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Cutaneous Larva Migrans Clinical Presentation

  • Author: David T Robles, MD, PhD; Chief Editor: William D James, MD  more...
 
Updated: May 10, 2016
 

History

History findings may be as follows:

  • Tingling/prickling at the site of exposure within 30 minutes of penetration of larvae, although Archer describes a case of late-onset cutaneous larva migrans (CLM) [11]
  • Intense pruritus
  • Erythematous, often linear lesions that advance
  • Often associated with a history of sunbathing, walking barefoot on the beach, or similar activity in a tropical location

Predispositions to contracting cutaneous larva migrans include the following:

  • Hobbies and occupations that involve contact with warm, moist, sandy soil
  • Tropical/subtropical climate travel
  • Barefoot beachgoers/sunbathers
  • Children in sandboxes
  • Carpenter
  • Electrician
  • Plumber
  • Farmer
  • Gardener
  • Pest exterminator
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Physical

Cutaneous signs of cutaneous larva migrans (CLM) include the following:

  • Pruritic, erythematous, edematous papules and/or vesicles
  • Serpiginous (snakelike), slightly elevated, erythematous tunnels that are 2- to 3-mm wide and track 3-4 cm from the penetration site
  • Nonspecific dermatitis
  • Vesicles with serous fluid
  • Secondary impetiginization
  • Tract advancement of 1-2 cm/day

Systemic signs are rarely seen but may include, peripheral eosinophilia (Loeffler syndrome), migratory pulmonary infiltrates, and increased immunoglobulin E (IgE) levels.

Lesions are typically distributed on the distal lower extremities, including the dorsa of the feet and the interdigital spaces of the toes, but can also occur in the anogenital region, the buttocks, the hands, and the knees. Scalp lesions have been reported.[12]

See the images below.

A patient who was sunbathing nude on a beach in Ma A patient who was sunbathing nude on a beach in Martinique presented with classic erythematous, serpiginous tracts on the left heel.
Cutaneous larva migrans on the right thumb. Cutaneous larva migrans on the right thumb.
Cutaneous larva migrans on the left thigh. Cutaneous larva migrans on the left thigh.
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Causes

Common etiologies and where the parasites of cutaneous larva migrans (CLM) are most commonly found include the following:

  • Ancylostoma braziliense (hookworm of wild and domestic dogs and cats) is the most common cause. [13] It can be found in the central and southern United States, Central America, South America, and the Caribbean. [14]
  • Ancylostoma caninum (dog hookworm) is found in Australia.
  • Uncinaria stenocephala (dog hookworm) is found in Europe.
  • Bunostomum phlebotomum (cattle hookworm)

Rare etiologies include the following:

  • Ancylostoma ceylonicum
  • Ancylostoma tubaeforme (cat hookworm)
  • Necator americanus (human hookworm)
  • Strongyloides papillosus (parasite of sheep, goats, and cattle)
  • Strongyloides westeri (parasite of horses)
  • Ancylostoma duodenale
  • Pelodera ( Rhabditis) strongyloides [15]
  • Gnathostorna spinigerum
  • Strongyloides stercoralis
  • Bunostornum phlebotomum
  • Strongyloides myopotami
  • Strongyloides procy onis [8]
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Contributor Information and Disclosures
Author

David T Robles, MD, PhD Dermatologist, Chaparral Medical Group

David T Robles, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Jacquiline Habashy, MSc Western University of Health Sciences College of Osteopathic Medicine of the Pacific

Jacquiline Habashy, MSc is a member of the following medical societies: American Osteopathic College of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Daniel Mark Siegel, MD, MS Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate Medical Center

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Association for Physician Leadership, American Society for Dermatologic Surgery, American Society for MOHS Surgery, International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Margaret C Douglass, MD Program Director, Department of Dermatology, Henry Ford Hospital

Disclosure: Nothing to disclose.

Lydia A Juzych, MD Senior Staff, Department of Dermatology, Henry Ford Health Sciences Center

Lydia A Juzych, MD is a member of the following medical societies: Alpha Omega Alpha, Michigan State Medical Society, Michigan Dermatological Society, American Medical Association, American Medical Student Association/Foundation, American Medical Womens Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

References
  1. Edelglass JW, Douglass MC, Stiefler R, Tessler M. Cutaneous larva migrans in northern climates. A souvenir of your dream vacation. J Am Acad Dermatol. 1982 Sep. 7(3):353-8. [Medline].

  2. Herbener D, Borak J. Cutaneous larva migrans in northern climates. Am J Emerg Med. 1988 Sep. 6(5):462-4. [Medline].

  3. Jones WB 2nd. Cutaneous larva migrans. South Med J. 1993 Nov. 86(11):1311-3. [Medline].

  4. Patel S, Sethi A. Imported tropical diseases. Dermatol Ther. 2009 Nov-Dec. 22(6):538-49. [Medline].

  5. Tamminga N, Bierman WF, de Vries PJ. Cutaneous larva migrans acquired in Brittany, France. Emerg Infect Dis. 2009 Nov. 15(11):1856-8. [Medline].

  6. González F CG, Galilea O NM, Pizarro C K. [Autochthonous cutaneous larva migrans in Chile. A case report]. Rev Chil Pediatr. 2015 Oct 8. [Medline].

  7. Vega-Lopez F, Hay RJ. Parasitic worms and Protozoa. Burns T, Breathnach S, Cox N, Griffiths C, eds. Rook's Textbook of Dermatology. 8th ed. United Kingdom: Wiley-Blackwell Publisher (P) Ltd; 2010. 37.16–37.17.

  8. Veraldi S, Persico MC, Francia C, Schianchi R. Chronic hookworm-related cutaneous larva migrans. Int J Infect Dis. 2013 Apr. 17 (4):e277-9. [Medline].

  9. Reichert F, Pilger D, Schuster A, Lesshafft H, Guedes de Oliveira S, Ignatius R, et al. Prevalence and Risk Factors of Hookworm-Related Cutaneous Larva Migrans (HrCLM) in a Resource-Poor Community in Manaus, Brazil. PLoS Negl Trop Dis. 2016 Mar. 10 (3):e0004514. [Medline].

  10. Sunderkötter C, von Stebut E, Schöfer H, Mempel M, Reinel D, Wolf G, et al. S1 guideline diagnosis and therapy of cutaneous larva migrans (creeping disease). J Dtsch Dermatol Ges. 2014 Jan. 12 (1):86-91. [Medline].

  11. Archer M. Late presentation of cutaneous larva migrans: a case report. Cases J. 2009 Aug 12. 2:7553. [Medline]. [Full Text].

  12. Meotti CD, Plates G, Nogueira LL, Silva RA, Paolini KS, Nunes EM, et al. Cutaneous larva migrans on the scalp: atypical presentation of a common disease. An Bras Dermatol. 2014 Mar-Apr. 89 (2):332-3. [Medline].

  13. Bowman DD, Montgomery SP, Zajac AM, Eberhard ML, Kazacos KR. Hookworms of dogs and cats as agents of cutaneous larva migrans. Trends Parasitol. 2010 Apr. 26(4):162-7. [Medline].

  14. Schuster A, Lesshafft H, Talhari S, Guedes de Oliveira S, Ignatius R, Feldmeier H. Life quality impairment caused by hookworm-related cutaneous larva migrans in resource-poor communities in Manaus, Brazil. PLoS Negl Trop Dis. 2011 Nov. 5(11):e1355. [Medline]. [Full Text].

  15. Jones CC, Rosen T, Greenberg C. Cutaneous larva migrans due to Pelodera strongyloides. Cutis. 1991 Aug. 48(2):123-6. [Medline].

  16. Aljasser MI, Lui H, Zeng H, Zhou Y. Dermoscopy and near-infrared fluorescence imaging of cutaneous larva migrans. Photodermatol Photoimmunol Photomed. 2013 Dec. 29 (6):337-8. [Medline].

  17. Jelinek T, Maiwald H, Nothdurft HD, Löscher T. Cutaneous larva migrans in travelers: synopsis of histories, symptoms, and treatment of 98 patients. Clin Infect Dis. 1994 Dec. 19(6):1062-6. [Medline].

  18. Rodilla F, Colomina J, Magraner J. Current treatment recommendations for cutaneous larva migrans. Ann Pharmacother. 1994 May. 28(5):672-3. [Medline].

  19. Van den Enden E, Stevens A, Van Gompel A. Treatment of cutaneous larva migrans. N Engl J Med. 1998 Oct 22. 339(17):1246-7. [Medline].

  20. Kincaid L, Klowak M, Klowak S, Boggild AK. Management of imported cutaneous larva migrans: A case series and mini-review. Travel Med Infect Dis. 2015 Sep-Oct. 13 (5):382-7. [Medline].

  21. Podder I, Chandra S, Gharami RC. Loeffler's Syndrome Following Cutaneous Larva Migrans: An Uncommon Sequel. Indian J Dermatol. 2016 Mar-Apr. 61 (2):190-2. [Medline].

  22. Richey TK, Gentry RH, Fitzpatrick JE, Morgan AM. Persistent cutaneous larva migrans due to Ancylostoma species. South Med J. 1996 Jun. 89(6):609-11. [Medline].

  23. Bolognia JL, Jorizzo JL, Rapini RP, eds. Dermatology. St. Louis, Mo: Mosby; 2003. 1307-09.

 
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A patient who was sunbathing nude on a beach in Martinique presented with classic erythematous, serpiginous tracts on the left heel.
Cutaneous larva migrans on the right thumb.
Cutaneous larva migrans on the left thigh.
 
 
 
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