Skip to main content

Advertisement

Log in

Mini review: hookworm-related cutaneous larva migrans

  • Review
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Hookworm-related cutaneous larva migrans (HrCLM) is a parasitic skin disease caused by the migration of animal hookworm larvae in the epidermis. Since these larvae cannot penetrate the basal membrane of human skin, they remain confined to the epidermis and are unable to develop and complete their lifecycle. By consequence, HrCLM is a self-limiting disease. However, if not treated promptly, the skin pathology may persist for months. HrCLM is endemic in many resource-poor communities in the developing world. In high-income countries, HrCLM occurs sporadically or in the form of small epidemics. Travelers account for the great majority of cases seen by health-care professionals in high-income countries. Transmission occurs when naked skin comes into contact with contaminated soil. Exposure may also occur indoors. Exceptionally, larvae may be transmitted through fomites. The first clinical sign is a small reddish papule. Thereafter, the characteristic serpiginous, slightly elevated, erythematous track becomes visible. Itching becomes more and more intense. Excoriations induced by scratching facilitate bacterial superinfection of the lesion. The diagnosis is essentially clinical. It is supported by a recent travel history and the possibility of exposure. The drug of choice is ivermectin in a single dose (200 μg per kg bodyweight). Repeated treatments with albendazole (400 mg daily) are a good alternative in countries where ivermectin is not available.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Caumes E, Danis M (2004) From creeping eruption to hookworm-related cutaneous larva migrans. Lancet Infect Dis 4:659–660

    Article  PubMed  Google Scholar 

  2. Beaver PC (1956) Larva migrans. Exp Parasitol 5:587–621

    Article  PubMed  CAS  Google Scholar 

  3. Haas W, Haberl B, Syafruddin, Idris I, Kallert D, Kersten S, Stiegeler P; Syafruddin (2005) Behavioural strategies used by the hookworms Necator americanus and Ancylostoma duodenale to find, recognize and invade the human host. Parasitol Res 95:30–39

    Article  PubMed  Google Scholar 

  4. Blackwell V, Vega-Lopez F (2001) Cutaneous larva migrans: clinical features and management of 44 cases presenting in the returning traveller. Br J Dermatol 145:434–437

    Article  PubMed  CAS  Google Scholar 

  5. Caumes E, Carrière J, Guermonprez G, Bricaire F, Danis M, Gentilini M (1995) Dermatoses associated with travel to tropical countries: a prospective study of the diagnosis and management of 269 patients presenting to a tropical disease unit. Clin Infect Dis 20:542–548

    Article  PubMed  CAS  Google Scholar 

  6. Hochedez P, Caumes E (2007) Hookworm-related cutaneous larva migrans. J Travel Med 14:326–333

    Article  PubMed  Google Scholar 

  7. Jelinek T, Maiwald H, Nothdurft HD, Löscher T (1994) Cutaneous larva migrans in travelers: synopsis of histories, symptoms, and treatment of 98 patients. Clin Infect Dis 19:1062–1066

    Article  PubMed  CAS  Google Scholar 

  8. Richey TK, Gentry RH, Fitzpatrick JE, Morgan AM (1996) Persistent cutaneous larva migrans due to Ancylostoma species. South Med J 89:609–611

    Article  PubMed  CAS  Google Scholar 

  9. Gutiérrez de la Solana Dumas J, Alvarez Mesa M, Manzur Katrib J (1983) An outbreak of cutaneous larva migrans. Rev Cubana Med Trop 35:303–316

    PubMed  Google Scholar 

  10. Heukelbach J, Wilcke T, Meier A, Sabóia Moura RC, Feldmeier H (2003) A longitudinal study on cutaneous larva migrans in an impoverished Brazilian township. Travel Med Infect Dis 1:213–218

    Article  PubMed  Google Scholar 

  11. Heukelbach J, Wilcke T, Feldmeier H (2004) Cutaneous larva migrans (creeping eruption) in an urban slum in Brazil. Int J Dermatol 43:511–515

    Article  PubMed  Google Scholar 

  12. Heukelbach J, Jackson A, Ariza L, Feldmeier H (2008) Prevalence and risk factors of hookworm-related cutaneous larva migrans in a rural community in Brazil. Ann Trop Med Parasitol 102:53–61

    Article  PubMed  CAS  Google Scholar 

  13. Jackson A, Heukelbach J, Calheiros CML, de Lima Soares V, Harms G, Feldmeier H (2006) A study in a community in Brazil in which cutaneous larva migrans is endemic. Clin Infect Dis 43:e13–e18

    Article  PubMed  Google Scholar 

  14. Lee CP, Bishop LJ (1988) The incidence of cutaneous larva migrans in Montserrat, Leeward Islands, West Indies. West Indian Med J 37:22–24

    PubMed  CAS  Google Scholar 

  15. Sandground JH (1939) Creeping eruptions in the Netherland East Indies caused by the invasion of the larva of Ancylostoma braziliense. Geneesk Tijdschr Ned Indië 13:805–810

    Google Scholar 

  16. Santarém VA, Giuffrida R, Zanin GA (2004) Cutaneous larva migrans: reports of pediatric cases and contamination by Ancylostoma spp larvae in public parks in Taciba, São Paulo State. Rev Soc Bras Med Trop 37:179–181

    Article  PubMed  Google Scholar 

  17. Guimarães AM, Alves EG, de Rezende GF, Rodrigues MC (2005) Toxocara sp. eggs and Ancylostoma sp. larva in public parks, Brazil. Rev Saude Publica 39:293–295

    Article  PubMed  Google Scholar 

  18. Beattie PE, Fleming CJ (2002) Cutaneous larva migrans in the west coast of Scotland. Clin Exp Dermatol 27:248–249

    Article  PubMed  CAS  Google Scholar 

  19. Bradley J (1999) Home-grown cutaneous larva migrans. N Z Med J 112:241–242

    PubMed  CAS  Google Scholar 

  20. Diba VC, Whitty CJ, Green T (2004) Cutaneous larva migrans acquired in Britain. Clin Exp Dermatol 29:555–556

    Article  PubMed  CAS  Google Scholar 

  21. Herrmann A, Christoph T, Sebastian G (2004) Larva migrans “saxoniae”: larva migrans infection in Saxony. J Dtsch Dermatol Ges 2:46–48

    Article  PubMed  Google Scholar 

  22. Klose C, Mravak S, Geb M, Bienzle U, Meyer CG (1996) Autochthonous cutaneous larva migrans in Germany. Trop Med Int Health 1:503–504

    Article  PubMed  CAS  Google Scholar 

  23. Zimmermann R, Combemale P, Piens MA, Dupin M, Le Coz C (1995) Cutaneous larva migrans, autochthonous in France. Apropos of a case. Ann Dermatol Venereol 122:711–714

    PubMed  CAS  Google Scholar 

  24. Conde JF, Feldman SR, Vallejos QM, Quandt SA, Whalley LE, Brooks T, Cabral G, Fleischer AB Jr, Arcury TA (2007) Cutaneous larva migrans in a migrant latino farmworker. J Agromedicine 12:45–48

    Article  PubMed  Google Scholar 

  25. Bouchaud O, Houzé S, Schiemann R, Durand R, Ralaimazava P, Ruggeri C, Coulaud JP (2000) Cutaneous larva migrans in travelers: a prospective study, with assessment of therapy with ivermectin. Clin Infect Dis 31:493–498

    Article  PubMed  CAS  Google Scholar 

  26. Davies HD, Sakuls P, Keystone JS (1993) Creeping eruption. A review of clinical presentation and management of 60 cases presenting to a tropical disease unit. Arch Dermatol 129:588–591

    Article  PubMed  CAS  Google Scholar 

  27. Freedman DO, Weld LH, Kozarsky PE, Fisk T, Robins R, Von Sonnenburg F, Keystone JS, Pandey P, Cetron MS; GeoSentinel Surveillance Network (2006) Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med 354:119–130

    Article  PubMed  CAS  Google Scholar 

  28. Heukelbach J, Gomide M, Araújo F Jr, Pinto NSR, Santana RD, Brito JRM, Feldmeier H (2007) Cutaneous larva migrans and tungiasis in international travelers exiting Brazil: an airport survey. J Travel Med 14:374–380

    Article  PubMed  Google Scholar 

  29. Robson NZ, Othman S (2008) A case of cutaneous larva migrans acquired from soiled toilet floors in urban Kuala Lumpur. Med J Malaysia 63:331–332

    PubMed  CAS  Google Scholar 

  30. Tomović M, Skiljević D, Zivanović D, Tanasilović S, Vesić S, Daković Z, Vukićević J, Pavlović MD, Medenica L (2008) Two cases of probable endogenous extensive cutaneous larva migrans in Serbia. Acta Dermatovenerol Alp Panonica Adriat 17:37–40

    PubMed  Google Scholar 

  31. Galanti B, Fusco FM, Nardiello S (2002) Outbreak of cutaneous larva migrans in Naples, southern Italy. Trans R Soc Trop Med Hyg 96:491–492

    Article  PubMed  CAS  Google Scholar 

  32. Tremblay A, MacLean JD, Gyorkos T, Macpherson DW (2000) Outbreak of cutaneous larva migrans in a group of travellers. Trop Med Int Health 5:330–334

    Article  PubMed  CAS  Google Scholar 

  33. Fülleborn F (1926) Experimentally generated “creeping eruption”. Dermatol Wochenschr 83:1474–1475

    Google Scholar 

  34. Siriez JY, Angoulvant F, Buffet P, Cleophax C, Bourrat E (2010) Individual variability of the cutaneous larva migrans (CLM) incubation period. Pediatr Dermatol 27:211–212

    Article  PubMed  Google Scholar 

  35. Veraldi S, Arancio L (2006) Giant bullous cutaneous larva migrans. Clin Exp Dermatol 31:613–614

    Article  PubMed  CAS  Google Scholar 

  36. Caumes E, Ly F, Bricaire F (2002) Cutaneous larva migrans with folliculitis: report of seven cases and review of the literature. Br J Dermatol 146:314–316

    Article  PubMed  CAS  Google Scholar 

  37. Veraldi S, Bottini S, Carrera C, Gianotti R (2005) Cutaneous larva migrans with folliculitis: a new clinical presentation of this infestation. J Eur Acad Dermatol Venereol 19:628–630

    Article  PubMed  CAS  Google Scholar 

  38. van Nispen tot Pannerden C, van Gompel F, Rijnders BJ, Caumes E, den Hollander JG (2007) An itchy holiday. Neth J Med 65:188–190

    PubMed  Google Scholar 

  39. Veraldi S, Persico MC (2007) HIV, cutaneous larva migrans and fever. Int J STD AIDS 18:433–434

    Article  PubMed  CAS  Google Scholar 

  40. Schuster A, Lesshaft H, Reichert F, Ignatius H, Feldmeier H (2011) Life quality impairment caused by hookworm-related cutaneous larva migrans (CLM) in resource-poor communities in Manaus, Brazil. PLoS Negl Trop Dis (in press)

  41. Veraldi S, Schianchi R, Carrera C (2000) Epiluminescence microscopy in cutaneous larva migrans. Acta Derm Venereol 80:233

    PubMed  CAS  Google Scholar 

  42. Malvy D, Ezzedine K, Pistone T, Receveur MC, Longy-Boursier M (2006) Extensive cutaneous larva migrans with folliculitis mimicking multimetameric herpes zoster presentation in an adult traveler returning from Thailand. J Travel Med 13:244–247

    Article  PubMed  Google Scholar 

  43. Sakai H, Otsubo S, Nakao M, Yamasaki H, Kagei N, Iizuka H (2008) Multiple papules and nodules on the face and neck caused by the larvae of an unknown nematode: a noncreeping type eruption. J Am Acad Dermatol 58:668–670

    Article  PubMed  Google Scholar 

  44. Yap FB-B (2011) Cutaneous larva migrans in Hospital Kuala Lumpur, Malaysia: rate of correct diagnosis made by the referring primary care doctors. Trans R Soc Trop Med Hyg 105:405–408

    Article  PubMed  Google Scholar 

  45. Caumes E, Carrière J, Datry A, Gaxotte P, Danis M, Gentilini M (1993) A randomized trial of ivermectin versus albendazole for the treatment of cutaneous larva migrans. Am J Trop Med Hyg 49:641–644

    PubMed  CAS  Google Scholar 

  46. Caumes E, Datry A, Paris L, Danis M, Gentilini M, Gaxotte P (1992) Efficacy of ivermectin in the therapy of cutaneous larva migrans. Arch Dermatol 128:994–995

    Article  PubMed  CAS  Google Scholar 

  47. Caumes E (2003) Treatment of cutaneous larva migrans and Toxocara infection. Fundam Clin Pharmacol 17:213–216

    Article  PubMed  CAS  Google Scholar 

  48. Van den Enden E, Stevens A, Van Gompel A (1998) Treatment of cutaneous larva migrans. N Engl J Med 339:1246–1247

    Article  PubMed  Google Scholar 

  49. Sanguigni S, Marangi M, Teggi A, De Rosa F (1990) Albendazole in the therapy of cutaneous larva migrans. Trans R Soc Trop Med Hyg 84:831

    Article  PubMed  CAS  Google Scholar 

  50. Veraldi S, Rizzitelli G (1999) Effectiveness of a new therapeutic regimen with albendazole in cutaneous larva migrans. Eur J Dermatol 9:352–353

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to H. Feldmeier.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Feldmeier, H., Schuster, A. Mini review: hookworm-related cutaneous larva migrans. Eur J Clin Microbiol Infect Dis 31, 915–918 (2012). https://doi.org/10.1007/s10096-011-1404-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-011-1404-x

Keywords

Navigation