Larva migrans B76.9

Immigration of larvae of various parasite species (worms/flies) into the skin with characteristic, inflammatory, linear, itchy migration pathways.

Various parasites can trigger the clinical picture of"larva migrans cutanea syndrome". In this respect, the so-called "larva migrans" is not an independent clinical picture, but merely the clinical symptom of an infestation by these parasites.

In contrast to larva migrans-visceralis syndrome (caused by Toxocara canis or Toxocara cati, the roundworms of dogs and cats), the term "larva migrans-cutanea syndrome" instead of "larva migrans" (larva migrans actually refers to the pathogen) is the better term.

• Larvae of the horse flies
• Ancylostoma species (hookworms such as Ancylostoma braziliense, Ancylostoma caninum, etc., which are primarily pathogenic to animals and for which humans are a false host)
• Strongyloides species
• Cordylobia anthropophaga (Tumbu fly: Africa)

Ankylostomatidae (in particular Ancylostoma braziliense and caninum; Strongyloides stercoralis): The larvae of the above-mentioned nematodes (threadworms) actively bore through the skin when walking barefoot or lying on the beach. Sources of infection are beaches contaminated with dog and cat excrement and children's play areas. In contrast to Ancylostoma duodenale and Necator americanus, which cause a systemic clinical picture(ancylostomiasis), these species are unable to connect to the vascular system in the human skin. The result is a local (cutaneous) infestation with the clinical picture of larva migrans cutanea syndrome.

Myiasis linearis migrans (especially arthropod larvae of the genus Gastrophilus): Fly larvae penetrating the skin. Infestation usually occurs on African beaches when walking barefoot.

Most common disease in tropical travelers; no age restrictions; more common in children and adolescents and younger adults.

Occurs mainly on the lower extremities and in the gluteal region, corresponding to the typical predilection sites, namely those exposed to sand contaminated with larvae, as found in the tropical and subtropical areas concerned. Infestation of the capillitium is rare.

The clinical picture with the itchy, bizarre ducts is diagnostic. In the rare follicular symptoms, bacterial folliculitis must be excluded.

1% ivermectin cream (off-label use; preparation - Soolantra® - is, however, approved for the treatment of rosacea) 2x daily for a period of 14 days.

Alternatively: 10%-15% Tiabendazole ointment(e.g. R254, Mintezol) under occlusion several times a day for 5-7 days. Note: Tiabendazol is often no longer available. If necessary, purchase via foreign countries.

Alternative: Albendazole 10% in Vaseline (apply 3 times daily to the affected areas)

Supplementary: if necessary, glucocorticoid supplementation in case of a strong inflammatory reaction or alternating therapy

According to the S1 guideline, systemic therapy is the 1st choice therapy.

• Albendazole (e.g. Eskazole) 800 mg/day p.o. for 3 days.
• Alternative (off-label): Ivermectin (Mectizan) 200 µg/kgKG p.o. as a single dose. Note: Ivermectin can be obtained and prescribed declared as an individual therapeutic trial through an international pharmacy.

Notice!

Man is a false host; even untreated there is always spontaneous healing. But this can take months.

Hookworm folliculitis must always be treated systemically!

The visceral "larva migrans" caused by human pathogens often lacks the typical bizarre duct structures in the skin, resulting in organ infestation.

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