Vesiculobullous Cutaneous Larva Migrans in the Absence of Domestic Dogs and Cats. Successful Treatment with Oral Ivermectin.

While conducting research in a protected ecological reserve within Ecuador's subtropical rainforest, a 49-year-old biologist, residing in an Andean city, contracted hookworm-related cutaneous larva migrans (Hr-CLM) in the vesiculobullous clinical form. Since there were no domestic dogs or cats in the reserve, it is likely that wild animals carrying Ancylostoma sp. larvae infected the patient. She was effectively treated with two doses of oral ivermectin, administered 31 days after getting the infection. This case was diagnosed in a temperate city; therefore, a comprehensive travel history and clinical assessments are crucial for an accurate diagnosis and timely treatment.

Diagnosis of Cutaneous Larva Migrans using Point of Care Ultrasound.

Larva migrans is a cutaneous parasitic infection that occurs when an immature hookworm larva inadvertently penetrates the dermis of a human, typically on the extremities. Traditionally, a clinical diagnosis is made when a tortuous/serpiginous eruption is seen superficially in the skin with complaints of intense pruritus. Point of care ultrasound (POCUS) is a useful diagnostic tool for soft tissue complaints in the emergency department (ED). We describe a case of an 18-year-old woman who presented to the ED with foot pruritis four days after walking on the beach barefoot. POCUS examination revealed several motile structures in the dermis of the patient's foot, confirming our suspicion of cutaneous larva migrans. The patient was then placed on an oral anthelmintic and her symptoms resolved shortly after.

Follicular larva migrans.

Follicular larva migrans (FLM) is a rare and atypical clinical presentation of hookworm-related cutaneous larva migrans (HrCLM). FLM is characterized clinically by follicular, round, small, erythematous papules that are sometimes topped by vesicles or pustules. These lesions are usually located on the abdomen, back, buttocks and thighs and are accompanied by more or less severe pruritus. Some typical and/or short and fragmented tracks may also be visible. FLM is more resistant to anti-helminthic drugs than classical HrCLM: this is likely due to the deep location of larvae in hair follicles. We present two cases of FLM and a review of the literature.

Cutaneous larva migrans in a child: a case report and review of literature.

Introduction: Cutaneous larva migrans (CLM) is a dermatitis caused by the invasion and migration of parasitic larvae of hookworms, primarily affecting tropical and subtropical regions. This report presents a case of CLM in a Nepali child and provides an overview of the literature on this condition. Case report: A 4-year-old boy from a rural area in Nepal presented with a pruritic skin lesion on his left foot, initially misdiagnosed as fungal infection. The lesion gradually expanded, forming a serpiginous erythema, and became intensely pruritic. The patient's family had poor socioeconomic conditions, and the child frequently walked barefoot in an area with many domestic and stray dogs. Diagnosis was confirmed clinically, and treatment with oral albendazole and antihistamines resulted in complete resolution of symptoms. Discussion: CLM is a neglected zoonotic disease, with an underestimated burden in developing countries due to underreporting and misdiagnosis. The larvae of Ancylostoma spp. are common culprits, causing a localized inflammatory reaction as they migrate through the skin. Diagnosis is mainly clinical and routine investigations usually reveal no abnormality. Complications may include secondary bacterial infections, allergies, and rare migration to internal organs. Treatment options include albendazole or ivermectin, with preventive measures emphasizing hygiene, footwear use, and pet deworming. Conclusion: CLM is a neglected disease that primarily affects marginalized communities in tropical regions. Raising awareness among healthcare providers, conducting observational studies, and developing treatment guidelines, especially for children, are essential steps to address this public health concern. Preventive efforts, such as promoting hygiene and footwear use, should be encouraged to reduce CLM incidence.

Cutaneous Larva Migrans as a frequent problem in travellers.

Dermatological disorders are among the most common complaints of patients seeking medical assistance after returning from trips to tropical countries. Among exotic dermatoses, one of the frequently encountered diagnoses is Cutaneous Larva Migrans (CLM), primarily caused by the nematodes Ancylostoma braziliense and A. caninum. Cats and dogs, which serve as the definitive hosts for these nematodes, excrete with their stool parasite eggs into the environment, where they transform into larvae. Human infection occurs through the invasive form of the larvae, which penetrate the skin, causing itching and the characteristic serpiginous, slightly raised, and enlarging lesion at the site of invasion. Diagnosis is made based on the highly characteristic clinical presentation, although in non-endemic countries, diagnostic errors and delays in initiating effective causal treatment are relatively common. Effective therapy includes oral albendazole and ivermectin. Prevention of CLM involves avoiding skin contact with potentially contaminated soil by wearing shoes and using towels and mats on the beach. Due to the high interest in travel and the risk of importing exotic diseases, it is important to promote knowledge of tropical medicine among healthcare professionals as well as the travellers.

Cutaneous larva migrans: A One Health Perspective on Familial Infection Among Tourists Returning from Southeast Asia.

Cutaneous larva migrans (CLM) is a dermatosis caused by accidental infestation with animal hookworms and is widely distributed in tropical and subtropical regions. Humans become infected when their skin comes into contact with soil contaminated with dog faeces. The filariform larvae penetrate and burrow into human skin, causing a condition known as "creeping eruption". We describe a case, well-documented by photos, of CLM infection in a family of three who returned from Thailand.

Sudden emergence and spread of cutaneous larva migrans in Sudan: A case series calls for urgent actions.

Cutaneous larva migrans (CLM) is a self-limiting dermatosis parasitic disease that is caused by zoonotic hookworm mainly infects cats, dogs, and accidentally humans. The disease affects hosts through the invasion and the migration of the hookworm larva into top layers of the skin. The disease occurs in tropical and subtropical regions; where people commonly are infected when sitting or barefoot walking on places contaminated with feces of infected cats or dogs. Due to self-limiting nature of the disease, the exact burden and prevalence are commonly underestimated. In this communication, we investigated all cases presented to the skin-diseases outpatient clinic' at the reference hospital of Tropical Diseases Medicine in Khartoum state between January 2019 and January 2021. This is the first-ever a case series report of cutaneous larva migrans in Sudan. We identified 15 cases of CLM presented with rash (100 %), redness of skin (67 %), and only adults were presented with larva crawling under their skins (27 %). Infection sites were (53 %) leg, (40 %) foot, only 7 % showed abdominal infection. The majority of patients were children or young adults, 47 % of them are ≤5 year-old, male to female ratio is 2.75:1. Duration of infection was one to three weeks and all patients fully recovered after treatment with albendazole. This urges for One Health interventions including deworming cats and dogs, improving water, sanitation, and hygiene, community-engagement and raising awareness in area with risk of infection.

Reflectance Confocal Microscopy and Dermoscopy For the Diagnosis and Treatment of Cutaneous Larva Migrans.

We describe a 39-year-old woman with a 1-month-old linear erythema diagnosed with cutaneous larva migrans by reflectance confocal microscopy (RCM). This case reveals that the great significance of diagnosing and treating cutaneous larva migrans (CLM) by RCM and dermoscopy, which might provide novel insights into dermatological clinical practice.

Assessment of an Immuno-Diagnostic Method for Hookworm-Related Cutaneous Larva Migrans Using Crude Extracts of Ancylostoma caninum.

People can become infected with cutaneous larva migrans (CLM) through skin penetration by the infective zoonotic larvae of hookworms. Few studies have investigated CLM's immunodiagnosis, and the existing studies were limited to crude somatic or excretory/secretory antigens (Ags) from adult worms. Here, we aimed to develop an indirect enzyme-linked immunosorbent assay (ELISA) to differentiate and diagnose hwCLM by detecting immunoglobulin (Ig)E, IgG, and IgG subclasses 1-4 (IgG1-4) against the somatic Ag of adult Ancylostoma caninum checkerboard titrations of adult A. caninum worm extract. Pooled serum controls were immunocharacterized using an indirect ELISA. The IgG1-4 and IgE results were unsatisfactory; however, the use of total IgG achieved results comparable to those of immunoblotting. Thus, we continued to analyze the IgG-ELISA using serum samples from patients with hwCLM and heterologous infections as well as from healthy controls. The sensitivity and excellent specificity of the total IgG-ELISA were 93.75% and 98.37%, respectively, and its positive and negative predictive values were 75% and 99.67%, respectively. Antibodies from five cases of angiostrongyliasis, gnathostomiasis, and dirofilariasis cross-reacted with the somatic Ag of adult A. caninum. This new assay can adequately serodiagnose hwCLM when combined with clinical features and/or histological examination.

Genetic characterization of the zoonotic parasite Ancylostoma caninum in the central and eastern United States.

Ancylostoma caninum is the most common nematode parasite of dogs in the United States. The present study aimed to describe the molecular epidemiology of A. caninum isolates from the central and eastern states of the United States using the partial mitochondrial cytochrome oxidase (cox1) gene and to compare them with those reported globally. We isolated eggs from faecal samples of dogs and characterized each isolate based on cox1 sequences. A total of 60 samples originating from Kansas, Iowa, New York, Florida and Massachusetts were included. 25 haplotypes were identified in the United States dataset with high haplotype diversity (0.904). Sequence data were compared to sequences from other world regions available in GenBank. Global haplotype analysis demonstrated 35 haplotypes with a haplotype diversity of 0.931. Phylogenetic and network analysis provide evidence for the existence of moderate geographical structuring of A. caninum haplotypes. Our results provide an updated summary of A. caninum haplotypes and data for neutral genetic markers with utility for tracking hookworm populations. Sequences have been deposited in GenBank (ON980650-ON980674). Further studies of isolates from other regions are essential to understand the genetic diversity of this parasite.

Loeffler's Syndrome and Multifocal Cutaneous Larva Migrans: Case report of an uncommon occurrence and review of the literature.

Cutaneous larva migrans (CLM) is a zoonotic skin disease that is frequently diagnosed in tropical and subtropical countries. Loeffler's syndrome (LS) is a transient respiratory ailment characterised by pulmonary infiltration along with peripheral eosinophilia and commonly follows parasitic infestation. We report a 33-year-old male patient who presented to a tertiary care hospital in eastern India in 2019 with LS that was attributed secondary to multifocal CLM. Treatment with seven-day course of oral albendazole (400 mg daily) coupled with nebulisation (levosalbutamol and budesonide) led to complete resolution of cutaneous lesions and respiratory complaints within two weeks. There was complete resolution of pulmonary pathology at four-weeks follow-up.

Cutaneous larva migrans: A case report successfully treated with albendazole.

Introduction: Cutaneous larva migrans (CLM) is helminthic infection that is mostly found in tropical and subtropical areas [1]. It is commonly seen with those who have contact with soil that is contaminated by cat and dog's hookworm larvae. CLM present as erythematous, serpiginous, pruritic cutaneous eruption that is caused by accidental percutaneous penetration and subsequent migration of larvae. Case: We present a case of 45 year old male with erythematous, serpiginous, pruritic eruption over the dorsum of foot.Clinical findings and investigations: Patient had a 2-3 cm linear, erythematous, serpiginous localized lesion characteristic of a papular tip on the dorsal surface of the right foot. Total and differential blood counts, peripheral blood smear and chest x-ray were sent for investigations. Intervention and outcome: Patient was prescribed Albendazole at a dose of 400mg, once a day for seven days. After treatment, the lesion and pruritus had regressed significantly. Conclusion: Hookworm-related CLM is diagnosed clinically based on the typical clinical presentation (skin findings). Clinicians should be aware of the possibility of hookworm-related CLM with history of travel to tropical areas, specially walking barefoot.

Cutaneous larva migrans imported from a tropical trip - Case report and literature review.

INTRODUCTION: Cutaneous larva migrans (CLM) is a zoonotic disease caused by hookworms characteristic of tropical and subtropical regions. In Poland, new cases appear every year in patients who have travelled to tropical areas. Most of the cases are initially under-diagnosed, which results in a delay in starting proper treatment. CASE REPORT: A 49-year-old woman presented to the Outpatient Dermatology Clinic with a pruritic and fibrous cutaneous lesion on the plantar region of her left foot. She had returned from a tourist trip to Honduras one week before the skin lesion erupted. RESULTS: The diagnosis of CLM due to Ancylostoma sp. infestation was confirmed. Locally applied cryotherapy was ineffective. The oral treatment of albendazole resulted in complete resolution of the symptoms without recurrence after a 6-month follow up period. CONCLUSIONS: CLM should be considered in travellers to tropical countries. Oral anti-parasitic agents seem to be more effective than topical treatment for dermatosis.

Cutaneous larva migrans in early infancy: A Ugandan case report.

Helminths are an important cause of worm infestation in low-income countries. The majority spread with soil to skin contact. In unusual patients presenting below 1 year, treatment can be challenging. The disease can be self-limiting; however, treatment is believed to reduce progression to more serious disease. Here, we present a case of a 3-month-old with cutaneous larva migrans.

Common Dermatologic Conditions in Returning Travelers.

PURPOSE OF REVIEW: Travel medicine practitioners often are confronted with returning travelers with dermatologic disorders that could be of infectious causes or inflammatory or allergic. Some dermatologic processes are the result of exposure to insects or acquired due to environmental exposures. There is a broad range of dermatosis of infectious and non-infectious etiologies that clinicians need to consider in the differential diagnosis of dermatosis in travelers. RECENT FINDINGS: With increasing international travel to tropical destinations, many individuals may be exposed to rickettsia (i.e., African tick bite fever, scrub typhus, or Mediterranean spotted fever), parasitic infections (i.e., cutaneous larva migrans, cutaneous leishmaniasis, African trypanosomiasis, or American trypanosomiasis), viral infections (i.e., measles or Zika virus infection), bacterial (i.e., Buruli ulcer) or ectoparasites (scabies or tungiasis), and myiasis. Cutaneous lesions provide clinical clues to the diagnosis of specific exposures during travel among returned travelers. SUMMARY: Dermatologic disorders represent the third most common health problem in returned travelers, after gastrointestinal and respiratory illness. Many of these conditions may pose a risk of severe complications if there is any delay in diagnosis. Therefore, clinicians caring for travelers need to become familiar with the most frequent infectious and non-infectious skin disorders in travelers.

Current Use of Ivermectin in Dermatology, Tropical Medicine, and COVID-19: An Update on Pharmacology, Uses, Proven and Varied Proposed Mechanistic Action.

Ivermectin is a broad-spectrum antiparasitic drug with anti-inflammatory, anti-viral, anti-bacterial, and anti-tumor effects. In this review, we discuss the history, pharmacology, multimodal actions, indications in dermatology and tropical medicine, therapeutic and prophylactic use of ivermectin in COVID-19, safety, adverse effects, special considerations, and drug interactions of ivermectin.

A Unique Case of Cutaneous Larva Migrans and Asymptomatic Löeffler's Syndrome.

Cutaneous larva migrans is a fairly common parasitic skin disease typically found in more tropical climates such as the southeastern United States, with the most commonly encountered organism known as the hookworm, Ancylostoma braziliense. Löeffler's syndrome is a rare pulmonary manifestation with vague diagnostic criteria but frequently characterized by diffuse migratory pulmonary infiltrates on imaging studies with accompanying serum eosinophilia. Here, we present a unique case of Löeffler's syndrome secondary to cutaneous larva migrans.