Parasite

Cutaneous Larva Migrans

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Cutaneous Larva Migrans, Creeping Eruption

  • Epidemiology
  1. Children are most commonly affected
  2. Occurs in Southeast Asia, Central America, South America, Caribbean, Southeastern United States
  • Risk Factors
  1. Utility workers (Plumber's itch)
  2. Beach combers (especially in southeast U.S.)
  3. Post-flood or hurricane
  • 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)
  • 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
    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 bid for 3 days
      1. Mebendazole no longer available as of 2012
      2. Use Albendazole instead
  • 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]