Abstract
BackgroundCutaneous larva migrans (CLM) is a neglected parasitic skin disease caused by hookworm larvae such as Ancylostoma braziliense and Ancylostoma caninum. It is more common in tropical and subtropical countries. Evidence regarding clinical profiles, risk factors and outcomes of children with CLM in the Eastern province of Sri Lanka is scarce.AimThe aim of this study was to evaluate demographic profile, risk factors, clinical manifestations and outcomes associated with CLM in children who presented to paediatric and dermatological clinics of the Teaching Hospital, Batticaloa, Sri Lanka. MethodA retrospective study was conducted over three years from January 2017 to December 2019 among children who presented with CLM infection to paediatric and dermatological clinics of the Teaching Hospital, Batticaloa, Sri Lanka. Twenty-eight children who were aged between 1 and 14 years were recruited for the study. Detailed information including demographic factors such as age, sex, residence and mother’s education, risk factors for infection, main reason for clinic visit, duration of illness, site of lesions, number of lesions, treatment received from out-patients department and/or general practitioner, duration of treatment, associated secondary bacterial infection, family history of similar infections and laboratory investigations were extracted from clinical records. Data were analyzed using SPSS version 19.0 (IBM Corp., Armonk, NY).ResultsAmong 28 children recruited for this study, 19 (67.9%) were male children and 9 (32.1) were female children. The majority of children were below 6 years (n=25, 88.3%). Twenty-six (92.9%) children had residence in rural areas and also belonged to low socioeconomic class. Most cases were detected in Valaichenai (32.1%) and Kattankudy (21.4%) ‘Medical Officer of Health’ (MOH) regions. The majority of mothers were educated only up to ordinary level or below (n=19, 67.8%). All patients had pets either dogs or cats at home and no pets had been dewormed. Almost 92.9% of children acquired disease whilst playing on the infected soilThe main reason for clinic visit had been itchiness and this presentation accounted for 60.7% (n=17). Skin infection accounted for 25% of presenting problems. Majority of them presented late to the clinic with the lesions of more than three weeks of duration (n=17, 60.7%). Single lesion was noted in the majority (n=27, 96.4%) except one child who had three lesions. Buttock lesions were observed in 35.7%, feet in 25%, and 10.7% in legs.Investigations revealed eosinophilia in 50% (n=14) of patients and neutrophil leukocytosis was seen in five patients (17.9%). All patients received treatment either from the general practitioner or outpatient department for variable duration without success before attending the specialist clinic. Fifty percent of patients needed treatment with Albendazole and antihistamine for more than three weeks to achieve complete cure. It was also observed that overall occurrence had been declining over the past three years.ConclusionCLM is a common and unreported disease in Eastern province, Sri Lanka. The majority of children presented from low socio-economic backgrounds. The common risk factors were the presence of dewormed pets at home and contamination with infected soil. The majority of children had a single lesion on presentation. Fifty percent of children needed more than three weeks of treatment to achieve a good response.
Highlights
Cutaneous larva migrans (CLM) is a cutaneous dermatosis and more common in tropical and subtropical countries and in countries where poor socioeconomic conditions prevail
The aim of this study was to evaluate demographic profile, risk factors, clinical manifestations and outcomes associated with CLM in children who presented to paediatric and dermatological clinics of the Teaching Hospital, Batticaloa, Sri Lanka
The majority of children presented from low socio-economic backgrounds
Summary
Cutaneous larva migrans (CLM) is a cutaneous dermatosis and more common in tropical and subtropical countries and in countries where poor socioeconomic conditions prevail It is caused by hookworms of dogs and cats, which include Ancylostoma braziliense and Ancylostoma caninum [1]. It is known as creeping eruption as larvae enter the skin whilst children play on the infected soil, subsequently starting to creep and form linear lesions in the skin. Cutaneous larva migrans (CLM) is a neglected parasitic skin disease caused by hookworm larvae such as Ancylostoma braziliense and Ancylostoma caninum It is more common in tropical and subtropical countries. Risk factors and outcomes of children with CLM in the Eastern province of Sri Lanka is scarce
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