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CASE REPORT
Year : 2017  |  Volume : 18  |  Issue : 1  |  Page : 36-38

Cutaneous larva migrans in children: A case series from Southern India


1 Department of Paediatrics, Vinayaka Missions Medical College and Hospital, Karaikal, Puducherry, India
2 Department of Dermatology, Venereology and Leprosy, Vinayaka Missions Medical College and Hospital, Karaikal, Puducherry, India

Date of Web Publication12-Dec-2016

Correspondence Address:
Indira Subhadarshini Paul
Vinayaka Missions Medical College and Hospital, Karaikal - 609 609, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.188454

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  Abstract 


Cutaneous larva migrans or creeping eruptions is a parasitic skin infection caused by hookworm larva. It is common in warmer tropical and subtropical countries. Here, we report four patients aged between 7 months and 14 years presented to outpatient Department of Paediatrics with cutaneous lesions over buttocks, right hand, right foot, and left thigh. Wandering threadlike progressive lesions were noticed on cutaneous examination, consistent with a diagnosis of cutaneous larva migrans. Complete resolution seen after treatment with oral albendazole.

Keywords: Creeping eruption, cutaneous larva migrans, infant


How to cite this article:
Paul IS, Singh B. Cutaneous larva migrans in children: A case series from Southern India. Indian J Paediatr Dermatol 2017;18:36-8

How to cite this URL:
Paul IS, Singh B. Cutaneous larva migrans in children: A case series from Southern India. Indian J Paediatr Dermatol [serial online] 2017 [cited 2019 Aug 25];18:36-8. Available from: http://www.ijpd.in/text.asp?2017/18/1/36/188454




  Introduction Top


Cutaneous larva migrans is characterized by progressive linear or serpiginous lesions most commonly seen over the dorsum and soles of the foot. Tropical climates, overcrowding, poor hygiene, and sanitation problems play a very important role in the causation of this disease.[1]Ancylostoma duodenale also called “old world hookworm” and Necator americanus also called “new world hookworm” are the most common intestinal parasites found to cause creeping eruptions.


  Case Reports Top


Case 1

A 7-month-old male child presented to us with 2 weeks history of the pruritic lesion on the buttocks migrating at the rate of 2–3 cm/day. No history of fever, cough, or loose stool. Baby was developmentally normal. Vaccination was done up to date. On examination revealed a slightly raised, erythematous, threadlike tract on the buttocks of size approximately 10 cm length, healing at one end and progressing at another end [Figure 1]. Systemic examination reveals no abnormality. Peripheral blood analysis was normal with no eosinophilia. Fecal analysis was negative for parasites. A clinical diagnosis of cutaneous larva migrans was made.
Figure 1: Raised, erythematous, thread like tract on the buttocks of size approximately 10 cm length, healing at one end and progressing at another end

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Case 2

A 6-year-old female child referred from primary health center for evaluation of erythematous, serpentine, pruritic cutaneous lesion over dorsum right hand [Figure 2]. The lesion persists for 3 weeks, and the size is progressing every day. As history noted initially, it was 5 cm in length, and while presenting to us it was 8 cm in length. There was a history of walking in barefoot and playing in the sand. There was no other associated complain. Systemic examination was normal. Baseline hematological and biochemical investigations were within normal limits. Based on history and clinical findings, a diagnosis of cutaneous larva migrans was made.
Figure 2: Erythematous, serpentine, pruritic cutaneous lesion over dorsum right hand

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Case 3

An 8-year-old male child presented to us with a complaint of intensely itchy lesion over the dorsum and all 4 toes of the right foot except great toe for 3 weeks, for which home remedies were taken. Mother gave us a history of child playing in the muddy soil. On examination, eczematous curvilinear tract of about 12 cms in length was seen on the dorsum of the right foot [Figure 3]. Systemic examination revealed no abnormality. Laboratory analysis was normal. Based on history and examination, a diagnosis of cutaneous larva migrans was entertained.
Figure 3: eczematous curvilinear tract of about 12 cms in length was seen on the dorsum of the right foot

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Case 4

A 14-year-old male child presented with progressive single itchy lesion over left thigh over 1 week duration. Father gave a history of child playing throwball in the sand. He had no other symptoms and was otherwise well. On cutaneous examination, there was an erythematous curvilinear tract of about 15 cm long on the lateral aspect of left thigh [Figure 4]. The remainder of his physical examination was unremarkable. His peripheral blood analysis reports were within normal limits. Based on history and cutaneous examination, a diagnosis of cutaneous larva migrans was made.
Figure 4: Erythematous curvilinear tract of about 15 cm long on the lateral aspect of left thigh

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  Discussion Top


Cutaneous larva migrans is also known as “sand worms,” creeping verminous dermatitis, creeping eruption, plumber's itch and duck hunter's itch.[2] In Indian scenario, the disease commonly occurs in the coastal areas of the country where the suitable condition exists.[3] Human gets infected while walking barefoot on soil contaminated with faeces. The filariform larvae of the parasite penetrate into the skin. The commonly affected areas are dorsum and sole of the feet, buttocks, and legs. The larvae secretes proteases and hyaluronidase which facilitate the penetration and migration through the epidermis.[4] The larvae wander in serpiginous route in the epidermis of skin at a speed of 3 cm/day. Clinically, the primary lesion is pruritic, erythematous serpiginous burrow.[2] Larvae die usually in 2–8 weeks. Survival up to 2 years has been reported. The incubation period ranges from 1 to 6 days.

Diagnosis is based on history and clinical examination. Peripheral eosinophilia and increased serum IgE may be seen.[4] Epiluminescence microscopy is an effective noninvasive method to detect larva and confirm the diagnosis.[5]

Complications of cutaneous larva migrans are infective and allergic. Infective includes superadded infections with staphylococcus pyogenes due to eczematization.[6] Rarely, it may present with folliculitis and allergic pulmonary response (present as Loffler's syndrome). It has to be differentiated from scabies, erythema chronicum migrans, larva currens, phytophotodermatitis, and dermatophyte infection.[7]

All patients were treated with oral albendazole and showed complete clearance of the lesions during follow-up. However, a single dose of ivermectin (200 μg/kg) and 3 days regimen of albendazole (400 mg/day) has a similar efficacy of 92–100%.[6] Rarely, thiabendazole is used orally and topically as it is associated with gastrointestinal disturbances. Freezing the leading point of the burrow is an effective older method of treatment.[2] Sometimes, it produces significant tissue destruction. The larva is up to 2 cm. ahead of the visible burrow, and hence may cause treatment failure.

The prognosis is excellent. Awareness, early recognition and treatment help in preventing complication. By treating cats and dogs with anthelmintic drugs and avoiding contact with contaminated soils help in prevention. Both health education and control of animal reservoirs can be effective in controlling cutaneous larva migrans.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Meffert JI. Parasitic infestations. In: Fitzpatrick TB, Aeling J, editors. Dermatology Secrets. 1st ed. New Delhi, India: Jaypee Brothers; 1977. p. 217.  Back to cited text no. 1
    
2.
Padmavathy L, Rao LL. Cutaneous larva migrans – A case report. Indian J Med Microbiol 2005;23:135-6.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Karthikeyan K, Thappa DM. Cutaneous larva migrans. Indian J Dermatol Venereol Leprol 2002;68:252-8.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
Siddalingappa K, Murthy SC, Herakal K, Kusuma MR. Cutaneous larva migrans in early infancy. Indian J Dermatol 2015;60:522.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Elsner E, Thewes M, Worret WI. Cutaneous larva migrans detected by epiluminescent microscopy. Acta Derm Venereol 1997;77:487-8.  Back to cited text no. 5
    
6.
Kaur S, Jindal N, Sahu P, Jairath V, Jain VK. Creeping eruption on the move: A case series from Northern India. Indian J Dermatol 2015;60:422.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.
Dhanaraj M, Ramalingam M. Cutaneous larva migrans masquerading as tinea corporis: A case report. J Clin Diagn Res 2013;7:2313.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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