eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Cutaneous Larva Migrans: Follow-up

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Coauthor(s): Jining Wang, MD, Department of Dermatology, Dean Health System; Kim Wang, MD, Staff Physician, Department of Pathology, Northwestern University Medical School
Contributor Information and Disclosures

Updated: Jan 21, 2009

Follow-up

Deterrence/Prevention

  • Prevention of cutaneous larva migrans (CLM) is critical.
  • Advise patients to avoid sitting, lying, or walking barefoot on wet soil or sand.
  • Advise individuals to cover the ground with an impenetrable material when sitting or lying.
  • Pets should be dewormed.
  • Beaches that allow cats and dogs should be avoided.

Complications

  • Severely excoriated lesions causing secondary infection with Staphylococcus aureus or Streptococcus pyogenes may lead to edema, making the tracks less visible.
  • Heavy infestation of larvae may lead to Löffler syndrome, which is characterized by pulmonary infiltrates and eosinophilia. In one study, only 12% of patients with Löffler syndrome and CLM had pulmonary symptoms, such as a cough.4 Larvae localized to the skin may elicit a generalized sensitization with soluble antigens in the lung to cause the pulmonary infiltrates.
  • If human nematodes (ie, A duodenale, N americanus, S stercoralis) are the cause of CLM, topical treatments such as cryosurgery or 10% thiabendazole solution do not prevent systemic involvement. Monitor patients for several months after treatment for gastrointestinal and respiratory symptoms.
  • One individual with CLM reportedly experienced complications caused by erythema multiforme.5

Prognosis

  • Prognosis is excellent.
  • Even without treatment, the larvae eventually die and the cutaneous lesions resolve in weeks to months.

Patient Education

  • Advise individuals to cover sandboxes when not in use.
  • When on beaches, advise people to lie on beach towels, not directly on the sand, and to wear sandals or water socks.
 


More on Cutaneous Larva Migrans

Overview: Cutaneous Larva Migrans
Differential Diagnoses & Workup: Cutaneous Larva Migrans
Treatment & Medication: Cutaneous Larva Migrans
Follow-up: Cutaneous Larva Migrans
Multimedia: Cutaneous Larva Migrans
References
Further Reading
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References

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Further Reading

See Image 33 at the McGill Faculty of Medicine Web site.

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Keywords

cutaneous larva migrans, CLM, Ancylostoma braziliense, Ancylostoma caninum, Ancylostoma ceylanicum, Ancylostoma duodenale, Ancylostoma tubaeforme, Bunostomum phlebotomum, Capillaria, creeping eruption, diarrhea, duck hunter itch, Gnathostoma, ground itch, hookworm, hypersensitivity reaction, malabsorption, Necator americanus, nematodes, ocular larva migrans, plumber itch, roundworm, sandworm disease, serpiginous pruritic lesions, Strongyloides myopotami, Strongyloides papillosus, Strongyloides stercoralis, Strongyloides westeri, Uncinaria stenocephala

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Coauthor(s)

Jining Wang, MD, Department of Dermatology, Dean Health System
Jining Wang, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Kim Wang, MD, Staff Physician, Department of Pathology, Northwestern University Medical School
Kim Wang, MD is a member of the following medical societies: United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Medical Editor

Michael D Nissen, MBBS, BMedSc, FRACP, FRCPA, Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital
Michael D Nissen, MBBS, BMedSc, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University
Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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