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Competing Interests: Competing interests: None.

General Purpose: To provide information about infection with cutaneous larva migrans (CLM)., Target Audience: This continuing education activity is intended for physicians, physician assistants, NPs, and nurses with an interest in skin and wound care., Learning Objectives/outcomes: After participating in this educational activity, the participant will:1. Distinguish the clinical features, diagnosis, and management of CLM.2. Explain the epidemiology of CLM., Abstract: Cutaneous larva migrans is a hookworm infection and one of the most common skin diseases of tourists in tropical countries. Most commonly, the infection is transmitted by contact with feces of dogs and cats containing hookworm eggs. This case-based review explores the epidemiology, diagnosis, clinical features, and management of cutaneous larva migrans infection.

Toxocara canis and T. cati are among the most widely distributed helminthic species in the world with a high zoonotic impact. Millions of people are infected a and hundreds of thousands are suffering from toxocarosis, a disease encompassing four different entities: larva migrans visceralis (VLM) syndrome, ocular larva migrans (OLM) syndrome, covert toxocarosis (covT), common toxocarosis (comT) and neurotoxocarosis (NT). Toxocara infections in humans may remain clinically inapparent but may also induce severe diseases. This contribution gives a synoptic overview of the most important historical, clinical, diagnostic and therapeutical aspects of toxocarosis in humans., (© 2020 Elsevier Ltd All rights reserved.)

Tropical regions receive a significant part of the traveling population. It is very important that health professionals are familiar with the main tropical skin diseases and able to advice patients appropriately. This article reviews the main tropical diseases of travelers, with an emphasis on diagnosis, management, and prevention. Among others, cutaneous larva migrans, myiasis, tungiasis, Chagas disease, Dengue fever, African trypanosomiasis, filariasis, and leishmaniasis are discussed. Increasing awareness among travelers and health care professionals can help reduce morbidity and mortality. Continued research on new drugs and vaccines is needed to reduce the risks of tropical diseases., (© 2018 Wiley Periodicals, Inc.)

Hookworm-related cutaneous larva migrans is an infestation of the skin caused by nematodes. Involvement of genitals is extremely rare. We report the case of a child with this infestation on the penis who cleared rapidly with topical ivermectin., (© 2019 Wiley Periodicals, Inc.)

Larva migrans cutanea is a typical skin parasitosis of tropical and subtropical regions. In Central European countries, such as Slovakia and Czech Republic, larva migrans cutanea is just an imported disease. Its clinical symptoms are characterized by formation of erythematous focus with serpiginous morphology, which is caused by migration of helminth in epidermis. The disease does not threaten the patient's life, but causes significant discomfort, especially in form of pruritus in the affected area. Thanks to growing trend of today's tourism more tourists are exposed to the harmful effects of the environment in final destinations. This leads to an increase in frequency of imported diseases, with which physicians in our latitudes may not have enough experience.

Background: Cutaneous larva migrans (CLM), a zoonotic helminthiasis imported to Canada by travelers to the tropics, causes morbidity due to severe, intractable pruritus. Treatment in Canada is only available through the Special Access Program (SAP) of Health Canada, thus, many patients are prescribed ineffective courses of non-targeted therapy., Objective: We analyzed patients with CLM referred to our specialized Tropical Disease Unit (TDU) having failed non-targeted therapy prior to referral, and characterized demographic and travel related correlates of CLM., Methods: Patients with CLM evaluated between June 2012 and December 2014 were identified through our SAP application log, and charts were reviewed for demographic, clinical, and travel-related data following IRB approval., Results: 25 patients with CLM were identified: 12 women, and 13 men. Median age was 35 years (range 4-58 years). Patients had primarily acquired their CLM in the Caribbean (80%), with Jamaica being the most well represented source destination (N = 10, 40%). Reported symptoms included intense, function-limiting pruritus (N = 25, 100%) and loss of sleep (N = 3, 12%). Twelve patients (48%) with CLM had received at least 1 course of non-targeted therapy prior to referral. Non-targeted therapies included topical steroids (N = 7), cryotherapy (N = 3), oral antibiotics (N = 2), and oral mebendazole (N = 11). Median duration of symptoms was 34 days (range 5-226 days). Of 25 patients with CLM, 23 (92%) were prescribed a single 3-day course of albendazole and responded appropriately, and 2 (8%) required a second 3-day course of albendazole., Conclusions: Although CLM is non-communicable and of little public health relevance in Canada, it causes significant morbidity. A substantial proportion of patients with CLM referred to our specialized TDU had a prolonged course of illness and were prescribed ineffective and non-targeted therapies. Oral albendazole or ivermectin, or topical thiabendazole, are the drugs of choice for CLM, and should be prescribed as first-line therapy., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Cutaneous larva migrans (CLM) is a pruritic dermatitis caused by migration of animal hookworm larvae into the skin. We present a case of CLM in a 31-year-old pregnant woman. The treatment of CLM relies on antihelminthic agents, such as thiabendazole, albendazole, and ivermectin. This case was interesting in that the standard treatment options previously mentioned were contraindicated owing to the patient's pregnancy. Cryotherapy with liquid nitrogen resulted in complete resolution of her lesion and symptoms.

This article provides a focused update and clinical review on select helminth infections. The goal is to report atypical clinical presentations and newer management recommendations. The results and recommendations should be interpreted with the understanding that future studies may alter what is presented.

In today's world, many people can travel easily and quickly around the globe. Most travel travel-related illnesses include fever, diarrhea, and skin disease, which are relatively uncommon in returning travelers. We review four of the most common emerging infestations and skin infections in the Americas, which are important to the clinical dermatologist, focusing on the clinical presentation and treatment of cutaneous larva migrans, gnathostomiasis, cutaneous amebiasis, and trombiculiasis.

Cutaneous larva migrans (CLM, creeping eruption) is a skin disease commonly seen in travelers returning from the tropics. The lesions are caused by intradermal migration of animal hookworm larvae which cannot mature in humans. While the typical serpiginous skin lesions are easily diagnosed and treated with albendazole or ivermectin, unusual presentations can be misdiagnosed and cause prolonged morbidity. We present 3 cases of CLM, which were difficult to diagnose and/or treat.Case 1 is a 34-year old Caucasian male who presented with itchy papular lesions on the soles of both feet and was initially treated for plantar psoriasis.Case 2 is a 54-year old Caucasian male who suffered from extensive follicular larva migrans on the buttocks for several months and was only cured after repeated courses of albendazole and ivermectin.Case 3 is a 29-year old Caucasian male with pruritic inflammatory papules on the trunk. Despite extensive diagnostic procedures including skin biopsies and tissue cultures the correct diagnosis was only made later during the course of the illness. After treatment for CLM with albendazole (800 mg/d for 3 days) and after resolution of perifocal edema and inflammation the typical serpiginous tracks became more obvious. They responded rapidly to anthelminthic treatment.These cases highlight the importance of careful history taking and work-up in individuals presenting with atypical skin lesions. In case of exposure to CLM empiric anthelminthic treatment might be considered.

Objective: To determine the efficacy of combination treatment of Albendazole along with liquid nitrogen in cutaneous larva migrans., Study Design: Quasi-experimental study., Place and Duration of Study: Abbasi Shaheed Hospital and The Aga Khan Hospital, Karachi, from December 2008 to December 2010., Methodology: Eighteen cases of cutaneous larva migrans were collected and divided into two groups. Group-A was administered oral Albendazole 400 mg once per day along with topical steroid and oral cetrizine 10 mg once at night for 7 days. Group-B also received oral Albendazole 400 mg once per day along with cetrizine 10 mg once at night but they also received single application of liquid nitrogen to freeze the larva., Results: It was found that in Group-A only 2 out of 9 (22%) showed improvement whereas 78% had to be given liquid nitrogen cryotherapy 3 - 7 days after Albendazole to prevent migration of larva. In Group-B, the improvement was 100% and all 9 patients were successfully treated., Conclusion: Use of liquid nitrogen along with oral anti-helminths is very effective in treating cutaneous larva migrans than Albendazole alone.

The zoonotic roundworms Toxocara canis and T. cati are not only present worldwide in their definitive hosts; they also frequently occur in other animal species, including humans. In those so-called paratenic hosts, the larvae do not develop into the adult stage, but rather migrate throughout the somatic tissue and persist as infectious L3 stage for extensive periods. Those arrested larvae may lead to severe inflammatory reactions and consequently to a wide range of pathological and clinical manifestations. However, the infected paratenic hosts also constitute a potential source of infection for the definitive hosts or humans who may also function as paratenic hosts. In the present review, current knowledge of larval migration in a variety of possible paratenic hosts is summarized including variations of migration routes and susceptibilities. Furthermore, information about the clinical and pathological changes for the presented species and possible consequences of the somatic migration of larvae, i.e. the resulting tissue damage as well as adverse host reactions to arrested larvae are reviewed. There are still many questions unanswered regarding larval behaviour in hosts other than their definitive host. Therefore, it is of great importance to continue further elaboration on the biology of Toxocara spp. to prevent further spreading of larvae in both the paratenic and the definitive host., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Tungiasis (sand flea disease) and cutaneous larva migrans (creeping eruption) are parasitic skin diseases in which the infectious agents only temporarily invade human skin. The parasites die in situ and eventually are eliminated by tissue repair mechanisms. Both diseases are zoonoses. Humans only accidentally become a host for animal hookworm larvae (resulting in cutaneous larva migrans), but get infected with Tunga penetrans as frequent as domestic animals. In travelers to tropical and subtropical regions tungiasis and cutaneous larva migrans are the most common imported skin diseases. The diagnosis is made clinically. In tungiasis the clinical manifestations depend on the stage of the disease. Intense local inflammation and bacterial superinfection are common. Cutaneous larva migrans is treated orally with ivermectin or albendazole. A repellent based on coconut oil effectively prevents penetration of sand fleas.

Cutaneous larva migrans or creeping eruption is an uncommon parasitic skin infection caused by the filariform larvae of dog or cat hook worms. We report a case of larva migrans on the anterior abdominal wall, in a 52 year old lady, who did gardening as a hobby.

Diagnostic and therapeutic problems of ocular toxocarosis in patients with late pathological changes was observed. Multispecialistic methods (ophtalmological, radiological, immunoserological) in evaluation of patients were used. In the course of prolonged observation of patients treated many times with albendazole (Zentel, Smith Kline and Beecham GB) no improvement of vision and no regression of late and irreversible ocular pathology were noted.

A 38 year old woman from Dresden presented in September 2002, about four weeks after the Elbe River flooding with signs of cutaneous larva migrans on the back of her hand. There was no history of travel to tropical or subtropical regions in the last few years. Cryotherapy as well as systemic ivermectin (Stromectol) therapy were not successful in stopping progress of the lesions. Combination therapy with systemic ivermectin and topical tiabendazole (Lombristop) induced full remission. Cutaneous larva migrans normally occurs in German patients only after recent visits to tropical or subtropical regions. In our patient, however, it was most likely due to the unusual climatic conditions in the summer of 2002 in the Elbe region: Heavy rainfalls and inundation by regional rivers soaked the ground, followed by a period of unusually hot and sunny weather.

Background: Creeping eruption (CE), which is characteristic of tropical and subtropical regions, is being increasingly frequently observed in Italy. The presence on the beaches of stray animals infected by nematodes of the Ancylostoma species favors contact between human skin and the larva-infested soil., Materials and Methods: Our experience with 56 patients (13 cryotherapy, one thiabendazole together with cryotherapy, six thiabendazole, two albendazole with cryotherapy, and 34 albendazole) is described., Results: A prompt and definitive cure was achieved in all 56 patients. The therapeutic effectiveness of the various methods used is therefore equivalent., Conclusions: We believe that albendazole should be considered the first choice for treatment. It is extremely well tolerated and patient compliance is good.

Residents of western countries travel more and more to (sub)tropical areas for holidays or work. During their stay they come in contact with insects and parasites susceptible to induce skin disorders that can manifest during their stay or after returning. This dermatosis account for approximatively 10% of referral to outpatient tropical clinics. The aim of this paper is to provide family physicians not familiar with these pathologies some practical guidelines to help them to identify and treat some tropical dermatosis: cutaneous larva migrans, cutaneous leishmaniasis, Lyme disease, rickettsiosis. Cutaneous larva migrans is the most frequent serpiginous itching eruption observed in travellers. It is cause by transepidermal penetration of animal hookworms (ancylostomas) through contact with soil infested with cat and dog feces. Effective treatments include topical thiabendazole or oral albendazole or ivermectine. Persons visiting mediterranean countries can acquire cutaneous leishmanisis that has many clinical presentations; the most typical is "bouton d'Orient", which manifests as painless ulceration resistant to antibiotic treatment. Treatment with intralesionel pentavalent antimony or pentamidine injection are effective. Lyme disease is an endemic infection in certain areas of North America and Europe, caused by the spirochete borrelia and transmitted through tick bite. It manifest as non-itching large persistent migrant erythema. If untreated this infection may expose to chronic debilitating rheumatologic, cardiac and neurological complications. Rickettsiosis, especially boutonneuse fever, are a potentially fatal multisystemic infectious diseases transmitted through the bite of a dog tick. Diagnosis must be evoked in the presence of a brutal fever syndrome, a painless eschar and widespread eruption associate to systemic symptoms. This infection must be recognized clinically in order to begin rapidly treatment with cyclines.

Cutaneous larva migrans caused by the larvae of animal hookworms is the most frequent skin disease among travelers returning from tropical countries. Complications (impetigo and allergic reactions), together with the intense pruritus and the significant duration of the disease, make treatment mandatory. Freezing the leading edge of the skin track rarely works. Topical treatment of the affected area with 10%-15% thiabendazole solution or ointment has limited value for multiple lesions and hookworm folliculitis, and requires applications 3 times a day for at least 15 days. Oral thiabendazole is poorly effective when given as a single dose (cure rate, 68%-84%) and is less well tolerated than either albendazole or ivermectin. Treatment with a single 400-mg oral dose of albendazole gives cure rates of 46%-100%; a single 12-mg oral dose of ivermectin gives cure rates of 81%-100%.

Family physicians should be alert for unusual diseases in patients who are returning from foreign travel. Malaria is a potentially fatal disease that can be acquired by travelers to certain areas of the world, primarily developing nations. Transmitted through the bite of the Anopheles mosquito, malaria usually presents with fever and a vague systemic illness. The disease is diagnosed by demonstration of Plasmodium organisms on a specially prepared blood film. Travelers can also acquire amebic infections, which may cause dysentery or, in some instances, liver abscess. Amebiasis is diagnosed by finding Entamoeba histolytica cysts or trophozoites in the stool. Invasive amebic infections are generally treated with metronidazole followed by iodoquinol or paromomycin. Cutaneous larva migrans is acquired by skin contact with hookworm larvae in the soil. The infection is characterized by the development of itchy papules followed by serpiginous or linear streaks. Cutaneous larva migrans is treated with invermectin or albendazole. Case studies are presented.

The paper reports about the ocular symptomatology of toxocariasis that represents a severe parasitic disease especially in children. Recently, the incidence of this disease is increasing. Diagnostic process has improved by means of newly developed laboratory methods. Ocular findings on retina are in toxocariasis identified very late. Despite many antihelmintics, steroids and surgical treatment, a poor treatment success has been achieved, and the sight remains often permanently severely affected. Because of the risk of blindness the most efficient arrangement is prophylaxy from the side of parents, teachers, veterinarions and the society as a whole. (Fig. 3, Ref. 6.)

Baylisascaris procyonis is an ascarid which parasitizes the small intestine of raccoons. The parasite is not very pathogenic in the raccoon because larvae do not migrate in this host. In other animals the larvae migrate through the body. They do not develop into adult worms in the intestine but rather become encysted in granulomas, showing a preference for the brain. In humans these larvae cause different larva migrans syndromes. Patients with neural larva migrans syndrome show severe brain symptoms and the disease is sometimes fatal. This article describes the life cycle of the worm and the incidence, symptoms, diagnosis, treatment, and prevention of larva migrans syndromes, paying special attention to the Dutch situation.

A 29-year-old man with a furuncle-like lesion brought in a maggot on the next day after his first visit to our clinic. He said it moved out from the eruption spontaneously. He had previously visited Parana and Sao Paulo in Brazil before he noticed the symptom. The maggot was confirmed to be a third instar larva of Dermatobia hominis. Japanese cases of cutaneous myiasis are reviewed.

Purpose: To evaluate the clinical status and ELISA test changes in a group of children with ocular toxocariasis., Methods: We enrolled 37 patients in the studies. The follow-up period lasted at least 3 years (3-15 years) after the diagnosis had been established. In all cases a complete ophthalmological examination and actual ELISA test were performed. We compared the clinical status in two groups of patients: one with positive and the other with negative ELISA test at the time of control examination., Results: In a majority of initially positive serological patients the control ELISA test for Toxocara canis antigen was negative. In these cases various post-inflammatory lesions in the anterior and posterior pole of the eye were present. In 8 cases the ELISA test was positive, despite the absence of active inflammatory process. In 5 serologically positive patients the active inflammation was observed. In more than 50% of cases the visual acuity was decreased., Conclusion: Ocular toxocariasis is a long-lasting, severe type of uveitis that requires long treatment and causes dramatic visual impairment. ELISA test is a sensitive method indicating the intensity of inflammation in ocular toxocariasis.

The full spectrum of skin diseases related to travel in tropical areas is unknown. We prospectively studied 269 consecutive patients with travel-associated dermatosis who presented to our tropical disease unit in Paris during a 2-year period. The median age of these patients was 30 years; 137 patients were male; 76% of the patients were tourists; 38% had visited sub-Saharan Africa; and 85% had been appropriately vaccinated against tetanus. Cutaneous lesions appeared while the patient was still abroad in 61% of cases and after the patient's return to France in 39%. The diagnosis was definite in 260 cases; 137 of these cases (53%) involved an imported tropical disease. The most common diagnoses were cutaneous larva migrans (25%); pyodermas (18%); pruritic arthropod-reactive dermatitis (10%); myiasis (9%); tungiasis (6%); urticaria (5%); fever and rash (4%); and cutaneous leishmaniasis (3%). Hospitalization was necessary in 27 cases (10%), with a median duration of 5 days (range, 2-21 days). Travelers should be advised on how to avoid exposure to the agents and vectors of infectious dermatoses. Travel first-aid kits should include insect repellents and antibiotics effective against bacterial skin infections.

Ocular toxocariasis (ocular form of larval toxocariasis) arises mainly unilaterally and represents no rare disease. On 3rd Department of Infectology, 1st Faculty of Medicine, Charles University, Prague, 102 patients with proved larval toxocariasis were treated from 1981 to 1990. Ocular toxocariasis concerned only one third of this number. Most frequent form was the retinal toxocaral granuloma (in 55.2%), positioned by two thirds at the posterior pole of retina. In one case, endophthalmitis led to amaurosis of the eye. Clinical forms typical for ocular toxocariasis are presented. No statistically significant difference was observed in treatment effects using thiobendazole or diethylcarbamazine. All patients with ocular toxocariasis were treated with systematic steroids.

Although cutaneous larva migrans is more commonly seen in the southeastern US and tropical regions of the world, patients with such parasitic involvement may present in other non-endemic areas for various reasons, particularly travelers returning from tropical vacations. Awareness of the clinical presentation and symptomatology of cutaneous larva migrans is important for all physicians, including those practicing in northern climates, for prompt recognition and effective treatment of the disease. Furthermore, cutaneous larva migrans should be of particular interest to podiatrists, because the infestation commonly involves the feet, and a patient may initially present for treatment of secondary manifestations, ie, dermatitis, pruritus, or infection, as in this case report.

The authors report a rare case of ocular larva migrans lesions due toxocara canis in an 8-year-old child. Lesions were bilateral, consisting of peripheral chorioretinal granuloma, papillitis and vasculitis. Diagnosis was confirmed by eosinophilia (37%), positive serology in blood and aqueous humour and by raised immunoglobulins E in vitreous humour. The presence of vascular and chorioretinal lesions was demonstrated by fluorescein angiography. The patient was treated with antihelminthic drugs, topical and systemic steroids and ocular cryotherapy to the peripheral chorioretinal granuloma. The outcome was good, with lesions stabilised.

External ophthalmomyiasis occurred in a 16-year-old white girl who was infected on Catalina Island, an endemic area for the sheep bot fly. With the patient under topical anesthesia, we isolated the larva, Estrus ovis, removed it with jewelers' forceps, and examined it with light and scanning electron microscopy. The patient responded well to a treatment regimen of corticosteroids and antibiotics.

Parasitic infestation may resemble bacterial inflammation leading to inappropriate therapy. Three cases of cutaneous larva migrans of the upper extremity are presented in order to emphasize diagnostic and treatment modalities.