During the first day or two of infestation, the host may feel an itching or irritation which then passes as the area around the flea calluses and becomes insensitive.

This is not the case with T. penetrans, as only the adults feed on mammals, and the mature female remains in the host for the rest of her life.

First, it has a wide distribution: some 88 countries, in the Caribbean, Central and South America, tropical (sub-Saharan) Africa, and India.

[5] Host species for T. penetrans'[5] For the most part, the chigoe flea lives 2–5 cm below sand, an observation which helps explain its overall distribution.

This orifice allows the flea to breathe, defecate, mate and expel eggs while feeding from blood vessels.

The female flea continues in vivo development, described in stages by the Fortaleza classification of tungiasis.

Over the next two weeks, its abdomen swells with up to several hundred to a thousand eggs, which it releases through the caudal orifice to fall to the ground when ready to hatch.

[9] In dividing the natural history of the disease, the Fortaleza Classification formally describes the last part of the female flea's life cycle where it burrows into its host's skin, expels eggs, and dies.

Only the anus, the copulatory organs, and four rear air holes in fleas called stigmata remain on the outside of the epidermis.

The hypertrophic zone between tergites 2 and 3 in the abdominal region begins to expand a day or two after penetration and takes the appearance of a life belt.

[9] If the flea is left within the skin, dangerous complications can occur including secondary infections from trapped bacteria such as Staphylococcus, Streptococcus, enterobacteriaceae, and Clostridium tetani.

[1] Tungiasis was endemic in pre-Columbian Andean society for centuries before discovery of T. penetrans as native to the West Indies.

[12] The first European description was published in 1526 by Gonzalo Fernández de Oviedo y Valdés,[13] where he discussed the skin infestation and its symptoms on crew members from Columbus's Santa Maria after they were shipwrecked on Haiti.

The spread to greater Africa occurred throughout the 17th and 19th centuries, specifically in 1873 when the infected crewmen of the Thomas Mitchell's ship introduced it into Angola, having sailed from Brazil.

[18] Surgical extraction still remains the treatment of choice in patients with a low parasite load, such as tourists returning from endemic areas.

The only approach to reduce tungiasis-associated morbidity in heavily affected individuals is the application of a repellent to prevent the penetration of sand fleas.