Cutaneous larva migrans

Cutaneous larva migrans: Excerpt from Professional Guide to Diseases (Eighth Edition)

Cutaneous larva migrans, also known as creeping eruption, is a skin reaction to infestation by nematodes (hookworms or roundworms) that usually infect dogs and cats. Eruptions associated with cutaneous larva migrans clear completely with treatment.

Causes and incidence

Under favorable conditions — warmth, moisture, sandy soil — hookworm or roundworm ova present in feces of affected animals (such as dogs and cats) and hatch into larvae, which can then burrow into human skin on contact. After penetrating its host, the larva becomes trapped under the skin, unable to reach the intestines to complete its normal life cycle.

The parasite then begins to move, producing the peculiar, tunnel-like lesions that are alternately meandering and linear, reflecting the nematode’s persistent and unsuccessful attempts to escape its host.

Signs and symptoms

A transient rash or, possibly, a small vesicle appears at the point of penetration, usually on an exposed area that has come in contact with the ground, such as the feet, legs, or buttocks. The incubation period is typically 1 to 6 days. The parasite may be active almost as soon as it enters the skin. Local pruritus begins within hours following penetration.

As the parasite migrates, it etches a noticeable thin, raised, red line on the skin, which may become vesicular and encrusted. Pruritus quickly develops, often with crusting and secondary infection following excoriation. Onset is usually characterized by slight itching that develops into intermittent stinging pain as the thin, red lines develop. The larva’s apparently random path can cover from 1 mm to 1 cm a day. Penetration of more than one larva may involve a much larger area of the skin, marking it with many tracks.

Diagnosis

Characteristic migratory lesions strongly suggest cutaneous larva migrans. A thorough patient history usually reveals contact with warm, moist soil within the past several months.

Treatment

Topical application of thiabendazole, ivermectin, or albendazole is effective. The suspension is applied to lesions and the immediate surrounding areas four times daily for 1 week. Oral thiabendazole given in two divided doses for 3 to 5 days is effective. Oral ivermectin and albendazole are equally effective. Tell the patient that adverse effects of systemic thiabendazole include nausea, vomiting, abdominal pain, and dizziness.

Special considerations

Prevention requires patient teaching about the existence of these parasites, sanitation of beaches and sandboxes, and proper pet care.

❑ Reassure the patient, especially if he’s sensitive about his appearance, that larva migrans lesions usually clear 1 to 2 weeks after treatment. Stress the importance of adhering to the treatment regimen exactly as ordered.

❑ Have the patient’s nails cut short to prevent skin breaks and secondary bacterial infection from scratching. Apply cool, moist compresses to alleviate itching.

❑ Be alert for possible adverse reactions associated with systemic treatment, including nausea, vomiting, abdominal pain, and dizziness.

❑ Encourage the patient to verbalize feelings about the infestation, including embarrassment, fear of rejection by others, and body image disturbance.

❑ Instruct the patient and his family in good hand-washing technique, and stress the importance of preventing the spread of the infection among family members.

Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X

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