• Most common organism is the dog or cat hookworm, Ancylostoma braziliense.
• Other species include A. canium, Uncinaria stenocephala, and Bunostomum phlebotomum.

• Humans are accidental hosts.
• Filariform larvae penetrate the epidermis either through hair follicles or fissures or through intact skin with the use of proteases.
• Diagnosis is usually clinical. Organisms rarely recovered from biopsy and antibody titers unreliable because symptoms are due to hypersensitivity to the organism or its excreta, and immunity usually does not develop.

• Most common manifestation is an intensely pruritic, linear, serpiginous skin lesion known as a “creeping eruption.”
• Most common complication is secondary bacterial infection of the involved skin.
• Rare cases of a peripheral eosinophilia with pulmonary infiltrates (Loffler syndrome) occur when dermal penetration by the larvae occurs and the bloodstream is invaded.

• Contracted from contaminated soil.
• Worldwide distribution, but most frequent in warmer climates, including the Caribbean, Africa, South America, Southeast Asia, and Southeastern United States.
• Occupational exposures occur from crawling under buildings, such as plumbers and pipe-fitters.
• Route of spread:
  • Primary host (dog or cat) passes eggs to ground through feces.
  • Warm, sandy soil acts as an incubator.
  • Eggs mature into rhabditiform larvae (non-infectious), which molt in 5 days to filariform larvae (infectious).
  • Incubation period from infection to symptoms usually 7 to 10 days, although can range up to several months.

• Most common complication is secondary bacterial infection of the skin. Self-limited disease—if untreated, larvae die within 2 to 8 weeks but may persist for up to 1 year.
• Rarely, the larvae can invade the dermis and, subsequently, the bloodstream, leading to a peripheral eosinophilia and pulmonary infiltrates (Loffler syndrome).

• This is a self-limited disease and without treatment will resolve when the larvae die.
• There is a 98% response rate to topical thiabendazole and a 99% response rate reported with oral thiabendazole.

• Cutaneous larva migrans should be considered in anyone with an intensely pruritic, raised, serpiginous, linear cutaneous eruption.
• Hookworm infections (Strongyloides stercoralis, Uncinaria stenocephala, Bunostomum phlebotomum, Gnathostoma spinigerum )
• Free living nematodes (Pelodera strongyloides ), and insect larvae.
• Other cutaneous eruptions which may mimic cutaneous larva migrans include erythema chronicum migrans of Lyme disease, jelly fish stings, and photosensitivity.

Question: What is the incubation period?
Significance: Usual time from infection to symptoms is 7 to 10 days but may last for up to several months.

Question: Is there rash?
Significance: It is intensely pruritic, raised, serpiginous, and linear. Often located on the feet and extremities, buttocks, and genitalia.

Question: Is there pruritis?
Significance: Symptoms typically begin with some tingling in the affected area with the development of the typical rash with intense pruritus.

Question: How fast does rash spread?
Significance: Rash typically lengthens by 2 to 3 cm daily.

Test: Biopsy
Significance: Rarely yields organisms

Test: Serologic testing
Significance: Not helpful

• First-line treatment is topical thiabendazole, supplied as a 10% suspension of 500 mg/5 mL applied four times per day for 10 days.
• Alternatively, oral thiabendazole in a dose of 25 to 50 mg/kg/day q12h for 2 days
• Albendazole, not approved for use in the United States, is available in other countries and is administered as 400 mg/day for 3 days in adults.

• Symptoms persist for 8 weeks but up to 1 year in untreated patients.
• Those with extensive involvement should be seen after treatment to be certain of improvement in symptoms.

Q: Can children spread the infection to each other?
A: The usual spread of infection is from direct contact with the larvae. Spread from one individual to another usually does not occur.

Davies HD, Sakuls P, Keystone JS. Creeping eruption: a review of clinical presentation and management of 60 cases presenting to a tropical disease unit. Arch Dermatol 1993;129(5):588–591.

Jones SK. Cutaneous larva migrans—‘recurrens’[Letter]. Br J Dermatol 1994;130(4):546.

Uppal A, Liebers D, Tobin EH. Tracking the itch. When to suspect migrating larvae. Postgrad Med 1997;101(5):281–282, 288.

Van den Enden E, Stevens A, Van Gompel A. Treatment of cutaneous larva migrans. N Engl J Med 1998;339(17):1246–1247.