Practice Essentials

Cutaneous larva migrans (CLM) is a serpiginous eruption usually confined to the skin of the feet, buttocks, or abdomen caused by dog and cat hookworms, which are types of nematodes (roundworms).^[1]Skin findings are due to a hypersensitivity reaction to the worms and their byproducts.^{[2, 3]}

Although CLM can occur in the temperate zones in the warmer months of the year, infection is most commonly found in tropical and subtropical climates. Modern ease of travel necessitates inclusion of CLM in the differential diagnosis of serpiginous pruritic lesions, regardless of the location of practice.^{[4, 5]}See the images below.

Cutaneous larva migrans involving the foot with erythematous, edematous, serpiginous tracks. Infestation has caused a cellulitis.

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Cutaneous larva migrans involving the dorsal foot. Graphic courtesy of Dr Sara K. Ward.

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Pathophysiology

Larvae from animal nematodes that infect humans usually cause CLM. The normal hosts for these hookworms are cats and dogs, in which the roundworm eggs pass through the feces. The eggs optimally hatch in warm, shady, moist, sandy soil found in tropical and subtropical areas. Humans are infected with the larvae by walking barefoot on the sand. The larvae quickly penetrate the skin upon contact.

Beaches are the most common reservoir for the larvae that cause CLM; however, infection can occur from sandboxes and soil under houses or at construction sites.^[6]The prohibition of dogs and cats on beaches is a way to limit transmission of the infection.

Frequency

United States

Exact incidence is unknown; however, Jelinek et al reported that 6.7% of the 13,300 travelers visiting a travel-related disease clinic presented with CLM.^[7]In the United States, most cases occur in eastern and southern coastal areas from New Jersey to Texas. The highest incidence is in Florida.

International

Worldwide distribution is predominantly reported in tropical zones, although cases acquired in France and Portugal illustrate the broad distribution of the causative organisms.^{[8, 9]}CLM is indigenous to the Caribbean, Central and South America,^[10]Africa, Southeast Asia, and Australia.^[11]

Mortality/Morbidity

Mortality from the infection is not reported. Most episodes of CLM resolve with or without treatment and with no long-term adverse consequences. Morbidity is associated with an intensely pruritic rash, which leads to secondary impetiginization and cellulitis. In rare incidents of CLM in which nematodes use a human as a definitive host, infection can lead to the completion of the nematode life cycle with adult worms residing in the intestines. This causes diarrhea, malabsorption, and malnutrition.

Race

CLM has no racial predilection.

Sex

No sex predilection is observed.

Age

CLM affects all ages in the appropriate environment.

Clinical Presentation

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Media Gallery

Cutaneous larva migrans involving the foot with erythematous, edematous, serpiginous tracks. Infestation has caused a cellulitis.
Cutaneous larva migrans involving the dorsal foot. Graphic courtesy of Dr Sara K. Ward.

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Author

Martha L Muller, MD, MPH Professor of Pediatrics, Division of Infectious Diseases, University of New Mexico School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Martin Weisse, MD Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Michael D Nissen, MBBS FRACP, FRCPA, Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital

Michael D Nissen, MBBS is a member of the following medical societies: American Academy of Pediatrics, Royal College of Pathologists of Australasia, Royal Australasian College of Physicians, American Society for Microbiology, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

Jining Wang, MD Department of Dermatology, Dean Health System

Jining Wang, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Kim Wang, MD Staff Physician, Department of Pathology, Northwestern University Medical School

Kim Wang, MD is a member of the following medical societies: United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.