Hookworm-related Cutaneous Larva Migrans Research Articles

Hookworm – Related cutaneous larva migrans: Case report

Hookworm-related cutaneous larva migrans is caused by the intradermal migration of soil-dwelling filariform larvae of dog and cat hookworms, most commonly Ancylostoma, usually develop itchy skin lesions, usually consisting of migrating superficial serpiginous traces, or sometimes stationary follicular eruptions. The plantar topography or on the regions of the body in contact with the sand of the beaches of the Antilles, West Africa and East Asia, the presence of fine and not very mobile serpiginous furrows and eczematization with vesiculobullous eruption, are characteristic. There are misleading profuse forms such as pseudo-folliculitis. We present a Moroccan patient who developed the disease after their return from and who responded well to treatment with albendazole.

Cutaneous Larvae Migrans Treated with a Single Dose of Ivermectin

Hookworm-related cutaneous larva migrans (HrCLM) is a clinical diagnosis based on a history of exposure to contaminated soil and is associated with a characteristic red serpiginous lesion that migrates within the epidermis. Our patient presented with a red, tortuous migratory rash with localized pruritus on the left plantar foot of 1-month duration. He lacked recent travel history outside the southeastern United States. Upon admission, he presented with peripheral blood eosinophilia, an uncommon feature of HrCLM. A single dose of ivermectin was sufficient for treatment, and symptoms resolved within 3 days. This case highlights the increased incidence of domestically acquired hookworm infections, explores this epidemiological shift, and emphasizes relevant differential diagnoses.

A creeping holiday souvenir: about a misleading case of hookworm folliculitis†.

Hookworm-related cutaneous larva migrans occurs in endemic areas but also amongst travelers. Although this disease usually presents as a single pruritic raised erythematous track, misleading clinical presentations are not uncommon. This particularly extensive, follicular presentation of larva migrans should warn clinicians about atypical forms of this emerging tropical disease.

Bilesional serpiginous cutaneous ectoparasitosis in a Greek grazier.

A Balkan case of paucilesional truncal autochthonous hookworm-related cutaneous larva migrans contracted during winter in a cowman, successfully treated by 10% albendazole topical preparation.

Global output of research on epidermal parasitic skin diseases from 1967 to 2017

BackgroundEpidermal parasitic skin diseases (EPSD) occur in most countries and cause a considerable health and economic burden, particularly in the tropics and subtropics. The aim of this study was to assess and analyse peer-reviewed literature on EPSD in humans. The results of this study serve as an indicator of the extent the scientific community, health authorities, and international health agencies interact with EPSD as a health problem that is commonly associated with poverty and poor hygiene.MethodsA bibliometric analysis methodology was used. The Scopus database was used to retrieve documents about EPSD for the study period (1967–2017). The study focused on scabies, tungiasis, pediculosis, hookworm-related cutaneous larva migrans (HrCLM), myiasis, and cutaneous strongyloidiasis. Documents that specifically and explicitly discuss EPSD in animals, aquatic organisms, and birds were excluded.ResultsIn total, 4186 documents were retrieved. A fluctuated growth of publications on EPSD in the past five decades was found. The retrieved documents received 43 301 citations, an average of 10.3 citations per article and an h-index of 74. The keywords “scabies” and was the most commonly encountered keyword followed by the keywords “head lice” and “pediculosis”. The most active journal involved in publishing articles on EPSD was the International Journal of Dermatology (164; 3.9%). Researchers from 93 different countries published the retrieved articles. The USA led with 735 (17.6%) documents, followed by the UK (274; 6.5%), and Germany (259; 6.2%). In terms of institutions, the Charité – Universitätsmedizin Berlin in Germany was the most active in this field with 78 (1.9%) publications, followed by the Universidade Federal do Ceará in Brazil with 52 (1.2%) publications.ConclusionsResearch on scabies and pediculosis dominated the field of EPSD research to the expense of tungiasis, HrCLM, myiasis, and cutaneous strongyloidiasis. There was an underrepresentation of literature from the tropics and subtropics despite EPSD being common in these areas. This could possibly be explained by the presence of limited number of non-English journals in the Scopus database. International research collaborations and research networking should be strengthened to help advance and prioritize research on EPSD.

Epidemiology and morbidity of hookworm-related cutaneous larva migrans (HrCLM): Results of a cohort study over a period of six months in a resource-poor community in Manaus, Brazil.

BackgroundHookworm-related cutaneous larva migrans (HrCLM) is a neglected parasitic skin disease, widespread in resource-poor communities in tropical and subtropical countries. Incidence and risk factors have never been investigated in a cohort study.Methodology/Principal findingsTo understand the seasonal epidemiology of HrCLM, an open cohort of 476 children in a resource-poor community in Manaus, Brazil was examined for HrCLM monthly over a period of 6 months. Monthly prevalence and intensity of infection were correlated with the amount of monthly precipitation. Multivariable Cox regression analysis indicated male sex (hazard ratio [HR] 3.29; 95% confidence interval [CI] 1.95–5.56), walking barefoot on sandy ground (HR 2.30; 95% CI 1.03–5.16), poverty (HR 2.13; 95% CI 1.09–4.17) and age between 10 and 14 years (HR 1.87; 95% CI 1.01–3.46) as predictors of HrCLM. Monthly incidence rates ranged between 0.21 and 1.05 cases per person-year with an overall incidence of 0.52 per person-year.Conclusions/SignificanceHrCLM is a frequent parasitic skin disease in this resource-poor community. Every second child theoretically becomes infected during one year. Boys, 10 to 14 years old, belonging to the poorest households of the community, are the most vulnerable population group. Even in the tropical monsoonal climate of Amazonia there is a considerable seasonal variation with monthly incidence and number of lesions peaking in the rainy season.

Hookworm-related Cutaneous Larva Migrans with Exceptional Multiple Cutaneous Entries

Hookworm-related Cutaneous Larva Migrans with Exceptional Multiple Cutaneous Entries

Hookworm-related cutaneous larva migrans: our 201st patient.

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Prevalence and Risk Factors of Hookworm-Related Cutaneous Larva Migrans (HrCLM) in a Resource-Poor Community in Manaus, Brazil.

BackgroundHookworm-related cutaneous larva migrans (HrCLM) is a neglected tropical skin disease associated with significant clinical pathology. Little knowledge exists about prevalence and risk factors of HrCLM in endemic regions.Methodology/ Principal FindingsTo understand the epidemiology of HrCLM in Amazonia, we conducted a cross-sectional study in a resource-poor township in Manaus, Brazil. HrCLM was diagnosed in 8.2% (95% CI, 6.3–10.1%) of the study population (N = 806) with a peak prevalence of 18.2% (95% CI, 9.3–27.1%) in children aged 10–14. Most of the tracks (62.4%) were located on the feet, and 10.6% were superinfected. HrCLM was associated independently with age under 15, male sex, presence of animal faeces on the compound, walking barefoot on sandy ground and poverty.Conclusions/ SignificanceHrCLM is common in resource-poor communities in Amazonia and is related to poverty. To reduce the disease burden caused by HrCLM, living conditions have to be improved.

Demographic, socioeconomic and environmental changes affecting circulation of neglected tropical diseases in Egypt.

Egypt has been plagued by many neglected tropical diseases since Pharaonic time. These diseases are Schistosomiasis, soil-transmitted helminthiasis, lymphatic filariasis, leishmaniasis and fascioliasis beside the epidermal parasitic skin diseases. Indeed, theses diseases still persist as public health problem in the country by the influence of demographic, socioeconomic and environmental obstacles. This study seeks for understanding the contribution of each factor in each obstacle in neglected tropical diseases perpetuation which in turn could help the governorate in planning integrated control strategies. It was found that poverty, unregulated urbanization and inadequate sanitation are important socioeconomic factors that have great effect on the transmission dynamics of the diseases. The environmental factors which affect the epidemiology of these diseases in the country are scarcity of water, construction of dams, land reclamation for agriculture beside the climate factors. Unfortunately, the panic increase in the population growth rate minimizes the efforts done by the governorate to elevate the public health services. These conditions also affect the transmission of epidermal parasitic skin diseases including scabies, head lice and hookworm-related cutaneous larva migrans. The control programs and the recommendations to combat the diseases were discussed. The present study showed that the ecological factors affecting each neglected tropical disease in Egypt are somewhat similar which makes it worthy to develop an integrated control approaches aiming at improving the leading factors of neglected tropical diseases circulation in the country.

Foreign travel and hookworm-related cutaneous larva migrans

Funding sources: none. Conflicts of interest: none declared. Dear Editor, We read with interest the article of Vanhaecke et al.1 The authors delineate the causes of 78 cases of ‘creeping eruption’ presenting to a French tropical diseases referral centre. All of the 74 cases of hookworm‐related cutaneous larva migrans (HrCLM) had a history of recent foreign travel and all but one of these had returned from a tropical destination. The 44 cases of HrCLM reported by Blackwell and Vega‐Lopez from the Hospital for Tropical Diseases in London were all acquired outside of Europe, although the authors note that the condition is ‘most prevalent in the tropics [but] also occurs in temperate climates, including the U.K’.2 We wish to emphasize that the lack of a history of foreign travel does not preclude the diagnosis of HrCLM in the U.K. and other parts of northern Europe. A 39‐year‐old woman was referred to our dermatology department for assessment of a pigmented lesion on her left arm. A clinical diagnosis of melanoma was made and subsequently confirmed following complete excision of the lesion. A 3‐cm‐diameter erythematous, scaly plaque with occasional pustules and a serpiginous edge (Fig. 1) was noted on the lateral aspect of the dorsum of the left foot as an incidental finding during the initial consultation. On direct questioning the patient admitted that the plaque was itchy and had been present for 6 months. She was a dog owner and denied any foreign travel for the previous 4 years. A clinical diagnosis of HrCLM was made and the patient was treated with a single dose of oral ivermectin (200 μg kg−1), which led to complete resolution of the rash. Our patient is likely to have acquired the infestation through contact with the soil in her garden into which hookworm ova were excreted by her dog.

Aetiologies of creeping eruption: 78 cases

Creeping eruption is a migratory linear cutaneous trail. In addition to hookworm-related cutaneous larva migrans (HrCLM), other diseases can also be revealed by this sign. To report the different aetiologies of creeping eruption. All consecutive patients with creeping eruption presenting to our unit in Pitié Salpêtrière Hospital in Paris between 1 March 2008 and 31 January 2013 were included. The diagnoses were based on microscopic data when available (hookworm folliculitis, strongyloidiasis) or the association of epidemiological, clinical, biological features and good outcome after specific treatment (HrCLM, loiasis, gnathostomiasis). Seventy-four patients (95%) presented with HrCLM. All but one had been travelling in a tropical country; seven (9%) also presented with folliculitis. Skin scraping of hookworm folliculitis lesions was performed in five cases and revealed living nematode larvae in three cases. Two patients (3%) with cutaneous gnathostomiasis after returning from Bali and Japan presented with intermittent creeping dermatitis on the foot and thigh, respectively. One patient (1%), native to Cameroon, was diagnosed with loiasis and one patient (1%), with no travel history, presented with 'creeping hair'. Hookworm-related cutaneous larva migrans explains 95% of the cases of creeping eruption; gnathostomiasis, loiasis and cutaneous pili migrans may also be diagnosed.

Hookworm-related cutaneous larva migrans in patients living in an endemic community in Brazil: Immunological patterns before and after ivermectin treatment

Hookworm-related cutaneous larva migrans (Hr-CLM) is caused by animal hookworm larvae migrating in the human epidermis where they elicit an inflammatory response. This study describes the immunological profile in Hr-CLM patients. In 77 Hr-CLM patients from Manaus, Brazil, peripheral eosinophils were counted, and serum concentrations of total immunoglobulin E (IgE) and selected cytokines were determined by ELISA before and after treatment with ivermectin. Controls included patients' household members (endemic controls), non-endemic Brazilian and Japanese individuals. Eosinophil counts and total IgE in Hr-CLM patients were higher than in controls and correlated with disease severity. Concentrations of interleukin (IL)-4, IL-5, IL-6, and IL-10 were higher in Hr-CLM patients than in endemic controls (p < 0.001) while no differences were detected for interferon (IFN)-γ, tumor necrosis factor (TNF)-α, IL-1β, IL-2, or transforming growth factor (TGF)-β. Following ivermectin treatment, numbers of eosinophils and concentrations of IL-4, IL-5, and IL-10 decreased whereas IgE, IFN-γ, and TGF-β concentrations increased. The IL-5/IFN-γ ratio declined from 5.9 (interquartile range [IQR] 0.8-31.6) before to 0.1 (IQR 0.05-0.2; p = 0.001) after treatment. Thus, although an impact of other infections on the immune parameters determined cannot be excluded, Hr-CLM in endemic areas is associated with eosinophilia and elevated cytokine levels, particularly of IL-5 and IL-10, which decrease following ivermectin treatment.

Hookworm-Related Cutaneous Larva Migrans in Northern Brazil: Resolution of Clinical Pathology After a Single Dose of Ivermectin

To assess the effect of ivermectin on the morbidity caused by hookworm-related cutaneous larva migrans in patients in hyperendemic areas, we treated 92 patients (with 441 tracks in total) from Manaus, Brazil, with single-dose ivermectin (200 µg/kg). Four weeks later, patients had 60 tracks, and the associated morbidity improved significantly.

Follicular cutaneous larva migrans: a report of three cases and review of the literature

Hookworm-related cutaneous larva migrans (CLM) is characterized clinically by erythematous and slightly raised tracks, located especially on the feet. These tracks may be single or multiple, linear or serpiginous, more or less ramified and intertwined. The length is variable (up to many cm); the width ranges from 1mm to 4mm. Tracks are often accompanied by severe pruritus. Three adult Caucasian patients recently returned from trips to Malaysia and Thailand, presented with follicular CLM. The disease was characterized clinically by follicular, erythematous, small papules that were sometimes topped with vesicles or pustules, located on the buttocks. Pruritus was severe. Histopathological examinations revealed a perifollicular infiltrate predominantly consisting of lymphocytes and eosinophils. All patients were successfully treated with oral albendazole (400mg/day for sevendays). In the first patient, two courses were necessary. Dermatologists should be aware of the existence of this rare and atypical, although emerging, clinical presentation of hookworm-related CLM.

The efficacy of single dose ivermectin in the treatment of hookworm related cutaneous larva migrans varies depending on the clinical presentation

Treatment of hookworm-related cutaneous larva migrans (HrCLM) with a single dose of oral ivermectin has not been adequately evaluated to date. Response rates reported in three large studies varied from 77% to more than 95%. We evaluated the efficacy of ivermectin in the treatment of HrCLM. We retrospectively studied all returning travellers with HrCLM who consulted in our institution. Patients were then treated with a single, 200 μg/kg dose of ivermectin, orally. Sixty-two travellers (35 female, 27 male, mean age 35.6 years) with HrCLM and creeping dermatitis were included. Six patients (10%) also had associated hookworm folliculitis. Fifty-nine patients (95%) completely responded with one ivermectin dose. The response rate was 98% in the 56 patients presenting with only creeping dermatitis and 66% in the six patients presenting with additional hookworm folliculitis (P = 0.02). The efficacy of a single dose of oral ivermectin is higher in patients with only creeping dermatitis than in those with associated hookworm folliculitis.

Chronic hookworm-related cutaneous larva migrans

The purpose of this study is to present the 'chronic' or 'persistent' form of hookworm-related cutaneous larva migrans. From 1998 to 2011, 13 patients were seen in our department with clinically typical hookworm-related cutaneous larva migrans that had been present for more than 5 months and that, because of the absence of pruritus, had never been treated. The duration of hookworm-related cutaneous larva migrans ranged from 5 to 14 months (mean 7.8 months) in these 13 patients (10 males and three females, aged 23-55 years). The infestation was acquired in Brazil (three patients), Jamaica (three patients), Mexico (two patients), Tanzania (two patients), Thailand (two patients), and Martinique (one patient). The infestation was located on the feet in 10 patients; one of these patients also presented tracks on the back and another presented tracks on a knee. The chest (two patients) and thigh (two patients) were also involved. All patients presented with clinically typical hookworm-related cutaneous larva migrans: seven patients had one track and six patients had two tracks. Laboratory and instrumental examinations were within the normal range or negative. Histopathological examination revealed edema in the papillary and upper dermis, and a perivascular and perifollicular infiltrate in the upper dermis, consisting mainly of lymphocytes and eosinophils. No larvae were detected. This can be considered the 'chronic' or 'persistent' form of hookworm-related cutaneous larva migrans. Some pathogenetic hypotheses are suggested.

Molecular Characterization of Ancylostoma braziliense Larvae in a Patient with Hookworm-Related Cutaneous Larva Migrans

We report a case of hookworm-related cutaneous larva migrans diagnosed microscopically. Viable hookworm larvae were found by microscopic examination of a skin scraping from follicular lesions. Amplification and sequencing of the internal transcribed spacer 2 allowed the specific identification of the larvae as Ancylostoma braziliense.

Knowledge, attitudes, perceptions, and practices regarding cutaneous larva migrans in deprived communities in Manaus, Brazil

Hookworm-related cutaneous larva migrans (HrCLM) is a neglected parasitic skin disease commonly found in resource-poor communities in tropical countries. It is acquired via skin contact with faeces of cats and dogs, and causes intense pruritus and significant morbidity. We investigated knowledge, attitudes and practices in caregivers of patients with HrCLM by performing focus group discussions (FGDs) with 20 mothers of children with HrCLM in two endemic urban communities in Manaus, Brazil. Additionally, socio-demographic data of 70 actively detected HrCLM patients in both areas were obtained by using questionnaires. We found that mainly children who lived in large households and habitually walked barefoot were affected. Family income was low, housing was poor, and food shortage common. In the FGDs, mothers described HrCLM as a severely distressing condition with considerable impact on individual and family life. Inadequate treatment practices and the identification of poverty-related obstacles for practical prevention of HrCLM by the mothers of affected children indicate that both health education and improvement of living conditions are required jointly.

Life Quality Impairment Caused by Hookworm-Related Cutaneous Larva Migrans in Resource-Poor Communities in Manaus, Brazil

BackgroundHookworm-related cutaneous larva migrans (CLM) is a common but neglected tropical skin disease caused by the migration of animal hookworm larvae in the epidermis. The disease causes intense pruritus and is associated with important morbidity. The extent to which CLM impairs skin disease-associated life quality has never been studied.MethodsA modified version of the Dermatology Life Quality Index (mDLQI) was used to determine skin disease-associated life quality in 91 adult and child patients with CLM, living in resource-poor communities in Manaus, Brazil. Symptoms and signs were documented and skin disease-associated life quality was semi-quantitatively assessed using mDLQI scores. The assessment was repeated two and four weeks after treatment with ivermectin.ResultsNinety-one point five percent of the study participants showed a considerable reduction of skin disease-associated life quality at the time of diagnosis. The degree of impairment correlated with the intensity of infection (rho = 0.76, p<0.001), the number of body areas affected (rho = 0.30; p = 0.004), and the presence of lesions on visible areas of the skin (p = 0.002). Intense pruritus, sleep disturbance (due to itching) and the feeling of shame were the most frequent skin disease-associated life quality restrictions (reported by 93.4%, 73.6%, and 64.8% of the patients, respectively). No differences were observed in skin disease-associated life quality restriction between boys and girls or men and women. Two weeks after treatment with ivermectin, skin disease-associated life quality improved significantly. After four weeks, 73.3% of the patients considered their disease-associated life quality to have returned to normal.ConclusionsCLM significantly impaired the skin disease-associated life quality in child and adult patients living in urban slums in North Brazil. After treatment with ivermectin, life quality normalised rapidly.