| Summary: | Background: Tungiasis (infestation with the sand flea Tunga penetrans) is common in resource-poor populations throughout Brazil. However, the epidemiological situation and the clinical aspects are not fully understood.Methodology: To describe the prevalence and severity of tungiasis, associated pathology, as well as the seasonal variation in rural northeast Brazil, we performed two cross-sectional surveys: one in the rainy season, another in the dry season. Individuals were examined for the presence of tungiasis, number of lesions, symptoms and signs. In the rainy season, 88.6% (1,015/1,146), and in the dry season 91.1% (990/1,087) of the respective target populations were examined.Results: The prevalence of tungiasis was 21.6% (95% confidence interval: 19.0-24.1) in the rainy season and 29.5% (26.6-32.3) in the dry season (p<0.0001). The highest prevalence was found in boys (5 – 14 years) in the dry season (48.3%; 40.6-56.0). Most lesions occurred on the feet (rainy season: 96.3%; dry season: 97.5%); a considerable number of individuals presented with lesions on the hands (6.9% and 5.1%, respectively). Common symptoms and signs were desquamation of the skin (57.5% in the rainy season; 44.5% in the dry season), hyperkeratosis (51.6% and 34.6%) and nail deformation (32.0% and 23.3%). Superinfection was present in 15.5% and 13.7% of cases, respectively. Severe pathology, such as deep fissures (10.5% and 9.3%), loss of toe-nails (5.5% and 2.4%) and difficulty walking (1.4% and 0.7%) occurred less commonly.Conclusions: Tungiasis occurs to an important degree in Alagoas State, and prevalence and morbidity varies according to the season. Children were identified as a high-risk group.
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