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A 53 year old man presented with an itchy, red rash on his lower leg after a trip to Brazil. He recalled having been bitten on the right ankle while on a beach and had covered the bite with a plaster. The initial bite mark on the ankle extended by 1-2 cm per day in a serpiginous pattern across the ankle and up the leg (figure) . Other than intense irritation of the skin, he had no other symptoms and was systemically well.
Questions
1 What is the diagnosis?
2 What are the differential diagnoses?
3 How is it treated?
Answers
Short answers
1 Cutaneous larva migrans is a common, tropically acquired dermatosis caused by the percutaneous penetration and migration of larvae of nematode parasites.
2 Other infestations-including erythema migrans of Lyme disease, migratory myiasis, and larva currens caused by Strongyloides stercoralis -should be considered.
3 Cutaneous larva migrans is self limiting, but its clinical course is shortened by effective treatment with topical and oral anthelmintics such as albendazole, thiabendazole, and ivermectin.
Long answers
Cutaneous larva migrans is one of the most common imported parasitic infestations diagnosed in travel clinics 1 and to be considered in the returned traveller. 2 3 It is a parasitic skin infection caused by hookworm larvae which parasitise cats and dogs but may also penetrate into the epidermis of humans. 4 It is most commonly, but not exclusively, found in the tropical and subtropical areas as well as the southwestern United States, and is usually associated with outdoor activities that include exposure to contaminated water or soil in such areas.
In Brazil, cutaneous larva migrans is highly endemic in resource poor communities:...