Cutaneous Larva Migrans in Turkey: An Imported Case Report

Abstract

Cutaneous larva migrans (CLM) is a parasitic infection most commonly found in tropical and subtropical areas. However, with the ease and increase of foreign travel to many countries around the world, the infection is not limited to these areas. CLM is an erythematous, serpiginous infection with skin eruption caused by percutaneous penetration of the larvae to the skin. In this report, a case diagnosed as imported CLM after an Amazon trip and treated with albendazole was presented. A 36 year-old male patient admitted to infectious diseases clinic with intense itching, erythematous, raised, streaklike serpiginious eruptionand some redness at bilateral foot especially at the right foot for about one week. The patient was living in Turkey, and travelled to Brazil for an Amazon trip three months ago and the lesions began immediately after this occasion. CLM was diagnosed with the typical lesions in the patient and oral albendazole treatment 2 x 400 mg/day for 3 consecutive days was carried out with oral amoxicillin/clavulanat 3 x 1 g/day for the secondary bacterial infection. The patient responded very well to oral albendazole treatment with a result of a rapid improvementof pruritus in days and no side effect was observed during the treatment period.After discharge, during his controlit was seenthat the lesions were regressed with leaving hyperpigmentation. In cases with cutaneous larva migrans, diagnosis is often made by the presence of pruritic typical lesions and tunnels, travel story to endemic regions, the story of barefoot contact with sand and soil in these regions, and the sun tanning story on the beach. The lesions are often seen in the lower extremities, especially in the dorsal and plantar surface of the foot. Laboratory findings are not specific. Temporary peripheral eosinophilia can be seen and biopsy can be done to confirm the diagnosis but usually no parasite is seen in the histopathological examination. Contact dermatitis, bacterial and fungal skin infections and other parasitic diseases should be considered in differential diagnosis. For the treatment ivermectin 1 x 200 mg/kg single dose or albendazole 400 mg/day for three days is recommended. As a result, cutaneous larva migrans should be kept in mind especially in patients with a history of travel to endemic areas and a history of bare feet contact with sandy beaches and soil in this region and with itchy, red and serpiginous skin lesions.

A case of cutaneous larva migrans from Turkey

“…These are Central and South America, Mexico, Caribbean, Africa, Southeast Asia, Mediterranean regions, the south-eastern parts of the United States, and some other tropical areas. It is the most common skin disease seen after traveling to tropical and subtropical regions [1][2][3]. However, when we look at the literature, cases have been reported in non-endemic regions like our country [4].…”

“…A small number of CLM cases have been reported in our country. While 4 of them were autochthonous, 4 of them had a history of traveling to the endemic region [2,3,[5][6][7]. Although facilitating the transportation between countries makes it easier to see the disease, global warming and its effects make it easier to see some parasitic diseases in non-endemic regions as a result of changes of both climate and environment.…”

“…CLM występuje endemicznie w niektórych regionach świata, do których należą: Ameryka Środkowa i Południowa, Meksyk, Karaiby, Afryka, Azja Południowo-Wschodnia, rejon Morza Śródziemnego, południowo-wschodnie Stany Zjednoczone oraz niektóre inne obszary tropikalne. CLM jest najczęstszą chorobą skóry u osób podróżujących do regionów tropikalnych i subtropikalnych [1][2][3]. Przegląd piśmiennictwa wskazuje jednak, że CLM może występować także w regionach nieendemicznych, m.in.…”

“…w Turcji [4], gdzie odnotowano niewielką liczbę przypadków. Cztery przypadki miały charakter autochtoniczny, natomiast u kolejnych 4 pacjentów ustalono, że przebywali w regionie endemicznego występowania choroby [2,3,[5][6][7]. Mimo że usprawnienie transportu między krajami ułatwia śledzenie chorób, schorzenia pasożytnicze wskutek globalnego ocieplenia i jego skutków klimatycznych oraz środowiskowych są coraz częściej obserwowane w regionach wcześniej nieendemicznych.…”

“…Regions where lesions are most common include ankles, feet, legs, hips and thighs. It has been reported in the literature that it is rarely seen in unusual areas such as the face, upper extremities, trunk, abdomen, breast, oral cavity, genital area and perineal regions [1][2][3]5]. Multifocal presentation can be seen as atypical involvement [10].…”