Cutaneous larvae migrans (also called “creeping eruption” or “ground itch”) is found in southeastern and Gulf states, and in tropical developing countries.
Cutaneous larva migrans (CLM) is a cutaneous lesion produced by percutaneous penetration and migration of larvae of various nematode parasites, characterized by erythematous, serpiginous, papular, or vesicular linear lesions corresponding to the movements of the larvae beneath the skin.
Causes of Cutaneous Larva Migrans
Humans are aberrant, dead-end hosts who acquire the parasite from environment contaminated with animal feces. Larvae remain viable in soil/sand for several weeks. Third-stage larvae penetrate human skin and migrate up to several centimeters a day, usually between stratum germinativum and stratum corneum. Parasite induces localized eosinophilic inflammatory reaction. Most larvae are unable to develop further or invade deeper tissues and die after days or months.
Symptoms of Cutaneous Larva Migrans
The larvae can then either lie dormant for weeks or months or immediately begin creeping activity that create 2-3mm wide, snakelike tracks stretching 3-4cm from the penetration site. These are slightly raised, flesh-coloured or pink and cause intense itching. Tracks advance a few millimetres to a few centimetres daily and if many larvae are involved a disorganised series of loops and tortuous tracks may form.
Sites most commonly affected are the feet, spaces between the toes, hands, knees and buttocks.
Diagnosis
The condition can be diagnosed by microscopic inspection of feces which can reveal hookworm eggs. In addition visual inspection of the skin would reveal telltale itchy red lines and blisters.
Treatment
Symptomatic Therapy Topical application of a glucocorticoid preparation under occlusion to lesion.
Anthelmintic Agents
Topical Agents Thiabendazole, ivermectin, albendazole are effective topically.
Systemic Agents Thiabendazole, orally 50 mg/kg/d in two doses (maximum 3 g/d) for 2 to 5 days; also effective when applied topically under occlusion. Ivermectin, 6 mg bid. Albendazole, 400 mg/d for 3 days; highly effective.
Cryosurgery Liquid nitrogen to advancing end of larval burrow.
Removal of Parasite Do not attempt to extract; parasite not in visible lesion.
Prevention
Avoid direct skin contact with fecally contaminated soil.
Human hookworm infestation can be prevented by practicing good personal hygiene, deworming pets, and not allowing children to play in potentially contaminated environments.
References