TUNGIASIS EN POBLACIÓN INDÍGENA DEL DEPARTAMENTO DE VAUPÉS. Epidemiología, clínica, tratamiento y prevención.

*Este trabajo es un resumen de la version original, que se publica en Biomedica 32 (2): junio, 2010. Se publica aqui con la autorizacion de los editores de Biomedica. Resumen Introduccion : La tungiasis o infestacion cutanea por la pulga Tunga penetrans ocurre en comunidades muy pobres. Las pulgas penetran la piel (usualmente de los pies), produciendo rasquina y luego dolor. La mayoria de las veces la enfermedad se resuelve sola pero en casos severos pueden presentarse deformidades que llevan a infeccion secundaria y a tetanos. Objetivo : Estudiar la entidad en indigenas del Vaupes. Metodos : 1. Revisar el tema. 2. Describir el area y la vivienda. 3. Detectar animales con la zoonosis. 4. Ilustrar la clinica y las complicaciones. 5. Tratar los pacientes y los animales con creolina. 6. Modificar el piso de las malocas en dos comunidades, con humectacion y arcillado de piso. 7. Educacion comunitaria. Resultados : 95 % de los 33.000 habitantes del Vaupes son indigenas. Algunos moran en viviendas de piso arenoso, seco, con detritos alimenticios y perros con tungiasis. Entre 1996-2007 confirmamos 942 casos del parasitismo o 3-8/1000 de los indigenas estudiados; y un 62 % de los perros presentaron tungiasis. Los pies se afectaron en el 98 % de los pacientes. Casos graves con mas de 20 lesiones ocurrieron en ninos y ancianos. Complicaciones: infeccion secundaria, dolor, anoniquia, artejos deformados, amputados e imposibilidad para la marcha. Hubo sepsis mortal en tres pacientes. Los banos con creolina y la extraccion del parasito fueron curativos, en hombres y animales. La modificacion de los pisos redujo a cero la enfermedad en una comunidad. Conclusiones : 1. La enfermedad es intra-domiciliaria. El piso de la vivienda y la convivencia con perros infestados son ideales para adquirirla. 2. La creolina, humectar el piso y arcillarlo controlaron un foco de la enfermedad, actividad que podria generalizarse. 3. Esta es la primera investigacion colombiana sobre tungiasis, conocida desde que afecto a los soldados de Gonzalo Jimenez de Quesada. Palabras clave: Tungiasis, Tunga penetrans , pulgas, zoonosis, ectoparasitosis, anoniquia, sepsis, pobreza, indigenas, Colombia, Vaupes. TUNGIASIS IN NATIVE AMERINDIANS IN VAUPES PROVINCE: EPIDEMIOLOGY, CLINICAL ASPECTS, TREATMENT, AND PREVENTION. Abstract Introduction : Tungiasis is a skin disease caused by a parasitic jigger flea called Tunga penetrans which is found in depressed tropical communities. The female fleas are embedded into the skin (usually in the feet) and cause localized itching and then pain. In most cases the condition resolves itself but severe infestation can cause deformity, existing the risk of secondary infection and tetanus. Objective : To study tungiasis seen in Vaupes native indians. Methods : To review the subject, to describe areas and housing conditions where this happens, to screen for sick animals suffering from these zoonoses, to describe clinical findings and complications of the disease, to treat both patients and animals with creolin; to modify the ground in houses (“malocas”) of two communities, humidifying and placing clay in floors; and to educate the community. Results : 95 % of 33.000 people living in Vaupes are native indians. Some live in houses with sandy ground, dry, with food waste spilled throughout the floor and sheltering infected dogs. Between 1996-2007 we were able to confirm 942 cases of this parasitic disease. Tungiasis was present in 3-8/1000 of studied native indians and 62 % of dogs. 98% of patients feet had lesions. Serious cases with more than 20 lesions occurred in children and elderly patients. Complications observed were secondary infection, pain, anonychia, deformed or amputated toefingers, inability to walk. Three patients had fatal sepsis. Spilling creoline in restrooms and pulling out parasite from both sick human and domestic animals was curative. Community incidence of disease went down to zero once floors were modified. Conclusions : 1. This is an in-house condition . Housing floors and living with infected dogs are main risk factors to acquire this condition. 2. Creolin and floor humidification –claying it afterwards- were strategies able to control a source of disease, action that could be expanded . 3. This study is the very first one about tungiasis carried out in Colombia; thecondition is known here after infection spreaded out among spanish soldiers serving under commander Gonzalo Jimenez de Quesada. Key words : Tungiasis, Tunga penetrans , jigger fleas, zoonoses, ectoparasitosis, anonychia, sepsis, poverty, native indians, Colombia, Vaupes.