JIGGER FLEAS (Tungum penetrans)
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This week I had the opportunity to see something new( a pleasure after 25 years)
that I thought the group might like. A 66 y/o active lady presented with a
tender small toe. On exam she had a 5mm firm nodule on the tip of her toe with a
surmounting black dot. The nodule had partially avulsed causing a fissure.
There was no hx of trauma. After local I saucerized the nodule and sectioned it
which revealed amorphous keratin like material. The next morning the derm path
man at our hospital called to tell me he had never seen anything like it and the
entomologist that worked with him thought it was a tungum penetrans(jigger
flea). I spoke to the patient and sure enough she had recently returned from
Brazil and that her husband had a similar lesion on his foot.  Another example
of our small world and the importance of tissue exam and history taking.
Incidently research reveals that the term" I'll be jiggered" comes from British
sailors in the tropics who acquired the pesky critters, especially under their
toenails which caused considerable pain.

L.J. Gregg,MD, 
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