The efficacy of topical, oral and surgical interventions for the treatment of tungiasis: A systematic review of the literature

• Published in: PLoS neglected tropical diseases 2021-08, Vol.15 (8), p.e0009722-e0009722
• Main Authors: Tardin Martins, Ana Carolina, de Brito, Amanda Ramos, Kurizky, Patrícia Shu, Gonçalves, Rodrigo Gurgel, Santana, Yago Ranniere Teixeira, de Carvalho, Fabiola Christian Almeida, Gomes, Ciro Martins
• Format: Article
• Language: English
• Subjects: Abstracts; Bias; Clinical trials; Disease; Evaluation; Health services; Ivermectin; Lesions; Literature reviews; Medical research; Medicine and Health Sciences; Medicine, Experimental; Niridazole; Observational studies; Oral medication; Parasites; Patient care planning; People and Places; Qualitative analysis; Research and Analysis Methods; Social Sciences; Surgery; Systematic review; Topical medication; Tropical diseases; Vulnerability
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0009722

Background Tungiasis is a neglected disease caused by Tunga penetrans that can be complicated by secondary infections and local tissue destruction. Adequate treatment is important, especially in vulnerable populations; potential treatment options proposed range from surgical extraction to the use of oral and topical medications. We aimed to perform a systematic review to assess the efficacy of topical, oral and surgical interventions for the treatment of tungiasis. Methodology/Principal findings The present review is registered in PROSPERO (CRD42021234741). On September 1, 2020, we searched PubMed, EMBASE, Scopus, Web of Science, Science Direct, Scielo and LILACS BVS. We included clinical trials and longitudinal observational studies that evaluated any topical, systemic or mechanical treatment for tungiasis. We used the Revised Cochrane Risk of Bias (RoB) Tool for Randomized Trials for clinical trial analysis. Qualitative and quantitative descriptive syntheses were performed. Our search strategy resulted in 3376 references. Subsequently, 2568 titles/abstracts and 114 full texts were screened. We finally included 19 articles; 9 were classified as clinical trials. Two and 3 articles presented low and some RoB, respectively, according to the tool. Only two articles tested the efficacy of oral medications (niridazole, ivermectin), with discouraging results. Six clinical trials evaluated topical products for the treatment of tungiasis; 2 evaluated dimeticone-based compounds and reported positive results in lesion reduction and cure. None reported significant adverse reactions. Surgical extraction was evaluated only in observational studies. Conclusions/Significance We conclude that, although surgical extraction is the most commonly used treatment, there is sufficient evidence supporting the use of occlusive agents, especially manufactured dimeticone-based products.