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Cutaneous Larva Migrans
Aka: Cutaneous Larva Migrans, Creeping Eruption
- Epidemiology
- Children are most commonly affected
- Occurs in Southeast Asia, Central America, South America, Caribbean, Southeastern United States
- Risk Factors
- Utility workers (Plumber's itch)
- Beach combers (especially in southeast U.S.)
- Post-flood or hurricane
- Pathophysiology
- Dog and cat Hookworms (related to human Hookworm)
- Ancylostoma braziliense
- Ancylostoma caninum
- Transmission
- Feces of dog or cat contaminate moist, warm soil/sand typically in humid environments
- Larvae in the soil or sand penetrate skin (esp. when walking barefoot)
- Symptoms
- Serpiginous rash on foot or extremities
- Intense Pruritus (especially at night)
- Signs
- Initial (Larva penetrates skin)
- Pruritic erythematous Papule at larval entry site
- Subsequent (Larva wanders around in skin)
- Serpiginous track advances noticeably each day
- Differential Diagnosis
- Contact Dermatitis
- Strongyloidiasis
- Similar rash, but typically associated with gastrointestinal symptoms (esp. Diarrhea)
- 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
- 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
- References
- Rabinowitz (2007) Am Fam Physician 76(9):1314-22 [PubMed]
- Snellings (2019) Am Fam Physician 100(12): 773-4 [PubMed]