Tungiasis Presenting as Onychomycosis: Probably the First Report of Flea Infestation of the Nail Observed Using Modified Potassium Hydroxide Mount Technique

Abstract

Tungiasis is an infection/infestation of the flea Tunga penetrans. These are bloodsucking ectoparasitic insectsbelonging to the phylum Arthropoda, and they do not possess wings, but they have long legsenabling them to jump up to 30 cm high. Thefleas are usually present on the skinand in the hair of domestic and wild animalsand are prevalent throughout the world. They may also be present in an environment consisting of drysandy soils, and theyinfect people who walk barefoot and residein flea-infested areas. Human tungiasis is both an accidentaland zoonotic infection, where the fleas enter the human skin and cause severe morbidity if not properly managed. There are a few reports of human tungiasis, most of which were diagnosed with skin infections. This is a first-of-its-kind observation of fleas in the nail, from a patient who is suspected to be suffering from onychomycosis. The nail in this case was processed differently, by using a modified potassium hydroxide (KOH) mount technique.