Nematode Zoonoses - CUTANEOUS LARVAL MIGRANS

(Creeping Eruption)

AGENT: 

Caused by the larvae of the dog and cat hookworms, Ancylostoma braziliense and Ancylostoma caninum. A number of other animal hookworms, gnathostomiasis, and strongyloidiasis are rarely also causative agents.

RESERVOIR AND INCIDENCE

Cutaneous Larval Migrans is prevalent throughout the tropic and subtropics. Human infection is common in SE U.S., particularly where people come in contact with moist sandy soil (e.g., beaches, children's sand piles) contaminated by dog or cat feces.

TRANSMISSION:

Direct skin contact with larvae. Soil to skin contact. Contamination with animal feces.

DISEASE IN ANIMALS:

Same as Ancylostomiasis.

DISEASE IN MAN:

At the site of larval entry, particularly on the hands or feet, up to several hundred minute, intensely pruritic erythematous papules appear. Two to 3 days later, serpiginous eruptions appear as the larvae migrate at a rate of several millimeters a day; the parasite lies slightly ahead of the advancing border. The process continues for weeks or up to a year, and the lesions may remain severely pruritic, vesiculate, and become encrusted and secondarily infected. Without treatment, the larvae eventually die and are absorbed.

DIAGNOSIS:

Presumptive - Characteristic clinical manifestations. Etiologic - ID of agent by biopsy in skin section but this is usually very difficult to achieve. Most cases are really not confirmed. No valid serodiagnostic tests currently available.

TREATMENT:

Simple transient cases require no treatment. Albendazole or thiabendazole. Antihistamines and antibiotic ointments.

PREVENTION/CONTROL:

Minimize contact (e.g., wear shoes!). Decontaminate environment: 10 lbs/100 sq ft. sodium borate - gravel/clay dog run; 1% sodium hypochlorite solution - cement dog run. Prevent environmental contamination. Public health education.