Year: 2022
Type: article
Study design: Case Report
Abstract: A 41-year-old man with a background history of peptic ulcer disease was admitted with acute gastroenteritis. This settled with intravenous fluid and supportive treatment. Admission blood investigations showed mild eosinophilia (28% and 3.3 × 109/ml absolute count). He reported a history of pruritus over the lower and inner thighs. On examination, he had two healing wounds over the posterior aspect of the right thigh and one on the medial aspect of the right thigh (Figure 1a and b). Interestingly, there were also serpiginous scabs leading to two of the lesions. On inquiry, he frequently enters the jungles and had last entered 7 days prior to the admission. On that occasion, he had wandered barefoot for several hours and later developed pruritus in the affected areas. He was diagnosed with cutaneous larva migrans (CLM) and was treated with a course of albendazole 400 mg daily for 5 days. (a) A wound on the inner aspect of the right thigh. (b) Two wounds with serpiginous scabs leading to two of the lesions. CLM is a creeping eruption caused by hookworms, most commonly due to animal hookworm with Ancylostoma (A) braziliense being the most common and others (A. caninum, A. ceylanicum, A. tubaeforme and Uncinariasis stenocephala) less common. Human hookworms (A. duodenale and Necator Americanos) can also cause CLM. It is also referred to as ‘ground itch’ or ‘sandworms’ as the larvae are found in sandy soil. CLM is often acquired through skin contact with soils containing eggs and larvae.1 CLM is classically seen in warmer climates.2 Human is an accidental host since the larva cannot break through the basement membrane to enter lymphatic to complete the cycle. Upon entry, the larva migrates subcutaneously creating the serpiginous tracks. This is typically erythematous in the acute stage. Other symptoms include pruritus, rash and inflammations unless complicated with secondary skin infection. Diagnosis is based on history and physical examination, while blood tests can reveal eosinophilia. Treatment is with topical agents and a course of anthelmintic, such as albendazole 400 daily for 3–5 days. Ivermectin is also effective and mebendazole is a second line drug.3 Conflict of interest: None declared.
Source: QJM
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4290929902