Cutaneous larva migrans

Background

• Also known as creeping eruption or sandworm disease
• Caused by movement of hookworm (helminth) larvae through epidermis
  • Ancylostoma caninum and Ancylostoma braziliense are most common pathogens
  • Typically occurs due to contact with dog/cat feces in soil/sand
  • More common in warm/tropical areas, particularly during rainy season
  • History is typically of a patient sunbathing, walking on the beach, etc in a tropical environment

Clinical Features

CLM on thigh of child

CLM on leg of 32y/o M

• Pruritic, serpiginous eruption
  • Pruritus can be severe and intractable, and can lead to impaired sleep and mood disturbance
  • Usually unilateral, but can be bilateral
  • Linear, moving lesions
  • Hand, feet, buttock most commonly affected.

Complications

• Loeffler's Syndrome
  • Respiratory symptoms, pulmonary infiltrates, and peripheral eosinophilia.
  • Believed by some to be a systemic immune reaction to the parasite but exact pathogenesis unknown.
  • Treatment: treating parasitic infection leads to resolution of the pulmonary symptoms.

Differential Diagnosis

Travel-related skin conditions

• Papules
  • Insect bites
  • Scabies
  • Seabather's eruption
  • Cercarial dermatitis (Swimmer's Itch)
• Macular
  • Chikungunya
• Sub Q Swelling and Nodules
  • Myiasis
  • Tungiasis
  • Loa loa
  • African Trypanosomiasis
  • Onchocerciasis
• Ulcers
  • Tropical pyoderma
  • Leishmaniasis
  • Mycobacterium marinum
  • Buruli ulcer
  • Dracunculiasis (Guinea Worm disease)
• Linear and Migratory Lesions
  • Cutaneous larvae migrans
  • Photodermatitis

See also domestic U.S. ectoparasites

Evaluation

• Clinical diagnosis, based on history and physical exam

Management

• Self-limited condition - larvae die within 2-8 weeks
  • Goal of treatment is to relieve severe pruritus
• First Line: ivermectin 200ug/kg, single dose.
  • Alternatives: Albendazole 400mg orally for 5 to 7days OR Topical tiabendazole 10-15% TID for 5 to 7days
• Mebendazole has poor oral bioavailability and does not work for cutaneous larva migrans

Disposition

• Discharge

See Also

• Helminth infections
• Parasitic Disease
• Travel Medicine