Invasion of the skin by sand fleas (Tungapenetrans) causes tungiasis in tropical areas of Africa, America, and India. It is most common on the feet, especially under the toes and toenails. The condition looks a bit like plantar warts, but if you watch for a while you will see the eggs being squirted out.

Prevention Wear shoes.

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• Carefully winkle the fleas out with a pin (most patients know how to do this themselves).

• If the fleas are very extensive, soak the feet in kerosene or treat with a single dose of ivermectin 200 micrograms/kg body weight.

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