CASE REPORT

Year: 2019 I Volume: 2 I Issue: 2 I Page: 56-57

Cutaneous Larva Migrans – A Case Report

Dr. Barkha Goel¹, Dr. Kishor Singh¹, Dr. Savita Agrawal¹, Dr. Sonal Jain¹, Dr. Srishti Agrawal¹

¹ Department of Dermatology, Venereology, and Leprosy, National Institute of Medical Sciences & Research, Jaipur – 303121

Corresponding Author:
Dr. Barkha Goel
G 2nd Year, Department of Dermatology, Venereology, and Leprosy
National Institute of Medical Sciences & Research, Jaipur – 303121

How to cite this article:
MGoel B, Singh K, Agrawal S, Jain S, Agrawal S. Cutaneous Larva Migrans-ACaseReport.JDAIndianJournalofClinical Dermatology. 2019;2:56-57

Abstract:

Cutaneous larva migrans or creeping eruption is one of the most common acquired tropical dermatosis caused by the filariform larvae of hookworm.We report a case of 55 years old female patient,farmer by occupation with cutaneous larva migrans over anterior abdominal wall which is an unusual site and was treated successfully with oral albendazole. We present this case for its occurrence on an unusual site.

Key words: Creeping eruption, Cutaneous larva migrans

Introduction:

Cutaneous larva migrans (syn, creeping eruption, sand worm eruption, plumbers itch, duck hunters itch) is common tropically acquired dermatosis caused by the accidental penetration of skin by third-stage larvae of animal hookworm; Ancylostoma brasiliense, A. caninum, A. ceylonicum, Uncineria stenocephala, ^[1] and Bubostomum phlebotomum. A. brasiliense (dog hookworm) is the commonest cause of these creeping eruptions in humans who act as dead-end hosts. The adult worms inhabit the small intestine of human, mainly jejunum and attach themselvesto the mucous membrane by means of buccal armature and causes anemia. Cutaneous parasitic infestations are major source of morbidity affecting millions of people worldwide and tropical climate; overcrowding, poor hygiene and sanitary ^[2] problems play very important role in their causation. Humans acquire the infection while walking barefoot on sandpits, seashore or areas with loose and wet soil.Most frequent sites of infection are distal extremities, back , and buttocks.^[3]

FIGURE 1 (a,b) : Characteristic curvilinear serpiginous erythematous lesions on the anterior abdominal wall Click here to view

FIGURE 2 (a,b) : A curvilinear tract, about 25 cms long on the anterior abdominal wall, healing at one end and progressing at the other Click here to view

Discussion:

Creeping eruption is a parasitic dermatosis caused by the penetration of larvae of hookworm into the epidermis of human^[4]. It is most commonly found in tropical and subtropical geographic areas and the southwestern United States with an overall prevalence of 8.2% . It has become an endemic in the Central America, South America, Southeast Asia, and Africa. It is characterized by an erythematous, serpiginous, pruritic, cutaneous eruption caused by percutaneous penetration and subsequent migration of the larvae of various nematode parasite. ^[5] The most frequent location is the distal lower extremities or buttocks. The most common cause is Ancylostoma braziliense and less common species are Ancylostoma caninum, Uncinaria stenocephala and Bunostomum phlebotomum. ^[3] The incubation period ranges from 1-6 days.Every larvae produces a single tract and migrates at a speed of 1-3cm/day in epidermis because of lack of enzymes necessary to penetrate and survive in the deeper dermis. In our patient, diagnosis was based on clinical features as there was no history of fever, pulmonary or intestinal symptoms. Biopsy is not much useful as the larvae may advance upto 2cm ahead of the visible burrow. Extensive lesions can be associated with wheezing, dry cough and urticaria. Creeping eruption is a self-limiting dermatosis which usually resolves in 2-8 weeks but rarely may persist for 2 years and the prognosis is excellent. Secondary infection and eczematization are common complications. Now a days, treatment of choice is 10% to 15% topical thiabendazole suspension, made by crushing a 500mg tablet of thiabendazole in 5g of a water-soluble cream, applied four times a day, for atleast 2 days after the last sign of burrow activity. This regimen is of great efficacy and least toxicity. Oral thiabendazole suspension of 500mg/5ml can be used twice per day for 2 days. Other useful drugs are albendazole 400mg/day for 3 consecutive days and oral ivermectin 150-200 ug/kg as a single dose.^[6] Albendazole is a powerful antihelminthic against infections caused by intestinal nematodes and was first used to treat creeping eruption in 1982^[7]. Liquid nitrogen cryotherapy can be used for a progressive end of larvae burrow. Avoidance of direct skin contact with contaminated soil by covering the ground with impenetrable material, wearing footwears, avoiding bare feet walking, and de-worming the pets are preventive measures. Literature review showed that only very few case with lesions on anterior abdominal wall have been reported till date so we present this case for its rarity. We conclude that sporadic cases of creeping eruption should be kept in mind in differential diagnosis of any creeping lesion even in non-endemic areas.

References:

1. Davies HD, Sakuls P Keystone JS. Creeping eruption. A review of clinical presentation and management of 60 cases presenting to a tropical disease unit. Arch Dermatol 1993; 129:528-529. 1999;341:929-35

2. Meffert JI. Parasitic infestations. In: Dermatology secrets 1st Ed. Fitzpatrick, Aeling J, editors. New Delhi, India: Jaypee Brothers; 1977. p.217.

3. Karthikeyan K, Thappa DM. Cutaneous larva migrans. Indian J. Dermatol Venerol Leprol 2001;68:252-8.

4. Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans. Lancet Infect Dis 2008;8:302-9.

5. Brenner MA, Patel MB. Cutaneous larva migrans: The creeping eruption. Cutis 2003;72:111-5.

6. Coumas E, Datry A, Paris L, et al. Efficacy of Ivermectin in the treatment of cutaneous larva migrans. Arch Dermatol 1992;128:994-5.

7. Coulaud JP, Binet D, Voyer C, Samson C, Moreau G, Rossignol JF. Treatment of the cutaneous larva migrans syndrome “Larbish” with albendazole. Apropos of 18 cases. Bull Soc Pathol Exot Filiales 1982;75:534-7.