This week's case was generously donated by Dr. Jacob Rattin, a pathology resident at Cleveland Clinic.
A traveler returning from a lengthy hiking exploration in South America presented with itching, pain, and lesions on the soles of their feet. A skin biopsy was performed with showed the following on hematoxylin and eosin (H&E):
H&E, 25x magnification
What is your diagnosis?
If this is an organism and not artifactual, what structures do you think are present? Is this a male or female?
6 comments:
Gee! This is something I have no experience in. From the travel history and clinical symptoms my guess is the Chigoe flea Tunga penetrans. The first picture shows an overall view with a thick cuticle. There is a light brown division possible between the front part and the abdomen. The fourth picture shows the cross sections of the legs. The fifth picture seems to have undeveloped eggs? Well, that’s my uneducated guess. Please, my gray matter needs more learning. At last but not least we have a case to scratch the head on.
Florida Fan
Oh, one more thing. The CDC reference says “ both male and female fleas feed intermittently on their host, but only mated females penetrate into the epidermis “.
Florida Fan
This is indeed Tunga penetrans - the jigger flea.
In picture 4, one can see the sclerotized mouthparts and tracheal structures. In picture 6 we see part of the ovary, while that last picture is probably showing the high number of produced eggs, making this for sure a female. Both male and female will take bloodmeals, but only the female burrows into the skin when fertilized.
Nice pictures! Thanks for sharing Dr. Rattin!
Guessing Tunga Penetrans female/Patrik
Tungiasis
Ohh fun! I want to see the foot!!
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