Treatment of Tungiasis with Dimeticone: A Proof-of-Principle Study in Rural Kenya
Identifieur interne : 001662 ( Pmc/Checkpoint ); précédent : 001661; suivant : 001663Treatment of Tungiasis with Dimeticone: A Proof-of-Principle Study in Rural Kenya
Auteurs : Marlene Thielecke [Allemagne] ; Per Nordin [Suède] ; Nicholas Ngomi [Kenya] ; Hermann Feldmeier [Allemagne]Source :
- PLoS Neglected Tropical Diseases [ 1935-2727 ] ; 2014.
Abstract
Tungiasis (sand flea disease) is a neglected tropical disease, prevalent in resource-poor communities in South America and sub-Saharan Africa. It is caused by an inflammatory response against penetrated female sand fleas (
Url:
DOI: 10.1371/journal.pntd.0003058
PubMed: 25079375
PubMed Central: 4117482
Affiliations:
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Treatment of Tungiasis with Dimeticone: A Proof-of-Principle Study in Rural Kenya</title>
<author><name sortKey="Thielecke, Marlene" sort="Thielecke, Marlene" uniqKey="Thielecke M" first="Marlene" last="Thielecke">Marlene Thielecke</name>
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<front><div type="abstract" xml:lang="en"><p>Tungiasis (sand flea disease) is a neglected tropical disease, prevalent in resource-poor communities in South America and sub-Saharan Africa. It is caused by an inflammatory response against penetrated female sand fleas (<italic>Tunga penetrans</italic>
) embedded in the skin of the host. Although associated with debilitating acute and chronic morbidity, there is no proven effective drug treatment. By consequence patients attempt to remove embedded sand fleas with non-sterile sharp instruments, such as safety pins, a procedure that represents a health threat by itself. In this proof-of-principle study we compared the topical application of a mixture of two dimeticones of low viscosity (NYDA) to the topical application of a 0.05% solution of KMnO4 in 47 school children in an endemic area in rural Kenya. The efficacy of the treatment was assessed during a follow up period of seven days using viability signs of the embedded parasites, alterations in the natural development of lesion morphology and the degree of local inflammation as outcome measures. Seven days after treatment, in the dimeticone group 78% (95% CI 67–86%) of the parasites had lost all signs of viability as compared to 39% (95% CI 28–52%) in the KMnO4 group (p<0.001). In the dimeticone group 90% (95% CI 80–95%) of the penetrated sand fleas showed an abnormal development already after 5 days, compared to 53% (95% CI 40–66%; p<0.001) in the KMnO4 group. Seven days after treatment, signs of local skin inflammation had significantly decreased in the dimeticone group (p<0.001). This study identified the topical application of dimeticones of low viscosity (NYDA) as an effective means to kill embedded sand fleas. In view of the efficacy and safety of the topical treatment with dimeticone, the mechanical extraction of embedded sand fleas using hazardous instruments is no longer warranted.</p>
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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS Negl Trop Dis</journal-id>
<journal-id journal-id-type="iso-abbrev">PLoS Negl Trop Dis</journal-id>
<journal-id journal-id-type="publisher-id">plos</journal-id>
<journal-id journal-id-type="pmc">plosntds</journal-id>
<journal-title-group><journal-title>PLoS Neglected Tropical Diseases</journal-title>
</journal-title-group>
<issn pub-type="ppub">1935-2727</issn>
<issn pub-type="epub">1935-2735</issn>
<publisher><publisher-name>Public Library of Science</publisher-name>
<publisher-loc>San Francisco, USA</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">25079375</article-id>
<article-id pub-id-type="pmc">4117482</article-id>
<article-id pub-id-type="publisher-id">PNTD-D-14-00936</article-id>
<article-id pub-id-type="doi">10.1371/journal.pntd.0003058</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
<subj-group subj-group-type="Discipline-v2"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Dermatology</subject>
<subj-group><subject>Skin Diseases</subject>
</subj-group>
</subj-group>
<subj-group><subject>Parasitic Diseases</subject>
<subj-group><subject>Ectoparasitic Infections</subject>
</subj-group>
</subj-group>
<subj-group><subject>Tropical Diseases</subject>
<subj-group><subject>Neglected Tropical Diseases</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v2"><subject>Research and Analysis Methods</subject>
<subj-group><subject>Imaging Techniques</subject>
<subj-group><subject>Photography</subject>
<subject>Video Recording</subject>
</subj-group>
</subj-group>
<subj-group><subject>Research Design</subject>
<subj-group><subject>Clinical Research Design</subject>
<subj-group><subject>Comparative Effectiveness Research</subject>
<subject>Symptom Scales</subject>
</subj-group>
</subj-group>
<subj-group><subject>Field Trials</subject>
<subject>Pilot Studies</subject>
</subj-group>
</subj-group>
</subj-group>
</article-categories>
<title-group><article-title>Treatment of Tungiasis with Dimeticone: A Proof-of-Principle Study in Rural Kenya</article-title>
<alt-title alt-title-type="running-head">Treatment of Tungiasis with Dimeticone</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Thielecke</surname>
<given-names>Marlene</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nordin</surname>
<given-names>Per</given-names>
</name>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ngomi</surname>
<given-names>Nicholas</given-names>
</name>
<xref ref-type="aff" rid="aff3"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Feldmeier</surname>
<given-names>Hermann</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
<xref ref-type="corresp" rid="cor1"><sup>*</sup>
</xref>
</contrib>
</contrib-group>
<aff id="aff1"><label>1</label>
<addr-line>Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany</addr-line>
</aff>
<aff id="aff2"><label>2</label>
<addr-line>Skaraborg Institute for Research and Development, Skövde, Sweden</addr-line>
</aff>
<aff id="aff3"><label>3</label>
<addr-line>African Population and Health Research Center, Nairobi, Kenya</addr-line>
</aff>
<contrib-group><contrib contrib-type="editor"><name><surname>Vinetz</surname>
<given-names>Joseph M.</given-names>
</name>
<role>Editor</role>
<xref ref-type="aff" rid="edit1"></xref>
</contrib>
</contrib-group>
<aff id="edit1"><addr-line>University of California San Diego School of Medicine, United States of America</addr-line>
</aff>
<author-notes><corresp id="cor1">* E-mail: <email>hermann.feldmeier@charite.de</email>
</corresp>
<fn fn-type="conflict"><p>I have read the journal's policy and the authors of this manuscript have the following competing interests: HF has received lecture and consulting fees from Pohl-Boskamp GmbH & Co KG. This does not alter our adherence to all PLOS policies on sharing data and materials. The other authors have reported no conflict of interest.</p>
</fn>
<fn fn-type="con"><p>Conceived and designed the experiments: HF PN NN. Performed the experiments: MT. Analyzed the data: MT PN. Contributed reagents/materials/analysis tools: HF. Contributed to the writing of the manuscript: MT HF. Literature research: HF. Data entry: MT. Study supervision: HF. Interpretation of data: HF MT NN. Critical revision of the manuscript for important intellectual content: MT PN NN HF.</p>
</fn>
</author-notes>
<pub-date pub-type="collection"><month>7</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="epub"><day>31</day>
<month>7</month>
<year>2014</year>
</pub-date>
<volume>8</volume>
<issue>7</issue>
<elocation-id>e3058</elocation-id>
<history><date date-type="received"><day>2</day>
<month>6</month>
<year>2014</year>
</date>
<date date-type="accepted"><day>18</day>
<month>6</month>
<year>2014</year>
</date>
</history>
<permissions><copyright-year>2014</copyright-year>
<copyright-holder>Thielecke et al</copyright-holder>
<license><license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>
, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p>
</license>
</permissions>
<abstract><p>Tungiasis (sand flea disease) is a neglected tropical disease, prevalent in resource-poor communities in South America and sub-Saharan Africa. It is caused by an inflammatory response against penetrated female sand fleas (<italic>Tunga penetrans</italic>
) embedded in the skin of the host. Although associated with debilitating acute and chronic morbidity, there is no proven effective drug treatment. By consequence patients attempt to remove embedded sand fleas with non-sterile sharp instruments, such as safety pins, a procedure that represents a health threat by itself. In this proof-of-principle study we compared the topical application of a mixture of two dimeticones of low viscosity (NYDA) to the topical application of a 0.05% solution of KMnO4 in 47 school children in an endemic area in rural Kenya. The efficacy of the treatment was assessed during a follow up period of seven days using viability signs of the embedded parasites, alterations in the natural development of lesion morphology and the degree of local inflammation as outcome measures. Seven days after treatment, in the dimeticone group 78% (95% CI 67–86%) of the parasites had lost all signs of viability as compared to 39% (95% CI 28–52%) in the KMnO4 group (p<0.001). In the dimeticone group 90% (95% CI 80–95%) of the penetrated sand fleas showed an abnormal development already after 5 days, compared to 53% (95% CI 40–66%; p<0.001) in the KMnO4 group. Seven days after treatment, signs of local skin inflammation had significantly decreased in the dimeticone group (p<0.001). This study identified the topical application of dimeticones of low viscosity (NYDA) as an effective means to kill embedded sand fleas. In view of the efficacy and safety of the topical treatment with dimeticone, the mechanical extraction of embedded sand fleas using hazardous instruments is no longer warranted.</p>
</abstract>
<abstract abstract-type="summary"><title>Author Summary</title>
<p>Tungiasis (sand flea disease), a parasitic skin disease, causes important morbidity, and eventually leads to mutilation of the feet. Hitherto, the only effective treatment is the surgical extraction of embedded sand fleas. In the endemic areas this is done using inappropriate sharp instruments and causes more harm than good. We identified the three last abdominal segments of <italic>Tunga penetrans</italic>
which protrude through the skin and through which the parasite breathes, defecates, and expels eggs - as an Achilles heel of embedded sand fleas. In a proof-of-principle study we investigated whether this Achilles heel is vulnerable to dimeticone with a low viscosity and a high creeping property. We randomized the left and the right feet to either receive a topical application of KMnO4 (the standard treatment in Kenya) or of dimeticone. The major outcome measure was the absence of viability signs of the treated sand fleas. The study shows that the topical application of a mixture of two dimeticones (NYDA) effectively kills embedded sand fleas within seven days. Since dimeticones are considered to be wholly non-toxic and are not expensive the new treatment could become a means to control tungiasis-associated morbidity on the population level.</p>
</abstract>
<funding-group><funding-statement>HF acknowledges the receipt of consulting fees and travel grants from Pohl-Boskamp GmbH & Co KG. MT received a travel grant from the Charité University Medicine Berlin, Germany. The study was partially funded by Pohl-Boskamp GmbH & Co KG (<ext-link ext-link-type="uri" xlink:href="http://www.pohl-boskamp.de/de/start/">http://www.pohl-boskamp.de/de/start/</ext-link>
) which provided the dimeticone. German Doctors e.V. (<ext-link ext-link-type="uri" xlink:href="https://www.german-doctors.de/de/">https://www.german-doctors.de/de/</ext-link>
), a non-profit governmental organization, funded the field work. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement>
</funding-group>
<counts><page-count count="10"></page-count>
</counts>
<custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name>
<meta-value>The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and its Supporting Information files.</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
<notes><title>Data Availability</title>
<p>The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and its Supporting Information files.</p>
</notes>
</front>
</pmc>
<affiliations><list><country><li>Allemagne</li>
<li>Kenya</li>
<li>Suède</li>
</country>
<region><li>Berlin</li>
</region>
<settlement><li>Berlin</li>
</settlement>
</list>
<tree><country name="Allemagne"><region name="Berlin"><name sortKey="Thielecke, Marlene" sort="Thielecke, Marlene" uniqKey="Thielecke M" first="Marlene" last="Thielecke">Marlene Thielecke</name>
</region>
<name sortKey="Feldmeier, Hermann" sort="Feldmeier, Hermann" uniqKey="Feldmeier H" first="Hermann" last="Feldmeier">Hermann Feldmeier</name>
</country>
<country name="Suède"><noRegion><name sortKey="Nordin, Per" sort="Nordin, Per" uniqKey="Nordin P" first="Per" last="Nordin">Per Nordin</name>
</noRegion>
</country>
<country name="Kenya"><noRegion><name sortKey="Ngomi, Nicholas" sort="Ngomi, Nicholas" uniqKey="Ngomi N" first="Nicholas" last="Ngomi">Nicholas Ngomi</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>
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