II. Epidemiology
- Children are most commonly affected
- Occurs in Southeast Asia, Central America, South America, Caribbean, Southeastern United States
III. Risk Factors
- Utility workers (Plumber's itch)
- Beach combers (especially in southeast U.S.)
- Post-flood or hurricane
IV. Pathophysiology
V. Symptoms
- Serpiginous rash on foot or extremities
- Intense Pruritus (especially at night)
VI. Signs
- Initial (Larva penetrates skin)
- Pruritic erythematous Papule at larval entry site
- Subsequent (Larva wanders around in skin)
- Serpiginous track advances noticeably each day
VII. Differential Diagnosis
- Contact Dermatitis
-
Strongyloidiasis
- Similar rash, but typically associated with gastrointestinal symptoms (esp. Diarrhea)
VIII. Management
-
Cryotherapy
- Ethyl chloride sprayed at advancing track edge
- Topicals
- Thiabendazole cream
- Systemic
- Ivermectin (Stromectol) 150-200 ug/kg for 1 dose
-
Eosinophilic enteritis Syndrome (rare complication)
- Mebendazole 100 mg bid for 3 days
- Mebendazole no longer available as of 2012
- Use Albendazole instead
- Mebendazole 100 mg bid for 3 days
IX. Prevention
- Avoid skin contact with infected ground
- Prohibit dog walking on beach
- Avoid allowing pets in sand box
- Pet care
- De-worm household pets
- Clean up pet droppings