Three clinical cases of cutaneous larva migrans

Three cases of cutaneous larva migrans (CLM) were diagnosed in a returnee from a trip to Thailand and in 2 domestic farmers during July and September, 2003. The linear and serpiginous skin lesions on the lower extremities were presented in all 3 cases. Routine laboratory findings were normal. In the imported case, a 650 x 30 micrometer sized filariform nematode larva, presumably a species of hookworm, was detected in the lesion. All cases were treated with 400 mg albendazole once daily for 3-5 days, and their skin lesions gradually improved. In the present study, a causative agent of CLM was isolated for the first time in the Republic of Korea. Moreover, we speculate that CLM is prevalent in farmers who are in frequent contact with soil in the Republic of Korea.     

Two imported cases of cutaneous larva migrans

Cutaneous larva migrans (CLM) is a rare serpiginous cutaneous eruption caused by accidental penetration and migration in the skin with infective larvae of nematode that normally do not have the human as their host. Although CLM has a worldwide distribution, the infection is most frequent in warmer climates. More recently, they have been increasingly imported from the tropics or subtropics by travelers. We experienced two patients who had pruritic serpiginous linear eruption in their skin for a few weeks after traveling to the endemic areas (Brazil and Thailand, respectively). After the treatment with albendazole, the skin lesions resolved with post-inflammatory hyperpigmentation. We report herein two cases of cutaneous larva migrans successfully treated with albendazole.     

A serologically diagnosed human case of cutaneous larva migrans caused by Ancylostoma caninum

A 15-year-old boy, who had recently arrived back from a trip to Cambodia for a missionary camp, presented with several serpiginous thread-like skin lesions that began as small papules on the left upper extremities 2 weeks before his visit to Hospital. The skin lesions were pruritic and erythematous, and had migrated to the chest and abdomen. The histopathological findings showed only lymphocytic and eosinophilic infiltrations in the dermis of the biopsied skin lesion. The patient's serum reacted strongly to the Ancylostoma caninum antigen by an ELISA method. Therefore, he was diagnosed with cutaneous larva migrans by A. caninum. After the oral administration of albendazole and ivermectin, the skin lesions resolved without recurrence. This is the first reported case of a cutaneous larva migrans caused by Ancylostoma canimum diagnosed serologically using ELISA in Korea.     

Occupational risk of cutaneous larva migrans: A case report and a systematic literature review

Cutaneous larva migrans (CLM) is a parasitic zoonosis of warm tropical and subtropical areas, although autochthonous cases have been increasingly reported in Western European countries. Data on the prevalence of CLM as an occupational disease in workers exposed to potentially contaminated soil or in close contact with dogs and cats are scant. Herein, we report an autochthonous case of CLM in a dog breeder from southern Italy (Apulia region), along with a systematic literature review describing the risk of CLM infection, mainly according to job categories. The patient was referred to the dermatology unit presenting a serpiginous lesion on his hand, raising the suspected CLM diagnosis. In non-endemic areas, CLM might represent a challenge for physicians in terms of diagnosis, treatment, and prevention, particularly in workplaces. The multidisciplinary approach in the diagnosis of CLM with the involvement of different scientific competences (i.e., dermatologists, veterinarians, and occupational physicians) may contribute to further assess the distribution of human CLM and associated risk factors, toward reducing the risk for the infection.     

A case of relapsing cutaneous larva migrans transmitted by a cheetah (Acinonyx jubatus)

A case of relapsing "creeping eruption" connected with parasites of the cheetah is reported in the man. The parasitological examination, carried out in two cheetahs liable of this syndrome, has shown two different helmintic species: Ancylostoma caninum and Ancylostoma tubaeforme.     

Life quality impairment caused by hookworm-related cutaneous larva migrans in resource-poor communities in Manaus, Brazil

Background

Hookworm-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.

Methods

A 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.

Results

Ninety-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.

Conclusions

CLM 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.     

Mouse strain difference in visceral larva migrans of Toxocara canis

The mode of larval migration (visceral larva migrans) in Toxocara canis infection was compared for BALB/c, C57BL/6, C3H/He, DBA/2, NC and BALB/c nude mice following oral infection with 400 eggs. The mean recovery of larvae from the liver on day 2 post infection (PI) was not different in terms of the strain, age or sex of the mice. The number of larvae recovered from the liver decreased in all strains on days 6, 12 and 21 PI, but the mean for BALB/c and (NC X BALB/c) F1 mice was significantly higher than that for C567BL/6, NC and BALB/c nude mice, unless the total number of larvae in the carcasses on day 21 PI was the same among those strains including athymic nude mice. The mean recovery of larvae from the liver on day 6 PI increased with age in both NC and BALB/c mice, although no sex difference was observed. From these results, it is emphasized that the age and strain of animals should be properly selected for animal experimentation with T. canis infection.     

First outbreak of Baylisascaris procyonis larva migrans in rabbits in Japan

A syndrome of progressive neurological signs was noticed in rabbits (Oryctolagus cuniculus) kept in a small wildlife park in mid-July 2000. Three out of 12 common raccoons (Procyon lotor) kept in this park were infected with Baylisascaris procyonis, and the larvae were found from affected rabbits. This outbreak is the first proven B. procyonis larva migrans in Japan, and the potential risk of serious zoonosis by this ascarid species should be considered by pet owners, veterinarians, physicians and public health authorities in this country as in North America where raccoons are endemic.     

Visceral larva migrans: migratory pattern of Toxocara canis in pigs.

The migratory pattern of Toxocara canis was investigated following infection of pigs with 60000 infective eggs. Groups of six pigs were slaughtered at 7, 14 and 28 days after infection (p.i.), and the number of larvae in selected organs and muscles was determined by digestion. A group of uninfected pigs was used as negative controls for blood parameters and weight gain. Toxocara canis migrated well in the pig, although the relative numbers of larvae recovered decreased significantly during the experiment. On day 7 p.i., high numbers of larvae were recovered from the lymph nodes around the small intestine and to some extent also from the lymph nodes around the large intestine, and from the lungs and the liver. On day 14, the majority of larvae were recovered from the lungs and the lymph nodes around the small intestine, and by day 28 p.i. most larvae were found in the lungs. Larvae were recovered from the brain on days 14 and 21, with a maximum on day 14 p.i. No larvae were found in the eyes. Severe pathological changes were observed in the liver and lungs, especially on day 14 p.i.; also, development of granulomas was observed in the kidneys. Finally, a strong specific antibody response towards T. canis L2/L3 ES products was observed from day 14 p.i. until termination of the experiment, and the maximum eosinophil response was observed 14 days p.i. The pig is a useful non-primate model for human visceral larva migrans, since T. canis migrate well and induce a strong immunological response in the pig. However, the importance of the pig as a paratenic host is probably minor, because of the relatively early death of most of the larvae.     

Anthelmintics for dogs and cats

As the dog and cat anthelmintic market is small, fragmented and dominated by old-fashioned narrow spectrum products, there is little incentive for the pharmaceutical companies to invest major research resources in this area. Development of new products will always be of relatively low priority and progress will be much slower than is the case with ruminant anthelmintics. Some successes since ICOPA V can however be claimed. The previously reported cesticidal properties of praziquantel have been put to good use and have contributed to the progress made in many hydatid control programmes. Ivermectin shows promise as an alternative heartworm prophylactic and the applications for multiple dose therapy with the benzimidazoles continue to increase. In the latter case, much still needs to be done to explore the full potential of this chemical group and to define optimum dosage regimes for both broad spectrum therapy and for the prophylaxis of T. cati and A. caninum infections. It is to be hoped that the increasing awareness of the general public concerning the role of worm control in the broader concept of responsible pet ownership will create a greater demand for expert advice and more effective chemotherapy.     

The specificity of nematode allergens in the diagnosis of human visceral larva migrans.

Extracts of nematodes have been used as skin test antigens in the diagnosis of nematode infections for many years. Ascaris lumbricoides and Toxocara canis are two nematodes commonly involved in human parasitism, the latter being associated with the clinical condition of Visceral Larva Migrans. In vitro and in vivo experiments reported in this paper confirm experimentally, as well as clinically, the existence of cross-reacting antigens between T. canis and Ascaris spp., and probably between T. canis and other nematodes. These cross-reactions compromise the usefulness of skin tests in the diagnosis of such parasitic infections.     

DNA fingerprints of dogs and cats

Human minisatellite probes consisting of tandem repeats of the 'core' sequence, a putative recombination signal in human DNA, cross-hybridize to multiple polymorphic fragments in dog and cat DNA to produce individual-specific DNA 'fingerprints'. Pedigree analysis shows that most of the DNA fragments detected in an individual are heterozygous, and that these fragments are derived from multiple dispersed autosomal loci. DNA fingerprints of cats and dogs should prove suitable for individual identification and for establishing family relationships. They are also suitable for rapid marker generation in large pedigrees and could be applied to linkage analysis in these animals.     

Cutaneous larva migrans among devotees of the Nallur temple in Jaffna, Sri Lanka

Background

Many cases of Cutaneous Larva Migrans (CLM) have been observed among devotees, during and immediately after the annual festival at the Nallur Hindu temple in Jaffna.

Objective

To ascertain the risk factors associated with infestation and devotees'' knowledge and practices regarding the condition.

Methodology/Principal Findings

A cross-sectional study using an interviewer-administered questionnaire and observation was conducted in August 2010. Out of 200 selected devotees 194(97%) responded. Soil and dog faecal samples were collected from the temple premises and examined for the presence of nematode larva and egg respectively. Among 194 male respondents, 58.2%(95% CI: 51.2%–65.0%) had lesions of CLM. One hundred and thirty (67%) respondents performed the ritual everyday; whereas 33% did so on special days. One hundred and twelve (57.7%) participants performed the ritual before 5.00am and remaining 42.3% performed after 5.00am. Among the participants, 77(36.7%) had the similar condition in previous years. One hundred and fifty seven (80.9%) were aware about this disease and 52(27%) devotees adopted some kind of precautionary measures. Bivariate analysis showed significant association between occurrence of CLM lesions and frequency of performing the ritual (p<0.001, OR-15.1; 95% CI:7.2-32.0), the timing of ritual performance (p = 0.022, OR-1.96; 95% CI:1.10–3.52), similar condition in previous year (p<0.001, OR-6.83; 95% CI: 3.39–13.76) and previous awareness of the condition (p = 0.005; OR-0.59;95% CI:0.43–0.82). Multivariate analysis showed that the frequency of ritual performance (OR-11.75; 95% CI 5.37–25.74) and similar conditions in previous years (OR-4.71; 95% CI: 2.14–10.39) were the independent risk factors. Two of the 20 soil samples were positive for the nematode larvae and three out of five dog faeces were positive for hookworm eggs.

Conclusions/Significance

Deworming the stray dogs around the temple premises combined with the awareness programs among the public may be the effective and feasible precautionary measures to control similar epidemics in future.