Outbreak of Cutaneous Larva Migrans among British Military Personnel in Belize

Abstract

Cutaneous larva migrans (CLM) is a common skin condition, seen most frequently in tropical or semitropical countries. It is caused by dermal invasion by filariform larvae of a variety of nonhuman nematodes. The commonest etiological agents are the hookworms of domestic cats and dogs (Ancylostoma species), man being infected by environmental skin contact with free-living larvae released from ova passed in animal feces. 1 In the natural host the larvae enter the bloodstream and migrate to the gastrointestinal tract, where they mature into the adult form. If man is infected as an incidental host, the larvae enter the dermis but are unable to reach the blood. The result is a “wandering” larva in the dermis, which in turn causes an intense inflammatory response. The incubation period until the symptoms appear varies typically from a few hours to several days, but may rarely be months or years.The characteristically serpiginous pruritic lesions are usually found on parts of the body that have been in contact with the ground. This is usually the soles of the feet, but will vary according to the individual’s behavior. For instance, lesions can be seen anywhere on the body in a tourist who has been sunbathing on infective ground. 2 The condition is self-limiting but extremely uncomfortable, and treatment with antihelminthic agents is usually rapidly effective.