Cutaneous Larva Migrans

Definition

Cutaneous larvae migrans is a parasitic skin disease caused by a hookworm larvae that usually infests dogs, cats, and other animals. Humans can pick up the infection by walking barefoot on soil or beaches contaminated with animal feces.

Description

Cutaneous larvae migrans (also called "creeping eruption" or "ground itch") is found in southeastern and Gulf states, and in tropical developing countries.

The hookworms that cause the condition are small, round blood-sucking worms that infest about 700 million people around the world. Cutaneous larvae migrans occurs most often among children, those who crawl beneath raised buildings, and sunbathers who lie down on wet sand contaminated with hookworm larvae.

Causes and symptoms

After an animal passes feces that are infested with hookworm eggs, the eggs hatch into infective larvae that

are able to penetrate human skin (even through solid material, such as a beach towel). The larvae are commonly found in shaded, moist, or sandy areas (such as beaches, a child's sandbox, or areas underneath a house), where they are easily picked up by bare feet or buttocks.

In minor infestations, there may be no symptoms at all. In more severe cases, a red elevation of the skin (papule) appears within a few hours after the larvae have penetrated the skin. This usually arises first in areas that are in contact with the soil, such as the feet, hands, and buttocks.

Between a few days and a few months after infection, the larvae begin to migrate beneath the skin, leaving extremely itchy red lines that may be accompanied by blisters. These red lines usually appear at the top of the sole of the foot or on the buttocks.

Tyically, the larvae travel through the bloodstream, to the lungs, and then migrate into the mouth where they are swallowed and attach to the small intestine lining. There they mature into adult worms. In cases where the larvae migrate through the lungs, they can produce anemia, cough, and pneumonia, in addition to the itchy rash.

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

People without intestinal symptoms do not need treatment, since the worms will eventually die or be excreted. Thiabendazole or albendazole are used to treat the infestation. Mild infections can be treated by applying one of the drugs to the skin along the tracks and the normal skin surrounding the area. Thiabendazole also can be given internally, but taken this way it can cause side effects including dizziness, nausea, and vomiting

Prognosis

No matter how severe an infestation, with adequate treatment patients recover completely. However, if the patient scratches the lesions open, the areas can become vulnerable to bacterial infection.

Prevention

In the United States, the prevalence of dogs and cats with hookworms is the reason why the infective larvae are found so commonly in soil and sand. The play habits of children, together with their attraction to pets, puts them at high risk for hookworm infection and cutaneous larvae migrans.

Human hookworm infestation can be prevented by practicing good personal hygiene, deworming pets, and not allowing children to play in potentially contaminated environments.

BOOKS

Turkington, Carol A., and Jeffrey S. Dover. Skin Deep: An A-Z of Skin Disorders, Treatments and Health. 2nd ed. New York: Facts on File, 1998.

PERIODICALS

Rizzitelli, G., G. Scarabelli, and S. Veraldi. "Albendazole: A New Therapeutic Regimen in Cutaneous Larva Migrans." International Journal of Dermatology 36, no. 9 (Sept.1997): 700-703.

Carol A. Turkington

KEY TERMS

Larvae—Immature forms of certain worms.