Cutaneous Larva Migrans

Infectious Agent

Larval stages of dog and cat hookworms (usually Ancylostoma spp.).

Transmission

Skin contact with contaminated soil or sand.

Epidemiology

Most cases are reported in travelers to the Caribbean, Africa, Asia, and South America. Beaches (and sandboxes) where domestic animals may roam are a common source of infection. Infection occurs in short- as well as long-term travelers.

Clinical Presentation

Creeping eruption usually appears 1–5 days after skin penetration, but the incubation period may be ≥1 month. Typically, a serpiginous, erythematous track appears in the skin and is associated with intense itchiness and mild swelling. Usual locations are the foot and buttocks, although any skin surface coming in contact with contaminated soil can be affected.

Diagnosis

Diagnosed on the basis of characteristic skin lesions. Biopsy is not recommended.

Treatment

Cutaneous larva migrans is self-limiting; migrating larvae usually die after 5–6 weeks. Albendazole is very effective for treatment. Ivermectin is effective but not approved for this indication. Symptomatic treatment for frequent severe itching may be helpful.

Prevention

Reduce contact with contaminated soil by wearing shoes and protective clothing and using barriers such as towels when seated on the ground.

CDC website: www.cdc.gov/parasites/zoonotichookworm

Bibliography

  1. Caumes E. Treatment of cutaneous larva migrans. Clin Infect Dis. 2000 May;30(5):811–4.  [PMID:10816151]
  2. Gillespie SH. Cutaneous larva migrans. Curr Infect Dis Rep. 2004 Feb;6(1):50–3.  [PMID:14733849]
  3. Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans. Lancet Infect Dis. 2008 May;8(5):302–9.  [PMID:18471775]
  4. Hochedez P, Caumes E. Hookworm-related cutaneous larva migrans. J Travel Med. 2007 Sep-Oct;14(5):326–33.  [PMID:17883464]
  5. Lederman ER, Weld LH, Elyazar IR, von Sonnenburg F, Loutan L, Schwartz E, et al. Dermatologic conditions of the ill returned traveler: an analysis from the GeoSentinel Surveillance Network. Int J Infect Dis. 2008 Nov;12(6):593–602.  [PMID:18343180]

Author

Susan Montgomery