Cutaneous Larva Migrans

1. Epidemiology
   1. Children are most commonly affected
   2. Occurs in Southeast Asia, Central America, South America, Caribbean, Southeastern United States
2. Risk Factors
   1. Utility workers (Plumber's itch)
   2. Beach combers (especially in southeast U.S.)
   3. Post-flood or hurricane
3. Pathophysiology
   1. Dog and cat Hookworms (related to human Hookworm)
      1. Ancylostoma braziliense
      2. Ancylostoma caninum
   2. Transmission
      1. Feces of dog or cat contaminate moist, warm soil/sand typically in humid environments
      2. Larvae in the soil or sand penetrate skin (esp. when walking barefoot)
4. Symptoms
   1. Serpiginous rash on foot or extremities
   2. Intense Pruritus (especially at night)
5. Signs
   1. Initial (Larva penetrates skin)
      1. Pruritic erythematous Papule at larval entry site
   2. Subsequent (Larva wanders around in skin)
      1. Serpiginous track advances noticeably each day
6. Differential Diagnosis
   1. Contact Dermatitis
   2. Strongyloidiasis
      1. Similar rash, but typically associated with gastrointestinal symptoms (esp. Diarrhea)
7. Management
   1. Cryotherapy
      1. Ethyl chloride sprayed at advancing track edge
   2. Topicals
      1. Thiabendazole cream
   3. Systemic
      1. Ivermectin (Stromectol) 150-200 ug/kg for 1 dose
   4. Eosinophilic enteritis Syndrome (rare complication)
      1. Mebendazole 100 mg bid for 3 days
         1. Mebendazole no longer available as of 2012
         2. Use Albendazole instead
8. Prevention
   1. Avoid skin contact with infected ground
      1. Prohibit dog walking on beach
      2. Avoid allowing pets in sand box
   2. Pet care
      1. De-worm household pets
      2. Clean up pet droppings
9. References
   1. Rabinowitz (2007) Am Fam Physician 76(9):1314-22 [PubMed]
   2. Snellings (2019) Am Fam Physician 100(12): 773-4 [PubMed]