Larva migrans B76.9

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 09.04.2021

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Synonym(s)

creeping disease; creeping eruption; creeping myiasis; Creeping sickness; creepinmg disease; Myiasis linearis migrans; plumber's itch; Plumber\'s itch; Skin mole; water dermatitis

History
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Lee, 1874

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

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

In distinction to the larva migrans visceralis syndrome (e.g. triggered by Toxocara canis or Toxocara cati, the roundworms of dogs and cats) the term "larva migranscutanea syndrome" instead of larva migrans (larva migrans refers to the pathogen in the ordinary sense) is the better terminology.

  • Larvae of horseflies
  • Ankylostoma species (hookworms such as Ancylostoma brasiliense, Ancylostoma caninum etc. which are primarily pathogenic to animals and are a false host for humans)
  • Strongyloides species
  • Cordylobia anthropophaga (tumbu fly: Africa).

Occurrence/Epidemiology
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Ankylostomatidae (esp. Ancylostoma brasiliens 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 by dog and cat faeces and children's play areas. In contrast to Ancylostoma duodenale and Necator americanus, which cause systemic disease(ancylostomiasis), these species do not succeed in connecting to the vascular system in human skin. The consequence is a local (cutaneous) infestation with the clinical picture of the larva migrans cutanea syndrome.

Myiasis linearis migrans (especially arthropod larvae of the genus Gastrophilus): Fly larvae penetrated through the skin. Mostly occurring on African beaches (barefoot walk).

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

Localization
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Mainly occurring on the lower extremities and glutaeal region, corresponding to the parts of the body that have been in contact with larval sand as found in tropical and subtropical areas. Rare is the infestation of the capillitium.

Clinical features
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At the point of entry, an itchy dermatitis with edema, papules, papulovesicles appears. Characteristic are linear or tortuous, filamentous, very itchy, strongly reddened ductal structures, which prolong themselves by 1-2 cm per day. In Strongyloides species the migration rate is particularly high at 10 cm/hour (see Larva currens below). The larva itself is located 1-2 cm in front of the gait. Danger of bacterial superinfection. Less frequent are follicular papules or pustules, caused by penetration of the larvae into the follicles at the support sites.

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

External therapy
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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

Internal therapy
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According to the S1 guideline, a systemic therapy is the first choice.

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

Operative therapie
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Cryosurgery can be attempted as an alternative to external therapy. However, this procedure is usually more side effects and less effective (nematode larvae may survive low temperatures). More and more people are leaving it!

Notice!

Care must be taken to treat a sufficiently large area of skin (larvae 1-2 cm before the end of the corridor).

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

Note(s)
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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.

Literature
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  1. Bachmeyer C et al (2003) Visceral larva migrans mimicking lymphoma. Chest 123: 1296-1297
  2. Brenner MA et al (2003) Cutaneous larva migrans: the creeping eruption. Cutis 72: 111-115
  3. Caumes E et al (1992) Efficacy of ivermectin in the therapy of cutaneous larva migrans. Arch Dermatol 128: 83-87
  4. Caumes E et al (2002) Cutaneous larva migrans with folliculitis: report of seven cases and review of the literature. Br J Dermatol 146: 314-316
  5. Davies HD et al (1993) Creeping eruption. A review of clinical presentation and management of 60 cases presenting to a tropical disease unit. Arch Dermatol 129: 588-591
  6. Grunow K, Bachter D (2007) Pruritic follicular bound papules and pustules gluteal. Dermatologist 58: 623-626
  7. Leiper RT (1909) The structure and relationships of Gnathostoma siamense (Levinsen). Parasitology 2: 77-80
  8. Lupi O et al (2015) Mucocutaneous manifestations of helminth infections: trematodes and cestodes. J Am Acad Dermatol 73:947-957
  9. Meotti CD et al (2014) Cutaneous larva migrans on the scalp: atypical presentation of a common disease. An Bras Dermatol 89:332-333
  10. Nenhoff P (2016) Larva migrans cutanea: successful topical therapy with ivermectin - a case report. J Dtsch Dermatol 14: 622-623.
  11. Owen R (1836) Gnathostoma spinigerum n. sp. Proc Zool Soc London 47: 123-126.

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 09.04.2021