Cutaneous Larva Migrans Clinical Presentation

  • Author: Lydia A Juzych, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 24, 2012
 

History

  • 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)[6]
  • 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/d
  • Systemic signs include peripheral eosinophilia (Loeffler syndrome), migratory pulmonary infiltrates, and increased immunoglobulin E (IgE) levels, but are rarely seen.
  • 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.

See the images below.

Patients who were sunbathing nude on a beach in MaPatients who were 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.[7] It can be found in the central and southern United States, Central America, South America, and the Caribbean.[8]
    • 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[9]
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Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

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, American Medical Association, American Medical Student Association/Foundation, American Medical Women's Association, Michigan Dermatological Society, Michigan State Medical Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel Mark Siegel, MD, MS  Director, Procedural Dermatology Fellowship Program, Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American College of Physician Executives, American Society for Dermatologic Surgery, American Society for MOHS Surgery, and International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

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

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.

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. Sep 1982;7(3):353-8. [Medline].

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

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

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

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

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

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

  8. 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. Nov 2011;5(11):e1355. [Medline]. [Full Text].

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

  10. 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. Dec 1994;19(6):1062-6. [Medline].

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

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

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

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

  15. Silverberg NB, Jackson RM, Laude TA, Tunnessen WW Jr. Picture of the month. Cutaneous larva migrans (creeping eruption). Arch Pediatr Adolesc Med. Feb 1998;152(2):203-4. [Medline].

 
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Patients who were 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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