Cutaneous larva migrans: clinical features and management of 44 cases presenting in the returning traveller

Abstract

Background Cutaneous larva migrans (CLM) is the result of a nematode infection, and shows a characteristic creeping eruption. As travel to the tropics increases, many British citizens may be returning with this infection, which is often misdiagnosed or treated incorrectly. Objectives To perform a retrospective survey of 44 cases of CLM presenting to the Hospital for Tropical Diseases in London over the last 2 years. Methods Cases were reviewed with regard to patient characteristics, source of infection, source of referral, clinical features and therapy. Results Most infections were acquired in Africa (32%), the Caribbean (30%) and South‐east Asia (25%), but also in Central and South America. There was a history of exposure to a beach in 95% of patients and the median duration of symptoms was 8 weeks (range 1–104). Lesions mainly affected the feet (39%), buttocks (18%) and abdomen (16%), but the lower leg, arm and face were also affected. Multiple lesions were seen in seven of 44 cases (16%). Laboratory abnormalities were absent in all patients. Of 44 patients seen, four needed no treatment, 28 were cured by a single course of treatment, 11 required a second course of therapy and one patient was treated three times. Thirty‐one patients received oral albendazole 400 mg daily for 3–5 days and 24 were cured (77%). Five patients received 10% thiabendazole cream topically for 10 days and four were cured (80%). Four patients received oral thiabendazole 1·5 g daily for 3 days and all required further therapy. Conclusions In view of the range of treatment regimens recorded, a randomized controlled trial comparing topical and systemic therapies is warranted.

One-week therapy with oral albendazole in hookworm-related cutaneous larva migrans: A retrospective study on 78 patients

“…According to data in the literature, a lower percentage cure rate was obtained with shorter duration (1-3 days): 46% (2), 88% (1), 94% (16), although cure rates of 100% were sometimes reported (9,11,12,14). Cure rates were 77% (24 out of 31 patients) with albendazole employed for 3-5 days (22). No response after 5 days of therapy was also reported (13,15,16).…”

“…Numerous articles were subsequently published (1,5,7,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Albendazole has been used at the dosage of 400 mg/day for 1 day (5,14), 3 days (22), 5 days (22) or 7 days (17,19,20).…”

Gnatostomiasis cutánea, primer caso confirmado en Colombia

“…En el presente caso, el paciente presentó inicialmente un intenso dolor abdominal en la región epigástrica que lo obligó a consultar en varias oportunidades, así como estreñimiento, síntoma que no es frecuente en esta condición (18). Estos síntomas se explican por la migración inicial de la larva en esta primera fase, que puede tomar dos o tres semanas, durante las cuales el gusano atraviesa la pared gástrica, alcanza la cavidad peritoneal y, finalmente, el hígado (5,8).…”

“…; esta condición se conoce en América Latina como paniculitis nodular migratoria eosinofílica (3).Generalmente, se presenta con lesiones eritematosas alargadas e intermitentes en el torso y las extremidades superiores. En este caso, las lesiones aparecieron y se restringieron a la región abdominal, lo que concuerda con la descripción del parásito que sale de la cavidad gástrica y se dirige hacia el hígado, desde donde comienza su segunda fase migratoria (18). Comúnmente, las lesiones son edematosas, sin fóvea, de aspecto hemorrágico, de longitud muy variable y pueden ser pruriginosas o dolorosas.…”

“…Comúnmente, las lesiones son edematosas, sin fóvea, de aspecto hemorrágico, de longitud muy variable y pueden ser pruriginosas o dolorosas. Una vez aparecen, persisten durante una o dos semanas y suelen deberse a una sola larva, aunque ocasionalmente pueden encontrarse dos o más (18,20). En este caso, el diagnóstico se hizo en cuanto la larva se extrajo, pero se ofreció el tratamiento indicado ante la posibilidad de que hubiera otras larvas infecciosas.…”