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Cutaneous larva migrans: clinical features and management of 44 cases presenting in the returning traveller
1Department of Dermatology, Middlesex Hospital and Hospital for Tropical Diseases, University College London Hospitals Trust, Arthur Stanley House, Tottenham Street, London W1P 9PG, UK.
Background:
Cutaneous larva migrans (CLM) is the result of a nematode infection, and shows a characteristic creeping eruption. As travel to the tropics increases, many British citizens may be returning with this infection, which is often misdiagnosed or treated incorrectly.
Objectives:
To perform a retrospective survey of 44 cases of CLM presenting to the Hospital for Tropical Diseases in London over the last 2 years.
Methods:
Cases were reviewed with regard to patient characteristics, source of infection, source of referral, clinical features and therapy.
Results:
Most infections were acquired in Africa (32%), the Caribbean (30%) and South-east Asia (25%), but also in Central and South America. There was a history of exposure to a beach in 95% of patients and the median duration of symptoms was 8 weeks (range 1-104). Lesions mainly affected the feet (39%), buttocks (18%) and abdomen (16%), but the lower leg, arm and face were also affected. Multiple lesions were seen in seven of 44 cases (16%). Laboratory abnormalities were absent in all patients. Of 44 patients seen, four needed no treatment, 28 were cured by a single course of treatment, 11 required a second course of therapy and one patient was treated three times. Thirty-one patients received oral albendazole 400 mg daily for 3-5 days and 24 were cured (77%). Five patients received 10% thiabendazole cream topically for 10 days and four were cured (80%). Four patients received oral thiabendazole 1.5 g daily for 3 days and all required further therapy.
Conclusions:
In view of the range of treatment regimens recorded, a randomized controlled trial comparing topical and systemic therapies is warranted.
Insights
Cutaneous larva migrans (CLM) is a nematode infection often seen in travelers. Oral albendazole and topical thiabendazole cream showed high cure rates, suggesting further research into optimal treatment is needed.
Area of Science:
- Tropical medicine
- Dermatology
- Infectious diseases
Background:
- Cutaneous larva migrans (CLM) is a nematode infection characterized by a creeping eruption.
- Increased travel to tropical regions leads to more British citizens returning with CLM, often facing misdiagnosis or incorrect treatment.
Purpose of the Study:
- To conduct a retrospective survey of 44 cutaneous larva migrans (CLM) cases.
- To analyze patient demographics, infection sources, referral patterns, clinical presentations, and treatment outcomes.
Main Methods:
- Retrospective review of 44 CLM cases presenting to the Hospital for Tropical Diseases, London.
- Data collected included patient characteristics, infection origin, referral source, clinical features, and therapies administered.
Main Results:
- Most infections were acquired in Africa (32%), the Caribbean (30%), and Southeast Asia (25%).
- 95% of patients had beach exposure history; median symptom duration was 8 weeks. Lesions commonly affected feet (39%), buttocks (18%), and abdomen (16%).
- Oral albendazole (400 mg/day for 3-5 days) cured 77% of patients. Topical thiabendazole cream (10% for 10 days) cured 80%. Oral thiabendazole (1.5 g/day for 3 days) required further treatment in all cases.
Conclusions:
- Treatment regimens for CLM varied, with oral albendazole and topical thiabendazole cream demonstrating good efficacy.
- A randomized controlled trial comparing topical and systemic therapies is recommended to establish optimal treatment protocols for CLM.