Spatial distribution, prevalence and potential risk factors of Tungiasis in Vihiga County, Kenya.

BACKGROUND:Tungiasis is a parasitic disease caused by the sand flea Tunga penetrans also known as jigger flea. Communities living in precarious conditions in tropical and sub tropical countries bear the brunt of the infection. The main objective of this study was to determine the burden of Tungiasis in Vihiga County in Kenya. METHODS:This was a cross-sectional study conducted in 21 villages in 3 Sub-locations in Vihiga County, western Kenya. A total of 437 participants, 5 years old and above were clinically examined for the presence of tungiasis after consenting to take part in the study. Diagnosis was made following standard methods. A semi- structured questionnaire was administered to assess socio-demographic factors, housing, presence and ownership of animals, knowledge and practice related to tungiasis. Data were analyzed using bivariate and multivariate regression analysis. GIS was used to map the geographic distribution of tungiasis in the area. RESULTS:The overall prevalence was found to be (21.5%; 95% CI: 17.7-25.3%). The cases were analysed and visualized in a map form. Multivariate analysis suggested that the occurrence of tungiasis was associated with variables that indicated low economic status (like a monthly income of Ksh ≤ 1000 (adjusted odds ratio 27.85; 95% CI: 4.13-187.59), earthen floor (0.36; 0.13-1.024) and lack of toilet facilities (4.27; 0.82-22.34), age of participant ≤14 (27.414; 10.02-74.99), no regular use of closed footwear (1.98; 0.987-3.97) and common resting place inside the house (1.93; 0.96-3.89). CONCLUSIONS:Tungiasis is an important health problem in Vihiga County occasioned by the low economic status of the people affected. Factors that point to poverty contribute to the occurrence of tungiasis. These findings suggest a need to design control strategies for tungiasis that are cost effective and easily accessible

Secondary bacterial infections and antibiotic resistance among tungiasis patients in Western, Kenya.

Tungiasis or jigger infestation is a parasitic disease caused by the female sand flea Tunga penetrans. Secondary infection of the lesions caused by this flea is common in endemic communities. This study sought to shed light on the bacterial pathogens causing secondary infections in tungiasis lesions and their susceptibility profiles to commonly prescribed antibiotics. Participants were recruited with the help of Community Health Workers. Swabs were taken from lesions which showed signs of secondary infection. Identification of suspected bacteria colonies was done by colony morphology, Gram staining, and biochemical tests. The Kirby Bauer disc diffusion test was used to determine the drug susceptibility profiles. Out of 37 participants, from whom swabs were collected, specimen were positive in 29 and 8 had no growth. From these, 10 different strains of bacteria were isolated. Two were Gram positive bacteria and they were, Staphylococcus epidermidis (38.3%) and Staphylococcus aureus (21.3%). Eight were Gram negative namely Enterobacter cloacae (8.5%), Proteus species (8.5%), Klebsiellla species (6.4%), Aeromonas sobria (4.3%), Citrobacter species (4.3%), Proteus mirabillis(4.3%), Enterobacter amnigenus (2.1%) and Klebsiella pneumoniae (2.1%). The methicillin resistant S. aureus (MRSA) isolated were also resistant to clindamycin, kanamycin, erythromycin, nalidixic acid, trimethorprim sulfamethoxazole and tetracycline. All the Gram negative and Gram positive bacteria isolates were sensitive to gentamicin and norfloxacin drugs. Results from this study confirms the presence of resistant bacteria in tungiasis lesions hence highlighting the significance of secondary infection of the lesions in endemic communties. This therefore suggests that antimicrobial susceptibility testing may be considered to guide in identification of appropriate antibiotics and treatment therapy among tungiasis patients

Polymicrobial infection isolates.

<p>Polymicrobial infection isolates.</p

A jigger infested foot of a five year old showing clinical signs of secondary infection.

<p>Erythema and formation of pus is visibe on the upper part of the foot.</p

Susceptibility profiles of Gram positive bacteria.

<p>Susceptibility profiles of Gram positive bacteria.</p

Photo of a lesion located at the base of the first toe oozing pus.

<p>One of the clinical signs of secondary infection of lesions caused by the jigger flea.</p

Susceptibility profiles of Gram negative bacteria.

<p>Susceptibility profiles of Gram negative bacteria.</p

Bacteria isolated.

<p>The ten strains of bacteria isolated in this study with <i>S</i>. <i>epidermidis</i> being the highest and <i>K</i>. <i>pneumoniae</i> being the least bacteria isolated.</p