Larva migrans - causes, symptoms, diagnosis and treatment. Cutaneous and visceral syndrome larva migrans
The doctor focuses my attention on the bladder, and I focus my attention on the scalloped tortuosity of the rising line on the back of the foot... The diagnosis is clear, but everything is in order.
The patient returned from vacation, and three weeks later an itchy rash and blisters appeared on the right foot.
From the anamnesis: my father and I vacationed in Vietnam, swam and sunbathed on the beach, and stayed more on the sand in the shade of nearby vegetation. Did you ask the child’s father if he himself had any rashes? It turned out that something was also bothering me on the soles of my feet.
On examination: on the dorsum of the right foot, transitioning to the sole, there are convoluted scalloped inflamed stripes of bizarre shapes against an inflamed background. In some areas there is a dyshidrotic rash; on the plantar side there is a large blister filled with serous fluid.
When examining the patient's father: there are similar rashes on the left sole.
Unlike the father, the child has an atopic predisposition in the form of hay fever and indications of diathesis at an early age.
The rash migrates within existing lesions.
Clinical diagnosis
Larva migrans, complicated by eczematous reaction
Nuances
Larva migrans (syn. cutaneous larva migrans, “creeping disease”) is a cutaneous form of the syndrome of the same name, caused by the larva migrans of various nematodes (roundworms), most often Ancylostoma braziliense. Helminth eggs mature in soil or sand, usually in warm and shady places. Infection occurs when walking barefoot or playing in sand contaminated with animal feces.
This is the most common disease among dermatozoonoses, which tourists bring from abroad with a tropical or subtropical climate.
Diagnosis is simple, it is based on the detection of sinuous, slightly elevated lines of bizarre outlines and indications in the anamnesis of stay in endemic regions.
Clinical manifestations may be complicated by an eczematous reaction with the formation of blisters, which is observed in individuals with an allergic (atopic) predisposition.
The passages that the larvae drill in the subepidermal space are filled with serous contents.
A dermoscopic examination can reveal a serous accumulation of fluid in the form of balloons with characteristic hemorrhagic points inside these cavities (see dermatoscopy photo).
Cryotherapy with liquid nitrogen and the use of corticosteroid ointments are effective in treatment.
In some cases, the prescription of anthelmintic drugs is required.
Keep in mind that in rare cases, larvae can enter the bloodstream and cause Loeffler's syndrome. In such cases, occurring with general symptoms and blood eosinophilia, refer patients for an X-ray examination of the lungs.
When ingested by migratory larvae of canine and feline Toxocara, symptoms of the visceral form of larva migrans may develop.
The doctor focuses my attention on the bladder, and I focus my attention on the scalloped tortuosity of the rising line on the back of the foot. The diagnosis is clear, but everything is in order.
The patient returned from vacation, and three weeks later an itchy rash and blisters appeared on the right foot.
From the anamnesis: my father and I vacationed in Vietnam, swam and sunbathed on the beach, and stayed more on the sand in the shade of nearby vegetation. Did you ask the child’s father if he himself had any rashes? It turned out that something was also bothering me on the soles of my feet.
On examination: on the dorsum of the right foot, transitioning to the sole, there are convoluted scalloped inflamed stripes of bizarre shapes against an inflamed background. In some areas there is a dyshidrotic rash; on the plantar side there is a large blister filled with serous fluid.
When examining the patient's father: there are similar rashes on the left sole.
Unlike the father, the child has an atopic predisposition in the form of hay fever and indications of diathesis at an early age.
The rash migrates within existing lesions.
Clinical diagnosis
Larva migrans, complicated by eczematous reaction
Larva migrans (syn. cutaneous larva migrans, “creeping disease”) is a cutaneous form of the syndrome of the same name, caused by the larva migrans of various nematodes (roundworms), most often Ancylostoma braziliense. Helminth eggs mature in soil or sand, usually in warm and shady places. Infection occurs when walking barefoot or playing in sand contaminated with animal feces.
This is the most common disease among dermatozoonoses, which tourists bring from abroad with a tropical or subtropical climate.
Diagnosis is simple, it is based on the detection of sinuous, slightly elevated lines of bizarre outlines and indications in the anamnesis of stay in endemic regions.
Clinical manifestations may be complicated by an eczematous reaction with the formation of blisters, which is observed in individuals with an allergic (atopic) predisposition.
The passages that the larvae drill in the subepidermal space are filled with serous contents.
A dermoscopic examination can reveal a serous accumulation of fluid in the form of balloons with characteristic hemorrhagic points inside these cavities (see dermatoscopy photo).
Cryotherapy with liquid nitrogen and the use of corticosteroid ointments are effective in treatment.
In some cases, the prescription of anthelmintic drugs is required.
Keep in mind that in rare cases, larvae can enter the bloodstream and cause Loeffler's syndrome. In such cases, occurring with general symptoms and blood eosinophilia, refer patients for an X-ray examination of the lungs.
When ingested by migratory larvae of canine and feline Toxocara, symptoms of the visceral form of larva migrans may develop.
Having penetrated the skin, the larvae form winding passages, the skin over which turns red and swells. The larvae migrate at the border of the dermis and epidermis, moving several centimeters daily. Skin lesions are accompanied by severe itching and can be localized in any area of the body. If a person was lying on contaminated soil, there are multiple outbreaks. Vesicles and blisters may later form.
In the human body, the larvae do not reach sexual maturity and die on their own after a few weeks. The rashes also disappear.
In Southeast Asia and Central America, a cutaneous form of larva migrans syndrome occurs, caused by quinques of the genus Reighardia and quinques of the genus Sebekia.
Larva migrans – causes, symptoms, diagnosis and treatment
Larva migrans is helminthiasis, a dangerous disease characterized by the presence of animal helminth larvae in the tissues, epidermis and internal organs. The larvae in the human body increase in size and begin to migrate, causing poor health. The disease is unpredictable, and lack of treatment can lead to spontaneous recovery or worsening of the condition and death. Treatment is prescribed by the doctor depending on the form of larva migrans.
Reasons
Warm, shaded and humid places become favorable environments for the reproduction of larvae. Ponds are dangerous in the summer, especially if there are domestic animals grazing nearby or dogs roaming nearby. In the sand near water, under spreading tree branches, worm eggs can accumulate and turn into larvae; running barefoot on contaminated soil can become infected. People in agricultural professions who come into contact with soil are at risk.
Infection in the visceral form occurs by the entry of helminth eggs into the human body through the oral cavity, for example, when swallowing water from a pond while swimming or eating unwashed food.
Symptoms
With both the cutaneous and visceral forms of the disease, fever may occur - high temperature, trembling in the body, nausea and dizziness.
Symptoms of the disease may not appear immediately after infection, but several months later.
Diagnostics
With the cutaneous form of larva migrans, diagnosing the disease can be difficult due to the fact that some clinical cases resemble scabies or other skin diseases. However, with a careful examination by an experienced doctor, this still seems possible.
Treatment
Prevention
The main prevention of larva migrans is hygiene: wash fruits and vegetables thoroughly before eating, do not swim in bodies of water whose water is questionable, wear protective clothing when working in the field.
Cutaneous form of the “wandering larva” syndrome(larva migrans) is a disease caused by a nematode larva that penetrates the skin and migrates, causing the formation of characteristic erythematous, serpiginating subcutaneous tracts.
Pathophysiology of the cutaneous form of wandering larva syndrome
In hosts (cats, dogs) nematodes penetrate into the skin and spread through the lymphatic and venous vessels into the lungs, penetrate the alveoli, migrate to the trachea and are swallowed. In the intestines, nematodes mature into adults and lay eggs, which are excreted by their animal hosts. After animals excrete infected feces, nematode eggs fall into sand or soil, where the larvae of the pathogen hatch.
Larvae enter the skin of the intermediate host (human) when walking barefoot, but they cannot overcome the basement membrane. Thus, the larvae spread in a serpiginating pattern under the skin, which is called "migratory eruptions."
History of the cutaneous form of wandering larva syndrome. The larvae penetrate the skin, migrate at a rate of 1-2 cm per day for 4 weeks to 6 months and can cause itching. After migration is completed, the larval life cycle usually ends and the skin passages regress. There are no general symptoms.
Clinic of the cutaneous form of wandering larva syndrome
Type: moves.
Color: From normal skin color to pink.
Size: 2 to 3 mm wide, spreading at a rate of 1-2 cm per day. Quantity: one move, several or a large number of moves. Localization: unprotected areas of the body: feet, legs, buttocks and hands.
General manifestations of the cutaneous form of wandering larva syndrome. In the visceral form (usually Toxocara canis, T. cati, A. lumbricoides), peripheral eosinophilia, hepatomegaly and pneumonitis can develop.
Differential diagnosis of the cutaneous form of wandering larva syndrome carried out with phytophotodermatitis, fungal infections of the feet, chronic migratory erythema, jellyfish sting and granuloma annulare.
Pathohistology of the cutaneous form of wandering larva syndrome: PAS staining shows larvae in suprabasal areas, spongiosis, intraepidermal vesicles, necrotic keratinocytes, and a chronic inflammatory infiltrate with a large number of eosinophils.
Course and prognosis of the cutaneous form of wandering larva syndrome. The cutaneous form of larva migrans is usually self-limiting, since humans are the non-primary “dead-end” host. Most larvae die after 2-4 weeks of migration under the skin, with skin rashes regressing within 4-6 weeks.
Treatment of the cutaneous form of wandering larva syndrome
In general, the rash resolves spontaneously within 4-6 weeks. Symptomatic treatment includes topical corticosteroids applied until the itching resolves.
In severe cases accompanied by intense itching, thiabendazole may be used; side effects include dizziness, nausea, seizures and vomiting. Thiabendazole 2% cream may be better tolerated. Previously, attempts were made to use trichloroacetic acid, cryotherapy or electrocoagulation to influence the passages, but these methods were not effective.
Skin syndrome larva migrans
Less often cutaneous form of larva migrans syndrome caused by the larvae of Necator americanus, Uncinaria stenocephala, Strongyloides stercoralis and Gnathostoma spinigerum. The disease is widespread in the tropics. In the US, most cases occur in the southeastern states. Workers, bathers and children usually get sick. Infection occurs through contact with larvae, which can be infested with soil or sand (including in a dog or cat litter box).
The peak incidence occurs in summer and early autumn.
Diagnosis of larva migrans syndrome
Together implementation In the larvae, a red papule usually appears, later vesicles and blisters form. The larva migrates, moving several centimeters every day and forming convoluted, intensely itchy passages several millimeters wide in the skin. The main complication of the disease is secondary purulent infection. Its cause is severe itching, which causes patients to scratch the skin, opening the way for pyogenic bacteria.
Larvae live in the skin for several weeks or even months and then die. They can penetrate into any area of the skin, but most often they affect the soles, feet, buttocks, face and back. In severe cases, the larvae migrate to the lungs and cause Loeffler's syndrome, manifested by pneumonia with volatile infiltrates. Rare complications include myositis and eosinophilic enteritis.
Typically, diagnosis is made based on clinical picture, and no additional laboratory tests are required. Biopsy reveals eosinophilic infiltrates and, occasionally, migratory larvae. In Loeffler's syndrome, larvae can be found in sputum or gastric lavage. In doubtful cases, the diagnosis can be made by ELISA or immunoblotting for antibodies to Ancylostoma camnum
As a rule, disease goes away on its own and does not require treatment. According to some data, in persistent and severe cases, topical thiabendazole (10% aqueous solution) and albendazole (5 mg/kg/day for 3 days) or thiabendazole (50 mg/kg/day in two doses, but not more than 3 g) are effective /day) inside. Prevention consists primarily of avoiding skin contact with moist soil, which may be contaminated with animal feces, and ensuring that children do not swear into their mouths.
The larvae of Spa (ota spirtigum, a nematode found in the East, and Caggeroligu, a horse gadfly, can cause similar skin lesions.
Etiology. As a rule, the larvae reaches sexual maturity only in the body of dogs and cats. The larvae, emerging from eggs released in feces, reach the filariform stage and have the ability to penetrate the skin. In humans, the larvae live in skin and migrate, leading to the formation of erythematous tracts visible on the surface of the skin.
Epidemiology and distribution. The spread of helminthiasis among humans requires appropriate conditions: ambient temperature and humidity for the development of eggs to the stage of infective filariform larvae. Beaches and other wet, sandy areas are high-risk areas because animals choose these areas to defecate and eggs
A. bragenae develop well in such soil. In the United States, the disease has been reported in the southern states along the Atlantic coast and the Gulf of Mexico.
Pathogenesis and clinical manifestations. Places of skin penetration by larvae become noticeable a few hours after their penetration. The migration of larvae in the skin is accompanied by severe itching. Scratching can lead to bacterial infection. Within 1 week, random erythematous, linear elements develop from the primary red papule, the length of which can reach 15-20 cm.
If left untreated, the larvae can remain viable for several weeks or months.
Loeffler's syndrome was observed in 26 of 52 cases of creeping rash. Transient volatile pulmonary infiltrates accompanied by increased numbers of eosinophils in the blood and sputum were interpreted as an allergic reaction to helminth infestation, but it may have been a reflection of pulmonary migration of larvae. "
Laboratory data. Eosinophils are found in the skin elements, but eosinophilic leukocytosis is moderate, except in cases of Loeffler's syndrome. The percentage of eosinophils in the blood can increase up to 50%, in sputum - up to 90%. Larvae are found on skin biopsy only in rare cases.
Treatment. The best drug is thiabendazole; it should be given orally at the dose suggested for the treatment of strongyloidiasis (see below). If necessary, treatment can be repeated. The drug can be used topically as a 10% aqueous suspension. Local application avoids the general toxicity of the drug. Superficial bacterial infections are suppressed by using moist dressings and elevating the limb. For intense itching, oral antihistamines are recommended.
Forecast. If left untreated, the disease lasts several months. Treatment is usually successful.
Prevention. It is necessary to prevent dogs and cats from contaminating recreational areas and children's play areas.
Larva migrans is helminthiasis, a dangerous disease characterized by the presence of animal helminth larvae in the tissues, epidermis and internal organs. The larvae in the human body increase in size and begin to migrate, causing poor health. The disease is unpredictable, and lack of treatment can lead to spontaneous recovery or worsening of the condition and death. Treatment is prescribed by the doctor depending on the form of larva migrans.
Reasons
Warm, shaded and humid places become favorable environments for the reproduction of larvae. Ponds are dangerous in the summer, especially if there are pets grazing nearby or dogs roaming nearby. In sand near water, under spreading tree branches, eggs can accumulate and turn into larvae; running barefoot on contaminated soil can become infected. People in agricultural professions who come into contact with soil are at risk.
Infection in the visceral form occurs by the entry of helminth eggs into the human body through the oral cavity, for example, when swallowing water from a pond while swimming or eating unwashed food.
Symptoms
With both the cutaneous and visceral forms of the disease, fever may occur - high temperature, trembling in the body, nausea and dizziness.
Symptoms of the disease may not appear immediately after infection, but several months later.
Diagnostics
With the cutaneous form of larva migrans, diagnosing the disease can be difficult due to the fact that some clinical cases resemble scabies or other skin diseases. However, with a careful examination by an experienced doctor, this still seems possible.
Treatment
Prevention
The main prevention of larva migrans is hygiene: wash fruits and vegetables thoroughly before eating, do not swim in bodies of water whose water is questionable, wear protective clothing when working in the field.
Cutaneous form of larva migrans (larva migrans cutanea)
You can also often find names such as larva migrans and creeping rash. Most of the pathogens that cause this form are representatives of the trematode class from the family Schistosomatidae and nematodes (Ancylostoma caninum, Ancylostoma brasiliensis, Strongyloides, etc.)
Causes of cutaneous larva migrans infection
Infection occurs through the skin when a person comes into direct contact with contaminated soil, sand or water. This often happens in areas where the disease is endemic, when traveling to exotic countries. Upon contact, the larvae penetrate the skin, where they can move around, leaving characteristic marks.
Clinical manifestations of larva migrans in humans can vary from a barely noticeable linear rash to severe swelling, redness of a certain area of the skin, up to a generalized attack of urticaria and fever with high temperature (39-40ºC).
In most cases, the penetration of the larva goes unnoticed, in rare cases there is itching, tingling, and a red spot or papule forms at the site of penetration, which disappears without a trace after 2-3 days. Characteristic of the cutaneous form of migrating larvae is the appearance of an inflamed ridge on the skin, which moves, leaving behind traces in the form of peculiar passages, the so-called “creeping rash”. During the day the larva can move 2 - 5 mm. A roller is nothing more than a helminth larva, which, through its movement (migration) under the skin, can cause allergic reactions, swelling, infiltration, redness and itching. A person may also have symptoms of general malaise in the form of fever, headache, dizziness, and general weakness.
Those parts of the body that were in direct contact with the contaminated environment are affected (in the vast majority of cases, this is contact with sand and water on the beach). Therefore, the most common symptoms appear:
- Lower limbs - legs - 40%;
- Buttocks and genitals - 20%;
- Belly - 15%.
After the larvae die, complete recovery occurs. This is observed after 4-6 months.
Severe itching of the skin, resulting from the “travel” of the larvae under the skin, provokes scratching, which can cause secondary bacterial infection of the skin.
Visceral form of larva migrans
The causative agents are the larvae of cestodes (Sparganum mansoni, Sparganum proliferum, Multiceps spp.) and nematodes (Tohocara caninum, Tohocara mysax, Tochoascaris leonina, Filarioidea, Neraticola, etc.). As with the cutaneous form, humans are not the final host for these pathogens, so the helminths do not grow to sexually mature individuals, but migrate throughout the body, settling in various organs in the form of larvae.
Causes of infection of the visceral form of larva migrans
Infection occurs by ingesting helminth eggs along with water and poorly processed food (fruits, vegetables). Most often, larva migrans is observed in young children under 5 years of age.
From helminth eggs that enter the intestines, larvae emerge, which, having penetrated the intestinal wall and entered the bloodstream, settle in various organs, causing their damage. In organs, the larvae take on the appearance of bubbles (for which they are called blister-like larvae) and can reach impressive sizes of 5 - 15 cm. Bubble-shaped larvae can compress surrounding organs and tissues, causing a characteristic clinical picture.
Symptoms of visceral lesions
Clinical manifestations of the visceral form are very diverse. Symptoms directly depend on which organ is affected. The first symptoms begin 5-6 months after the eggs enter the human body.
The visceral form is most severe when affected central nervous system(with accumulation of larvae in the brain). The clinic may manifest itself as general cerebral symptoms. Severe headaches, high blood pressure, seizures, paresis and paralysis of the limbs, symptoms of damage to the cranial nerves. It is characteristic that the symptoms of a focal lesion can arise spontaneously and after some time, just as spontaneously, disappear. Most often, the central nervous system is affected by tsenura and cysticerci.
The accumulation of larvae in the brain can cause a picture of a space-occupying formation (brain tumor).
In addition to the brain, larvae can be located in the spinal cord, eye, serous membranes, intermuscular connective tissue, causing dysfunction of these organs.
Infections by larvae of the lungs can cause inflammatory (bronchitis, pneumonia) and allergic (cause attacks of bronchial asthma) diseases.
For liver damage Symptoms of hepatitis and damage to the gallbladder and biliary tract (cholecystitis, cholangitis) may develop. The level of indirect bilirubin and acute-phase liver parameters (ALT, AST, alkaline phosphatase, thymol test) increase. There is a bitterness in the mouth, pain in the right hypochondrium, nausea, jaundice may develop, etc.
Ingestion of roundworm eggs into the human body can result in a severe allergic reaction. There is an increase in temperature to 39-40 ° C, there are pronounced signs of intoxication (headaches, general weakness, lack of appetite, nausea, dizziness, etc.). Papular and urticarial rashes in the form of urticaria may also occur on the skin. Without adequate treatment, the disease can have an unfavorable prognosis and lasts a long time, from 6 months to 2 years. With proper treatment, a complete cure occurs.
Treatment of visceral and cutaneous forms of larva migrans
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Albendazole (Nemozol, Vormil, Aldazole, etc.) is used for treatment.
It is not recommended to prescribe the drug in high doses to children under 6 years of age. The doctor selects the dose individually depending on age, body weight and severity of the disease.
The dose for patients weighing more than 60 kg is 400 mg (1 tablet) 2 times a day. For body weights less than 60 kg, the drug is prescribed at a rate of 15 mg/kg/day. This dose should be divided into 2 doses. The maximum daily dose should not exceed 800 mg.
For the treatment of systemic helminthiases, such as cystic and alveolar echinococcosis, neurocysticercosis, capillariasis, cystic lesions of the liver and brain, etc., longer treatment regimens are used. On average, the course of treatment lasts 28 days, sometimes several courses are necessary for complete recovery. More details about treatment regimens can be found in the attached document.
