Hookworm-related cutaneous larva migrans

Hookworm-related cutaneous larva migrans acquired in the UK

Hookworm-related cutaneous larva migrans (HrCLM) is a skin disease caused by infection with the larvae of animal hookworms. With conditions for infection more favourable in tropical climates, HrCLM in the UK is classically diagnosed in the returning traveller. We present two cases of clinically diagnosed UK-acquired HrCLM from a district general hospital in the south of England. A 68-year-old woman presented with a pruritic serpiginous tract on the right hand. She was a keen gardener and had been handling compost. A 50-year-old man, a long distance runner, presented with a similar lesion on the dorsum of his foot. Both patients were treated with a single dose of albendazole. These cases may represent an emerging infection in the UK. In the absence of a suggestive travel history, early recognition followed by efficient access to therapy is vital for treating HrCLM transmitted in the UK.

Falls in Diagnosis of Cutaneous Larva Migrans-a Case Report from Kosovo

INTRODUCTION:

Cutaneous larva migrans (CLM) is a dermatitis caused by hookworm larvae inoculation in the skin, most commonly acquired among individuals in tropical and sub-tropical areas or travelers who have visited those areas. The typical clinical presentation consists of itchy serpiginous lesion that advances.

CASE REPORT:

We are reporting a long time misdiagnosed case of a 37-year-old farmer from continental European region with a typical clinical presentation, and no history of traveling to endemic areas. We made the diagnosis of the CLM based on the patient’s history of itchy skin that had advanced for a few months, and clinical characteristics of the lesion in the right gluteus region consisting of erythema, papula and vesicles, together with erythematous/livid serpiginous tracks that formed an irregular and capricious path. The patient was successfully treated with oral mebendazole twice daily for three days and local therapy.

Autochthonous Hookworm-Related Cutaneous Larva Migrans Disease in Northeastern Italy: A Case Report

Here we report the case of a 42-yr-old patient who presented himself to us with a serpiginous erythematous lesion from the wrist of the right forearm up the arm to the right shoulder A similar lesion of a smaller size was also present in the left forearm. On the basis of clinical manifestations and progression of the lesion, combined with previous treatments and different diagnostic investigations, hookworm-related cutaneous larva migrans (HrCLM) disease was hypothesized. Albendazole was employed as treatment and the resolution of the symptoms confirmed the diagnosis. The relevance of the reported case relies on 3 main aspects: the acquisition of the disease in Italy, the initial treatment with topical corticosteroids that sped up the progression of the cutaneous trail, and the uncommon location of the lesions. Furthermore, the anamnestic data and the laboratory/clinical investigations strongly suggested an occupational exposure to the etiological agent. As illustrated here, HrCLM might represent a challenge for Western physicians in terms of diagnosis, treatment, and ways of acquisition. Describing the clinical presentation and the treatment of cases of cutaneous larva migrans might contribute to early and correct diagnosis, to an increase of our knowledge on this disease, and to an update on its epidemiology.

Aetiologies of creeping eruption: 78 cases

BACKGROUND

Creeping eruption is a migratory linear cutaneous trail. In addition to hookworm-related cutaneous larva migrans (HrCLM), other diseases can also be revealed by this sign.

OBJECTIVES

To report the different aetiologies of creeping eruption.

METHODS

All consecutive patients with creeping eruption presenting to our unit in Pitié Salpêtrière Hospital in Paris between 1 March 2008 and 31 January 2013 were included. The diagnoses were based on microscopic data when available (hookworm folliculitis, strongyloidiasis) or the association of epidemiological, clinical, biological features and good outcome after specific treatment (HrCLM, loiasis, gnathostomiasis).

RESULTS

Seventy-four patients (95%) presented with HrCLM. All but one had been travelling in a tropical country; seven (9%) also presented with folliculitis. Skin scraping of hookworm folliculitis lesions was performed in five cases and revealed living nematode larvae in three cases. Two patients (3%) with cutaneous gnathostomiasis after returning from Bali and Japan presented with intermittent creeping dermatitis on the foot and thigh, respectively. One patient (1%), native to Cameroon, was diagnosed with loiasis and one patient (1%), with no travel history, presented with 'creeping hair'.

CONCLUSION

Hookworm-related cutaneous larva migrans explains 95% of the cases of creeping eruption; gnathostomiasis, loiasis and cutaneous pili migrans may also be diagnosed.

Ventral dermatitis in rowi (Apteryx rowi) due to cutaneous larval migrans

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Rowi on a crèche island showed loss of feathers and dermatitis.

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We identified cutaneous larval migrans, possibly due to Trichostrongylus.

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This is the first instance of cutaneous larval migrans to be recorded in birds.

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Fatal complications resulted in the death of eight birds from aspergillosis.

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Intensive conservation management can result in pathways for novel infections.

The rowi is a critically endangered species of kiwi. Young birds on a crèche island showed loss of feathers from the ventral abdomen and a scurfy dermatitis of the abdominal skin and vent margin. Histology of skin biopsies identified cutaneous larval migrans, which was shown by molecular sequencing to be possibly from a species of Trichostrongylus as a cause of ventral dermatitis and occasional ulcerative vent dermatitis. The predisposing factors that led to this disease are suspected to be the novel exposure of the rowi to parasites from seabirds or marine mammals due to the island crèche and the limited management of roost boxes. This is the first instance of cutaneous larval migrans to be recorded in birds. Severe and fatal complications of the investigation resulted in the death of eight birds of aspergillosis and pulmonary complications associated with the use of bark as a substrate in hospital. Another bird died of renal failure during the period of hospitalisation despite oral and intravenous fluid therapy. The initiating cause of the renal failure was not determined. These complications have the potential to undermine the working relationship between wildlife veterinarians and conservation managers. This case highlights that intensive conservation management can result in increased opportunities for novel routes of cross-species pathogen transmission.

Cutaneous larva migrans on the scalp: atypical presentation of a common disease

Cutaneous larva migrans is a pruritic dermatitis due to the inoculation of helminths larvae in the skin, and it often occurs in children in tropical and subtropical areas. The authors describe an atypical case of cutaneous larva migrans in a 11 year-old child with scalp involvement, an unusual topography for this lesion.

S1 guideline diagnosis and therapy of cutaneous larva migrans (creeping disease)

GUIDELINE OBJECTIVES

These guidelines aim to enhance patient care by optimizing the diagnosis and treatment of infections due to creeping disease (cutaneous larva migrans) and to raise awareness among doctors of current treatment options.

METHODS

S1 guideline, non-systematic literature search, consensus process using a circular letter.

Hookworm-related cutaneous larva migrans in patients living in an endemic community in Brazil: immunological patterns before and after ivermectin treatmen

Hookworm-related cutaneous larva migrans (Hr-CLM) is caused by animal hookworm larvae migrating in the human epidermis where they elicit an inflammatory response. This study describes the immunological profile in Hr-CLM patients. In 77 Hr-CLM patients from Manaus, Brazil, peripheral eosinophils were counted, and serum concentrations of total immunoglobulin E (IgE) and selected cytokines were determined by ELISA before and after treatment with ivermectin. Controls included patients' household members (endemic controls), non-endemic Brazilian and Japanese individuals. Eosinophil counts and total IgE in Hr-CLM patients were higher than in controls and correlated with disease severity. Concentrations of interleukin (IL)-4, IL-5, IL-6, and IL-10 were higher in Hr-CLM patients than in endemic controls (p < 0.001) while no differences were detected for interferon (IFN)-γ, tumor necrosis factor (TNF)-α, IL-1β, IL-2, or transforming growth factor (TGF)-β. Following ivermectin treatment, numbers of eosinophils and concentrations of IL-4, IL-5, and IL-10 decreased whereas IgE, IFN-γ, and TGF-β concentrations increased. The IL-5/IFN-γ ratio declined from 5.9 (interquartile range [IQR] 0.8-31.6) before to 0.1 (IQR 0.05-0.2; p = 0.001) after treatment. Thus, although an impact of other infections on the immune parameters determined cannot be excluded, Hr-CLM in endemic areas is associated with eosinophilia and elevated cytokine levels, particularly of IL-5 and IL-10, which decrease following ivermectin treatment.

[Pitfalls in diagnosis and treatment of cutaneous larva migrans: three unusual cases from a dermatology clinic]

Cutaneous larva migrans (CLM, creeping eruption) is a skin disease commonly seen in travelers returning from the tropics. The lesions are caused by intradermal migration of animal hookworm larvae which cannot mature in humans. While the typical serpiginous skin lesions are easily diagnosed and treated with albendazole or ivermectin, unusual presentations can be misdiagnosed and cause prolonged morbidity. We present 3 cases of CLM, which were difficult to diagnose and/or treat.Case 1 is a 34-year old Caucasian male who presented with itchy papular lesions on the soles of both feet and was initially treated for plantar psoriasis.Case 2 is a 54-year old Caucasian male who suffered from extensive follicular larva migrans on the buttocks for several months and was only cured after repeated courses of albendazole and ivermectin.Case 3 is a 29-year old Caucasian male with pruritic inflammatory papules on the trunk. Despite extensive diagnostic procedures including skin biopsies and tissue cultures the correct diagnosis was only made later during the course of the illness. After treatment for CLM with albendazole (800 mg/d for 3 days) and after resolution of perifocal edema and inflammation the typical serpiginous tracks became more obvious. They responded rapidly to anthelminthic treatment.These cases highlight the importance of careful history taking and work-up in individuals presenting with atypical skin lesions. In case of exposure to CLM empiric anthelminthic treatment might be considered.

Infections in travelers

Travel medicine continues to grow as international tourism and patient medical complexity increases. This article reflects the state of the current field, but new recommendations on immunizations, resistance patterns, and treatment modalities constantly change. The US Centers for Disease Control and the World Health Organization maintain helpful Web sites for both patient and physician. With thoughtful preparation and prevention, risks can be minimized and travel can continue as safely as possible.

Hookworm-related cutaneous larva migrans in northern Brazil: resolution of clinical pathology after a single dose of ivermectin

To assess the effect of ivermectin on the morbidity caused by hookworm-related cutaneous larva migrans in patients in hyperendemic areas, we treated 92 patients (with 441 tracks in total) from Manaus, Brazil, with single-dose ivermectin (200 µg/kg). Four weeks later, patients had 60 tracks, and the associated morbidity improved significantly.

Pet roundworms and hookworms: a continuing need for global worming

Ascarids and ancylostomatids are the most important parasites affecting dogs and cats worldwide, in terms of diffusion and risk for animal and human health. Different misconceptions have led the general public and pet owners to minimize the importance of these intestinal worms. A low grade of interest is also registered among veterinary professions, although there is a significant merit in keeping our guard up against these parasites. This article reviews current knowledge of ascarids and ancylostomatids, with a special focus on pathogenicity, epidemiology and control methods in veterinary and human medicine.

Cutaneous larva migrans among devotees of the Nallur temple in Jaffna, Sri Lanka

BACKGROUND

Many cases of Cutaneous Larva Migrans (CLM) have been observed among devotees, during and immediately after the annual festival at the Nallur Hindu temple in Jaffna.

OBJECTIVE

To ascertain the risk factors associated with infestation and devotees' knowledge and practices regarding the condition.

METHODOLOGY/PRINCIPAL FINDINGS

A cross-sectional study using an interviewer-administered questionnaire and observation was conducted in August 2010. Out of 200 selected devotees 194(97%) responded. Soil and dog faecal samples were collected from the temple premises and examined for the presence of nematode larva and egg respectively. Among 194 male respondents, 58.2%(95% CI: 51.2%-65.0%) had lesions of CLM. One hundred and thirty (67%) respondents performed the ritual everyday; whereas 33% did so on special days. One hundred and twelve (57.7%) participants performed the ritual before 5.00am and remaining 42.3% performed after 5.00am. Among the participants, 77(36.7%) had the similar condition in previous years. One hundred and fifty seven (80.9%) were aware about this disease and 52(27%) devotees adopted some kind of precautionary measures. Bivariate analysis showed significant association between occurrence of CLM lesions and frequency of performing the ritual (p<0.001, OR-15.1; 95% CI:7.2-32.0), the timing of ritual performance (p = 0.022, OR-1.96; 95% CI:1.10-3.52), similar condition in previous year (p<0.001, OR-6.83; 95% CI: 3.39-13.76) and previous awareness of the condition (p = 0.005; OR-0.59;95% CI:0.43-0.82). Multivariate analysis showed that the frequency of ritual performance (OR-11.75; 95% CI 5.37-25.74) and similar conditions in previous years (OR-4.71; 95% CI: 2.14-10.39) were the independent risk factors. Two of the 20 soil samples were positive for the nematode larvae and three out of five dog faeces were positive for hookworm eggs.

CONCLUSIONS/SIGNIFICANCE

Deworming the stray dogs around the temple premises combined with the awareness programs among the public may be the effective and feasible precautionary measures to control similar epidemics in future.

Life quality impairment caused by hookworm-related cutaneous larva migrans in resource-poor communities in Manaus, Brazil

Background

Hookworm-related cutaneous larva migrans (CLM) is a common but neglected tropical skin disease caused by the migration of animal hookworm larvae in the epidermis. The disease causes intense pruritus and is associated with important morbidity. The extent to which CLM impairs skin disease-associated life quality has never been studied.

Methods

A modified version of the Dermatology Life Quality Index (mDLQI) was used to determine skin disease-associated life quality in 91 adult and child patients with CLM, living in resource-poor communities in Manaus, Brazil. Symptoms and signs were documented and skin disease-associated life quality was semi-quantitatively assessed using mDLQI scores. The assessment was repeated two and four weeks after treatment with ivermectin.

Results

Ninety-one point five percent of the study participants showed a considerable reduction of skin disease-associated life quality at the time of diagnosis. The degree of impairment correlated with the intensity of infection (rho = 0.76, p<0.001), the number of body areas affected (rho = 0.30; p = 0.004), and the presence of lesions on visible areas of the skin (p = 0.002). Intense pruritus, sleep disturbance (due to itching) and the feeling of shame were the most frequent skin disease-associated life quality restrictions (reported by 93.4%, 73.6%, and 64.8% of the patients, respectively). No differences were observed in skin disease-associated life quality restriction between boys and girls or men and women. Two weeks after treatment with ivermectin, skin disease-associated life quality improved significantly. After four weeks, 73.3% of the patients considered their disease-associated life quality to have returned to normal.

Conclusions

CLM significantly impaired the skin disease-associated life quality in child and adult patients living in urban slums in North Brazil. After treatment with ivermectin, life quality normalised rapidly.

Hookworm-related cutaneous larva migrans (CLM) is a parasitic skin disease common in developing countries with hot climates. In resource-poor settings, CLM is associated with considerable morbidity. The disease is caused by animal hookworm larvae that penetrate the skin and migrate aimlessly in the epidermis as they cannot penetrate the basal membrane. Particularly in the rainy season, the intensity of infection is high with up to 40 larval tracks in an affected individual. Tracks are very itchy and are surrounded by a significant inflammation of the skin. Bacterial superinfection is common and intensifies the inflammation. The psychosocial consequences caused by CLM have never been investigated. We showed that CLM causes skin disease-associated life quality impairment in 91 patients with CLM. Skin disease-associated life quality was significantly impaired. The degree of impairment correlated to the intensity of infection and the number of body areas affected. After treatment with ivermectin, life quality was rapidly restored.

Mini review: Hookworm-related cutaneous larva migrans

Hookworm-related cutaneous larva migrans (HrCLM) is a parasitic skin disease caused by the migration of animal hookworm larvae in the epidermis. Since these larvae cannot penetrate the basal membrane of human skin, they remain confined to the epidermis and are unable to develop and complete their lifecycle. By consequence, HrCLM is a self-limiting disease. However, if not treated promptly, the skin pathology may persist for months. HrCLM is endemic in many resource-poor communities in the developing world. In high-income countries, HrCLM occurs sporadically or in the form of small epidemics. Travelers account for the great majority of cases seen by health-care professionals in high-income countries. Transmission occurs when naked skin comes into contact with contaminated soil. Exposure may also occur indoors. Exceptionally, larvae may be transmitted through fomites. The first clinical sign is a small reddish papule. Thereafter, the characteristic serpiginous, slightly elevated, erythematous track becomes visible. Itching becomes more and more intense. Excoriations induced by scratching facilitate bacterial superinfection of the lesion. The diagnosis is essentially clinical. It is supported by a recent travel history and the possibility of exposure. The drug of choice is ivermectin in a single dose (200 μg per kg bodyweight). Repeated treatments with albendazole (400 mg daily) are a good alternative in countries where ivermectin is not available.

Dermatologic presentations of tropical diseases in travelers

Dermatoses are one of the three most common presenting health care problems in returning travelers. The spectrum of travel-related dermatoses is broad, and includes tropical, cosmopolitan, and environmental skin diseases. Bacterial infections are the main cause of skin consultations in returning travelers. Most of these infections are not specific to the tropics and are the consequences of arthropod bites. Conversely, tropical skin infections are less commonly observed. Knowledge of imported dermatoses among Western physicians is limited, even though it is becoming increasingly important that doctors be able to recognize and differentiate between the diverse varieties of diseases. This review highlights the most recent developments regarding dermatologic presentations of tropical diseases in travelers in order to provide more effective pre-travel counseling and an up-to-date aid to post-travel diagnosis and treatment.

Environmental monitoring and analysis of faecal contamination in an urban setting in the city of Bari (Apulia region, Italy): health and hygiene implications

Few studies have been conducted in Italy to quantify the potential risk associated with dynamics and distribution of pathogens in urban settings. The aim of this study was to acquire data on the environmental faecal contamination in urban ecosystems, by assessing the presence of pathogens in public areas in the city of Bari (Apulia region, Italy). To determine the degree of environmental contamination, samples of dog faeces and bird guano were collected from different areas in the city of Bari (park green areas, playgrounds, public housing areas, parkways, and a school). A total of 152 canine faecal samples, in 54 pools, and two samples of pigeon guano from 66 monitored sites were examined. No samples were found in 12 areas spread over nine sites. Chlamydophila psittaci was detected in seven canine and two pigeon guano samples. Salmonella species were not found. On the other hand, four of 54 canine faecal samples were positive for reovirus. Thirteen canine faecal samples were positive for parasite eggs: 8/54 samples contained Toxocara canis and Toxascaris leonina eggs and 5/54 samples contained Ancylostoma caninum eggs. Our study showed that public areas are often contaminated by potentially zoonotic pathogens.

A case report of cutaneous larva migrans

Cutaneous larva migrans (CLM) is a helminthic infection most commonly found in tropical and subtropical geographic areas. However, with the ease and increase of foreign travel by many around the world, CLM is no longer confined to these areas. CLM is an erythematous, serpiginous, cutaneous eruption caused by accidental percutaneous penetration and subsequent migration of larvae. Here, we present a case diagnosed as CLM and treated with Albendazole.

Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans

Hookworm-related cutaneous larva migrans is caused by the migration of animal hookworm larvae in the human skin. The disease mainly occurs in resource-poor communities in the developing world, but it is also reported sporadically in high-income countries and in tourists who have visited the tropics. Diagnosis is made clinically in the presence of a linear serpiginous track moving forward in the skin, associated with itching and a history of exposure. Itching is typically very intense and can prevent patients from sleeping. Bacterial superinfection occurs as a result of scratching. Treatment is based on oral drugs (albendazole or ivermectin) or the topical application of tiabendazole. To control hookworm-related cutaneous larva migrans at the community level, regular treatment of dogs and cats with anthelmintic drugs is necessary, but this is seldom feasible in resource-poor settings. Animals should be banned from beaches and playgrounds. For protection at the individual level, unprotected skin should not come into contact with possibly contaminated soil.