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Sunday, September 11, 2011

Skin Manifestation of Hook Worm Disease-Sand Worm Disease

Posted by Prahallad Panda on 1:13 PM Comments

MigransImage of Cutaneous Larva Migrans
Helminths/Nematodes, apart from causing disorders in the digestive system and systemic complications like anemia, malnutrition, intestinal obstruction and lungs complications; those from definitive hosts like dogs and cats; and some specis from human definitive host can also cause skin lesion in human.

Certain nematodes, particularly the hook worms in their larval form preferably enter the body through the skin from soil contaminated with feces; human or animals like dog or cat. Those may also enter the body through feco-oral route.
This type of entry through skin is mostly seen in the feet and commonly in countries where people do not use foot wears in outdoors. Common in countries like Brazil, West Indies and India; and other tropical countries. Also seen in travelers visiting these countries.
The skin lesion is variously called as Cutaneous larva migrans, Creeping eruption or Sandworm disease. It is caused mostly by larvae of animal hookworms. Ancylostoma braziliense is the most common offender. Other nematodes can be U. stenocephala, A. caninum and Toxocara cani of animal hook worm and Necator American of human hook worm.
Most often, people pick up the infection by walking through contaminated areas barefoot or with open-type shoes, or by sitting in tainted soil or sand.
The main affected areas are the dorsum and sole of the feet, buttocks, pelvic waist, legs and shoulders. More than one lesion is compatible with more than one entry point. The larvae of animal hook worms migrate in wilderness in the superficial skin of human who are not the definitive hosts for the nematodes and is almost a dead end; but in the process those may get lodged in some parts of body like muscles, breasts or very rarely in retina. Necator American travel in the skin for sometime before finding a small vein to enter the system.
In definitive hosts like dog and cat those can find a channel like small vein to enter, from where those can easily get their way to lungs and ultimately to the gut; where those lodge.
The main signs and symptoms are linear and/or serpiginous lesions; which creeps or migrates from 2–3 mm to 2–3 cm per day; popularly coining the terms in describing the disease. There is pruritus/itching at the entry point as well as in the tract.
This is intensified after some days by the inflammatory reaction of the host and may even interfere with sleep. Blisters may appear and cause pain.
Eosinophilia, increased eosinphil component of White blood cell population in blood (Differential Count, DC), Lungs infiltration in X-rays examination and increased immunoglobulin E levels may be observed, but are rare.
Clinically, the diagnosis of hookworm-related cutaneous larva migrans can apparently be made easily on the basis of typical pruritic serpiginous lesion that advances in a patient with a history of sunbathing, walking barefoot on the beach, or similar activity in a tropical location.
A single dose of ivermectin (200 μg per kg bodyweight), usual adult dose 12 mg; kills the migrating larvae effectively and relieves itching quickly. Oral albendazole (400 mg daily), given for 5–7 days, shows excellent cure rates and the drug is well-tolerated by patients.
Though a self-limiting disease, very few cases of diffuse unilateral sub-acute neuroretinitis (DUSN) has been described in the literatures.
In prevention, when visiting tropical countries, especially beaches and sandy, moist areas, it is best to wear shoes that completely cover the feet. Also, one should avoid sitting or lying on bare sand, even if on a towel.
Deworming of pets is a good idea.
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