{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T11:53:05Z","timestamp":1782129185353,"version":"3.54.5"},"reference-count":45,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T00:00:00Z","timestamp":1782000000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Tungiasis is a cutaneous ectoparasitosis caused by the penetration of gravid female Tunga penetrans fleas into the epidermis. Although endemic in tropical and subtropical regions, it remains rare in Europe, where most cases are travel-associated and secondary household transmission is seldom documented. This study describes imported tungiasis in Greece and investigates possible secondary household transmission in a non-endemic setting. Seven Greek men residing in Attica developed tungiasis following occupational exposure in Tanzania, together with one secondary case in a non-travelling household contact who had never travelled outside Greece. Diagnosis was based on clinical and dermoscopic findings and confirmed by amplification and sequencing of the mitochondrial cytochrome oxidase I (COI) gene. Household investigations were also performed. Eight male patients presented with painful plantar and\/or subungual nodular lesions. Sequence analysis of COI demonstrated 657\/662 bp (99%) identity with the Tunga penetrans reference sequence, and identical sequences were identified in all samples. A representative sequence was deposited in GenBank (accession no. PZ336383). All patients exhibited mild-to-moderate elevations of hepatocellular and cholestatic liver enzymes, which resolved within two weeks following treatment. One probable secondary household case was identified, and no infestation was detected among additional cohabitants or companion animals. This report documents imported tungiasis with probable secondary household transmission in Greece and highlights the importance of clinical awareness and environmental assessment in non-endemic settings.<\/jats:p>","DOI":"10.3390\/tropicalmed11060169","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T09:49:55Z","timestamp":1782121795000},"page":"169","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Imported Tungiasis in Greece: Secondary Household Transmission and Transient Mixed Liver Enzyme Elevation"],"prefix":"10.3390","volume":"11","author":[{"given":"Thomas","family":"Fotas","sequence":"first","affiliation":[{"name":"Department of Dermatology and Venereology, General Hospital \u201cAsklepieio Voulas\u201d, 16673 Voula, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6323-2955","authenticated-orcid":false,"given":"Ioannis A.","family":"Giantsis","sequence":"additional","affiliation":[{"name":"Department of Animal Science, Faculty of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menelaos","family":"Lefkaditis","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology and Parasitology, Faculty of Veterinary Science, University of Thessaly, 43100 Karditsa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6214-4884","authenticated-orcid":false,"given":"Ioannis S.","family":"Pappas","sequence":"additional","affiliation":[{"name":"Laboratory of Pharmacology and Toxicology, Faculty of Veterinary Science, University of Thessaly, 43100 Karditsa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0240-6417","authenticated-orcid":false,"given":"Mathis A. B.","family":"Christodoulopoulos","sequence":"additional","affiliation":[{"name":"Facult\u00e9 des Sciences, Site St Charles, Aix Marseille Universit\u00e9, 13331 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efterpi","family":"Zafiriou","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41500 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8221-0217","authenticated-orcid":false,"given":"Electra","family":"Nicolaidou","sequence":"additional","affiliation":[{"name":"First Department of Dermatology and Venereology, \u201cA. Sygros\u201d Hospital for Skin and Venereal Diseases, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8189-7486","authenticated-orcid":false,"given":"Alexander C.","family":"Katoulis","sequence":"additional","affiliation":[{"name":"Second Department of Dermatology and Venereology, \u201cAttikon\u201d General University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12461 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2692-8910","authenticated-orcid":false,"given":"Georgios","family":"Christodoulopoulos","sequence":"additional","affiliation":[{"name":"Department of Animal Science, Agricultural University of Athens, Iera Odos 75 Str., 11855 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,21]]},"reference":[{"key":"ref_1","unstructured":"Linardi, P.M., and Guimar\u00e3es, L.R. 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