Clinical Presentation in Humans

 

The "creeping itch" that is the main characteristic of cutaneous larva migrans is also found in many other parasitic diseases. For this reason, CLM is often confused for contact dermatitis, fungal infections, etc.

Creeping eruption of two weeks' duration on the leg (Kirby-Smith, et. al.).

The most common clinical symptom of CLM are the visible, raised, red (erythematous), twisting (serpiginous), itchy (pruritic), tracks or burrows formed on the skin.

Picture from Department of Dermatology, University of Iowa.

Common Clinical Symptoms include the following:

o At the point of entry, reddish papules develop, raised, red and itchy bumps (Ground Itch).

o As the larvae migrate through the skin very pruritic, serpiginous tracts develop that advance several millimeters or centimeters each day. Most patients with CLM have only one to three tracks that advance 2-5 cm daily.

(Kirby-Smith, et. al.)

o Nematode larvae can be found trapped in the follicular canal, stratum corneum, or dermis (all in upper layers of the human skin).

Photomicrograph of skin showing creeping eruption nematode in burrow X 480 (Kirby-Smith, et. al.)

o Creeping eruptions can be found all over the body—but often patients are travellers returning from the beach, so it is usually found on places that contact the sand when people lie down--the buttocks, abdomen, thigh, groin, and most often, the feet.

Picture from the Department of Dermatology, University of Iowa.

o The reaction is not due to the parasite itself, but an immune system allergic reaction to the presence of the larvae and its byproducts.

o These tracks can be so pruritic as to prevent sleep; older burrows become dry and encrusted, and frequent scratching can lead to secondary bacterial infection.

Infected burrow. (Kirby-Smith, et. al.)

o Hookworm folliculitis (mentioned in 1991) is a uncommon form of CLM and there is pustular follliculitis of the buttocks.

Mortality-- mortality from the infection is not reported. Most incidents of CLM resolve with or without treatment and with no long-term adverse reactions.

Morbidity—morbidity associated with the intensely pruritic rash and possible secondary bacterial infection. Rarely, deeper tissue migration can occur (migrate to lungs and intestines) and can cause pneumonitis (Loeffler's syndrome), or enteritis, or myositis (muscle soreness).