Cutaneous Larva Migrans (Creeping eruption)
exp date isn't null, but text field is
Introduction
- An infection of the skin by various nematode larvae which migrate, but never reach internal organs or complete their life cycles
- Migration leads to twisting, winding linear skin lesions produced by the burrowing of larvae
Victims are usually:
- People who go barefoot at the beaches
- Children playing in sandboxes and crawling on the bare ground
- Carpenters and plumbers working under homes
- Gardeners
The most common causes are cat and dog hookworm
- Ancylostoma braziliense
- Ancylostoma caninum
- Necator americanus
- Gnathostoma spinigerum
- Strongyloides stercoralis
Clinical features
Shortly after entering the skin:
- The larvae elicit intense pruritus
- Tiny papules and even papulovesicles develop
As the larvae begin to migrate:
- Intermittent stinging pain occurs
- Thin red, tortuous and minimally elevated lines are formed in the skin
- Rate of migration varies with the species
- Pruritus and excoriation promote secondary bacterial infections
Intestinal infections with Strongyloides stercoralis may be associated with perianal larva migrans syndrome called 'larva currens' because of the rapidity of larval migration (up to 10 cm/hr)
- Larva currens is an autoinfection caused by penetration of the perianal skin by Strongyloides stercoralis
Differential diagnosis
- Ring worm
Complications
- Secondary bacterial infection
- Fatal Strongyloides stercoralis hyperinfection in immunocompromised patients
Investigation
- None useful to management
Treatment goals
- Eradicate the larvae
- Eradicate gut Strongyloides
- Treat impetiginization
- Prevent re-infection
Drug treatment
Ivermectin
Adult: 150 microgram/kg orally as a single dose
Child over 5 years old: 200 micrograms/kg orally daily for 2 days
Or:
Albendazole
Adult: 400 mg orally twice daily for 2 days, repeated after 3 weeks if necessary
Child over 2 years: 400 mg once or twice daily for 3 days, repeated after 3 weeks if necessary
Antihistamines for pruritus
Antibiotics for secondary bacterial infections
Prevention
- Avoid direct contact of skin with sand