Parasite

Cutaneous Larva Migrans

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Cutaneous Larva Migrans, Creeping Eruption

  • See Also
  1. Visceral Larva Migrans
  2. Pet Borne Zoonoses
  3. Helminth
  • Epidemiology
  1. Children are most commonly affected
  2. In the U.S., primarily found in the Southeastern United States
  3. Worldwide, found in Southeast Asia, Central America, South America, Caribbean
  • Pathophysiology
  1. Dog and cat Hookworms (related to human Hookworm)
    1. Ancylostoma braziliense
    2. Ancylostoma caninum
  2. Transmission
    1. Feces of dog or cat contaminate moist, warm soil/sand typically in humid environments
    2. Larvae in the soil or sand penetrate skin (esp. when walking barefoot)
  3. Larvae migrate through the Epidermis leaving serpiginous tracks
    1. Local allergic response leads to raised, red, pruritic rash
  • Risk Factors
  1. Utility workers (Plumber's itch)
  2. Beach combers (especially in southeast U.S.)
  3. Post-flood or hurricane
  • Symptoms
  1. Serpiginous rash on foot or extremities
  2. Intense Pruritus (especially at night)
  • Signs
  1. Initial (Larva penetrates skin)
    1. Pruritic erythematous Papule at larval entry site
  2. Subsequent (Larva wanders around in skin)
    1. Serpiginous track advances noticeably each day
  • Differential Diagnosis
  1. Contact Dermatitis
  2. Strongyloidiasis or Necator americanus (New World Hookworm)
    1. Similar rash, but typically associated with gastrointestinal symptoms (esp. Diarrhea)
  • Management
  1. Cryotherapy
    1. Ethyl chloride sprayed at advancing track edge
  2. Topicals
    1. Thiabendazole cream
  3. Systemic
    1. Ivermectin (Stromectol) 150-200 ug/kg for 1 dose
  4. Eosinophilic enteritis Syndrome (rare complication)
    1. Mebendazole 100 mg orally twice daily for 3 days
  • Prevention
  1. Avoid skin contact with infected ground
    1. Prohibit dog walking on beach
    2. Avoid allowing pets in sand box
  2. Pet care
    1. De-worm household pets
    2. Clean up pet droppings
  • References
  1. Rabinowitz (2007) Am Fam Physician 76(9):1314-22 [PubMed]
  2. Snellings (2019) Am Fam Physician 100(12): 773-4 [PubMed]