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cutaneous larva migrans

A migratory, serpinginous or netlike tunneling in the skin. Etiology: 1) Ancylostoma braziliense: dog & cat feces 2) Ancylostoma canium 3) Ancylostoma duodenale [6] 4) Uncinaria stenocephala (European dog hookworm) 5) Bunostomum phlebotomum (cattle hookworm) 6) Strongyloides Epidemiology: 1) eastern & southern coastal USA 2) other tropical or subtropical coastal areas 3) transmission occurs when naked skin comes into contact with contaminated soil Pathology: - wandering hookworm larvae not adapted to intestinal maturation in humans - entry is generally through the skin - cutaneous larva migrans (migration of hookworm larvae in the epidermis) - larvae cannot penetrate the basal membrane of human skin, because it lacks the collagenase necessary to break through the basement membrane, thus remain confined to the epidermis & are unable to develop & complete their lifecycle - self-limiting disease - skin pathology may persist for months Clinical manifestations: - first clinical sign is a small reddish papule - later, the characteristic serpiginous, slightly elevated, erythematous track becomes visible - migration occurs at a rate of a few mm to cm per day [1] - pruritus becomes more & more intense - excoriations induced by scratching *images [3,4,5,6] Laboratory: - skin biopsy generally not needed (diagnosis is clinical) Complications: - bacterial superinfection from scratching Management: - self-limited disease; however, anthelmintic treatment can diminish symptoms & shorten the duration - with treatment, lesions may heal completely in 2 weeks [3] - drug of choice is ivermectin in a single dose (200 ug/kg) - albendazole 400 mg QD is alternative

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hookworm

General

larva migrans

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
  2. Feldmeier H, Schuster A. Mini review: Hookworm-related cutaneous larva migrans. Eur J Clin Microbiol Infect Dis. 2012 Jun;31(6):915-8. PMID: 21922198
  3. Juzych LA, James WD (images) Medscape: Cutaneous Larva Migrans http://emedicine.medscape.com/article/1108784-overview
  4. DermNet NZ: Cutaneous larva migrans (images) http://www.dermnetnz.org/arthropods/larva-migrans.html
  5. Ma DL, Vano-Galvan S IMAGES IN CLINICAL MEDICINE. Creeping Eruption--Cutaneous Larva Migrans. N Engl J Med. 2016 Apr 7;374(14):e16. PMID: 27050235 http://www.nejm.org/doi/full/10.1056/NEJMicm1509325
  6. Grim L You've Got Worms! Common Intestinal Parasites Medscape. Jan 23, 2023 https://reference.medscape.com/slideshow/intestinal-parasites-6014593