Photo Quiz: Risk in Travelers after Barefoot Sand Walking in Tropical Countries

Patient 1 was a 44-year-old woman, a journalist, who was attended to at the emergency unit of Hospital Universitario Miguel Servet for two pruriginous small lesions, each with a blackish center and a hyperkeratotic halo, on the heel of the right foot and a larger lesion adjacent to the distal edge of the nail of the fifth finger, approximately 1 cm in diameter. The previous month, she had traveled to Tanzania and Zanzibar Island, performing barefoot walks on sandy beaches and rocky areas. During the trip, she had presented an episode of gener- alized pruritus. The injuries were punctured with iodine anti- septic application, and the serous material was sent to the mi- crobiology laboratory. The direct microscopic examination showed brownish structures of arthropod parts and ovoid structures (Fig. 1, left). Resolution was satisfactory.