A little girl caught a ghastly infection on the soles of her feet after walking barefoot through a pigsty.
The 10-year-old had lesions on her feet for days after playing in the mud.
Doctors at a primary care clinic in New England, US, diagnosed her with a parasitic infection caused by sand fleas that burrow themselves in the skin, the New England Journal of Medicine says.
Her family told medics they had been on holiday in rural Brazil, during which the youngster walked through the pigsty with no shoes on.
The infection is known as Tungiasis, caused by fleas native to Central and South America.
It typically occurs in remote or poverty-hit areas, medics say.
The female sand flea burrows itself deep into the skin and suck the blood, causing the gruesome lesions to appear.
They particularly affect the toes, soles and heels, the World Health Organisation (WHO) says.
Lesions can become infected with bacteria, which leads to abscesses to form.
Within about three weeks, the parasite dies and symptoms begin to regress, according to WHO.
Treatment generally consists of surgically extracting the burrowed sand fleas and then applying topical antibiotic.
The WHO estimates around 20 million people are at risk of Tungiasis in the Americas.
Science Magazine reports a researcher from Berlin let a sand flea grow inside her skin to find out whether the parasites mate before or after burrowing.
And she found the parasites most likely have sex after females are already inside the host.
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