such as topical ivermectin and metrifonate have been somewhat successful, but not enough to be significant. [2,5] For superinfections, trimethoprim, sulfamethoxazole, metronidazole, amoxicillin, (with/without clavulanate) have been used successfully, though these treat only secondary infections.Successful topical treatments also include cryotherapy and electrodesiccation of the lesion. If formaldehyde, chloroform, or DDT are used topically, care should be taken when dealing with the resulting morbidity. The T. penetrans flea can also be suffocated using occlusive petrolatum, while Vaseline will kill the organism as well, most likely due to suffocation as the stigmata would be covered. The gum of the mammee apple (Mammea americana), a fruit that also goes by the name Saint Domingo apricot, has also been used to kill the chigoe flea, though this has not been reported in the main T. penetrans literature.Even without treatment, the burrowed fleas will die within five weeks and are naturally sloughed off as the skin sheds. Epidemiology
For the most part, the chigoe flea lives 2–5 cm below the sand, an observation which helps explains its overall distribution.
Oslers nodes are painful, red, raised lesions found on the hands and feet. They are associated with a number of conditions, including infective endocarditis, and are caused by immune complex deposition. Their presence is one definition of Oslers sign. Causes
Oslers nodes result from the deposition of immune complexes. The resulting inflammatory response leads to swelling, redness, and pain that characterize these lesions. The nodes are commonly indicative of subacute bacterial endocarditis. 10–25% of endocarditis patients will have Oslers nodes. Other signs of endocarditis include Roths spots and Janeway lesions. The latter, which also occur on the palms and soles, can be differentiated from Oslers nodes because they are non-tender.Oslers nodes can also be seen in

Systemic lupus erythematosus
Marantic endocarditis
Disseminated gonococcal infection
Distal to infected arterial catheter

Etymology
Oslers nodes are named after Sir William Osler who described them in the early twentieth century. He described them as "ephemeral spots of a painful nodular erythema, chiefly in the skin of the hands and feet." == References ==