Cutaneous larva migrans: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
* | *[[Pruritus|Pruritic]], serpiginous eruption<ref name="Prickett" /> | ||
** | **Pruritus can be severe and intractable<ref name="Vano-Galvan" />, and can lead to impaired sleep and mood disturbance<ref name="Kincaid">Kincaid L, Klowak M, Klowak S, Boggild AK. Management of imported cutaneous larva migrans: A case series and mini-review. Travel Med Infect Dis. 2015 Jul 29.</ref> | ||
**Usually unilateral, but can be bilateral | **Usually unilateral, but can be bilateral | ||
**Linear, moving lesions | **Linear, moving lesions | ||
**Hand, feet, buttock most commonly affected. <ref>Pascual J, Laoteppitaks C. Unique Rash after Beach Vacation. Journal of Emergency Medicine. 2017 June;52(6):878-879. Epub 2017 April 8</ref> | **Hand, feet, buttock most commonly affected. <ref>Pascual J, Laoteppitaks C. Unique Rash after Beach Vacation. Journal of Emergency Medicine. 2017 June;52(6):878-879. Epub 2017 April 8</ref> | ||
==Complications== | |||
*Loeffler's Syndrome<ref>Pascual J, Laoteppitaks C. Unique Rash after Beach Vacation. Journal of Emergency Medicine. 2017 June;52(6):878-879. Epub 2017 April 8</ref> | |||
**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== | ==Differential Diagnosis== | ||
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*Self-limited condition - larvae die within 2-8 weeks<ref name="Prickett" /> | *Self-limited condition - larvae die within 2-8 weeks<ref name="Prickett" /> | ||
**Goal of treatment is to relieve severe pruritus | **Goal of treatment is to relieve severe pruritus | ||
*First Line: ivermectin 200ug/kg, single dose. <ref>Feldmeier H, Schuster A. Mini-review: Hookwarm-related cutaneous larva migrans. Eur J Clin Microbiol Infect Dis (2012) 31:915-918</ref> | *First Line: [[ivermectin]] 200ug/kg, single dose. <ref>Feldmeier H, Schuster A. Mini-review: Hookwarm-related cutaneous larva migrans. Eur J Clin Microbiol Infect Dis (2012) 31:915-918</ref> | ||
**Alternatives: Albendazole 400mg orally for 5 to 7days OR Topical tiabendazole 10-15% TID for 5 to 7days | **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<ref name="Kincaid" /> | *Mebendazole has poor oral bioavailability and does not work for cutaneous larva migrans<ref name="Kincaid" /> | ||
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*Discharge | *Discharge | ||
==See Also== | ==See Also== | ||
Revision as of 20:44, 27 September 2019
Background
- Also known as creeping eruption or sandworm disease[1]
- Caused by movement of hookworm (helminth) larvae through epidermis[2]
- 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[1]
Clinical Features
Complications
- Loeffler's Syndrome[5]
- 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
- Papules
- Insect bites
- Scabies
- Seabather's eruption
- Cercarial dermatitis (Swimmer's Itch)
- Macular
- Sub Q Swelling and Nodules
- 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[2]
- Goal of treatment is to relieve severe pruritus
- First Line: ivermectin 200ug/kg, single dose. [6]
- 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[3]
Disposition
- Discharge
See Also
References
- ↑ 1.0 1.1 1.2 Vano-Galvan S, Gil-Mosquera M, Truchuelo M, Jaén P. Cutaneous larva migrans: a case report. Cases Journal. 2009;2:112. doi:10.1186/1757-1626-2-112.
- ↑ 2.0 2.1 2.2 Prickett KA, Ferringer TC. What's eating you? Cutaneous larva migrans. Cutis. 2015 Mar;95(3):126-8.
- ↑ 3.0 3.1 Kincaid L, Klowak M, Klowak S, Boggild AK. Management of imported cutaneous larva migrans: A case series and mini-review. Travel Med Infect Dis. 2015 Jul 29.
- ↑ Pascual J, Laoteppitaks C. Unique Rash after Beach Vacation. Journal of Emergency Medicine. 2017 June;52(6):878-879. Epub 2017 April 8
- ↑ Pascual J, Laoteppitaks C. Unique Rash after Beach Vacation. Journal of Emergency Medicine. 2017 June;52(6):878-879. Epub 2017 April 8
- ↑ Feldmeier H, Schuster A. Mini-review: Hookwarm-related cutaneous larva migrans. Eur J Clin Microbiol Infect Dis (2012) 31:915-918