Cutaneous larva migrans: Difference between revisions
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**History is typically of a patient sunbathing, walking on the beach, etc in a tropical environment<ref name="Vano-Galvan">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.</ref>
**History is typically of a patient sunbathing, walking on the beach, etc in a tropical environment<ref name="Vano-Galvan">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.</ref>


==Clinical Features==
[[File:LarvaMigrans2.png|thumb|CLM on thigh of child]]
[[File:LarvaMigrans2.png|thumb|CLM on thigh of child]]
[[File:LarvaMigrans.png|thumb|CLM on leg of 32y/o M]]
[[File:LarvaMigrans.png|thumb|CLM on leg of 32y/o M]]
 
*[[Pruritus|Pruritic]], serpiginous eruption<ref name="Prickett" />
==Clinical Features==
**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>
*Pruritis serpiginous eruption<ref name="Prickett" />
**Pruritis 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" />
==Rare 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.


==Disposition==
==Disposition==
*Discharge
*Discharge


==See Also==
==See Also==

Latest revision as of 12:38, 12 December 2020

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

CLM on thigh of child
CLM on leg of 32y/o M
  • Pruritic, serpiginous eruption[2]
    • Pruritus can be severe and intractable[1], and can lead to impaired sleep and mood disturbance[3]
    • Usually unilateral, but can be bilateral
    • Linear, moving lesions
    • Hand, feet, buttock most commonly affected. [4]

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

Travel-related skin conditions

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. ↑ 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. ↑ 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. ↑ 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.
  4. ↑ Pascual J, Laoteppitaks C. Unique Rash after Beach Vacation. Journal of Emergency Medicine. 2017 June;52(6):878-879. Epub 2017 April 8
  5. ↑ Pascual J, Laoteppitaks C. Unique Rash after Beach Vacation. Journal of Emergency Medicine. 2017 June;52(6):878-879. Epub 2017 April 8
  6. ↑ Feldmeier H, Schuster A. Mini-review: Hookwarm-related cutaneous larva migrans. Eur J Clin Microbiol Infect Dis (2012) 31:915-918
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