Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans

Successful Treatment of Cutaneous Larva Migrans With Combined Albendazole and Ivermectin Therapy: A Report of Two Cases From Sudan

Cutaneous larva migrans (CLM), caused by third-stage filariform larvae of cat and dog hookworms, presents as pruritic, serpiginous tracks upon skin penetration by larvae from contaminated soil. Herein, we report the successful treatment of two CLM patients using albendazole and ivermectin combination therapy. A 42-year-old man from Kordofan and a 38-year-old man from White Nile State presented with characteristic lesions on their lower extremities, resolving completely within one week post-treatment without recurrence. This report highlights the potential of combined albendazole-ivermectin therapy in managing CLM amid emerging antihelminthic resistance, suggesting that its broader application warrants further investigation.

K, Baral A, Shrestha R, Shrestha R. Cutaneous larva migrans in a child: a case report and review of literature

Introduction

Cutaneous larva migrans (CLM) is a dermatitis caused by the invasion and migration of parasitic larvae of hookworms, primarily affecting tropical and subtropical regions. This report presents a case of CLM in a Nepali child and provides an overview of the literature on this condition.

Case report

A 4-year-old boy from a rural area in Nepal presented with a pruritic skin lesion on his left foot, initially misdiagnosed as fungal infection. The lesion gradually expanded, forming a serpiginous erythema, and became intensely pruritic. The patient's family had poor socioeconomic conditions, and the child frequently walked barefoot in an area with many domestic and stray dogs. Diagnosis was confirmed clinically, and treatment with oral albendazole and antihistamines resulted in complete resolution of symptoms.

Discussion

CLM is a neglected zoonotic disease, with an underestimated burden in developing countries due to underreporting and misdiagnosis. The larvae of Ancylostoma spp. are common culprits, causing a localized inflammatory reaction as they migrate through the skin. Diagnosis is mainly clinical and routine investigations usually reveal no abnormality. Complications may include secondary bacterial infections, allergies, and rare migration to internal organs. Treatment options include albendazole or ivermectin, with preventive measures emphasizing hygiene, footwear use, and pet deworming.

Conclusion

CLM is a neglected disease that primarily affects marginalized communities in tropical regions. Raising awareness among healthcare providers, conducting observational studies, and developing treatment guidelines, especially for children, are essential steps to address this public health concern. Preventive efforts, such as promoting hygiene and footwear use, should be encouraged to reduce CLM incidence.

Protective efficacy of short-term infection with Necator americanus hookworm larvae in healthy volunteers in the Netherlands: a single-centre, placebo-controlled, randomised, controlled, phase 1 trial

BACKGROUND

Vaccine development against hookworm is hampered by the absence of the development of protective immunity in populations repeatedly exposed to hookworm, limiting identification of mechanisms of protective immunity and new vaccine targets. Immunisation with attenuated larvae has proven effective in dogs and partial immunity has been achieved using an irradiated larvae model in healthy volunteers. We aimed to investigate the protective efficacy of immunisation with short-term larval infection against hookworm challenge.

METHODS

We did a single-centre, placebo-controlled, randomised, controlled, phase 1 trial at Leiden University Medical Center (Leiden, Netherlands). Healthy volunteers (aged 18-45 years) were recruited using advertisements on social media and in publicly accessible areas. Volunteers were randomly assigned (2:1) to receive three short-term infections with 50 infectious Necator americanus third-stage filariform larvae (50L3) or placebo. Infection was abrogated with a 3-day course of albendazole 400 mg, 2 weeks after each exposure. Subsequently all volunteers were challenged with two doses of 50L3 at a 2-week interval. The primary endpoint was egg load (geometric mean per g faeces) measured weekly between weeks 12 and 16 after first challenge, assessed in the per-protocol population, which included all randomly assigned volunteers with available data on egg counts at week 12-16 after challenge. This study is registered with ClinicalTrials.gov, NCT03702530.

FINDINGS

Between Nov 8 and Dec 14, 2018, 26 volunteers were screened, of whom 23 enrolled in the trial. The first immunisation was conducted on Dec 18, 2018. 23 volunteers were randomly assigned (15 to the intervention group and eight to the placebo group). Egg load after challenge was lower in the intervention group than the placebo group (geometric mean 571 eggs per g [range 372-992] vs 873 eggs per g [268-1484]); however, this difference was not statistically significant (p=0·10). Five volunteers in the intervention group developed a severe skin rash, which was associated with 40% reduction in egg counts after challenge (geometric mean 742 eggs per g [range 268-1484] vs 441 eggs per g [range 380-520] after challenge; p=0·0025) and associated with higher peak IgG1 titres.

INTERPRETATION

To our knowledge, this is the first study to describe a protective effect of short-term exposure to hookworm larvae and show an association with skin response, eosinophilic response, and IgG1. These findings could inform future hookworm vaccine development.

FUNDING

Dioraphte Foundation.

Cutaneous larva migrans: A One Health Perspective on Familial Infection Among Tourists Returning from Southeast Asia

Cutaneous larva migrans (CLM) is a dermatosis caused by accidental infestation with animal hookworms and is widely distributed in tropical and subtropical regions. Humans become infected when their skin comes into contact with soil contaminated with dog faeces. The filariform larvae penetrate and burrow into human skin, causing a condition known as "creeping eruption". We describe a case, well-documented by photos, of CLM infection in a family of three who returned from Thailand.

Travel- and migration-associated epidermal parasitic skin diseases. A review

Epidermal parasitic skin diseases are a family of parasitic diseases which occur globally or are frequent in special settings. Epidermal parasitic skin diseases occur in travelers and migrants, although epidemiology and/or clinical manifestations differ between these groups. The objective of this study is to summarize the existing knowledge concerning tungiasis, hookworm-related cutaneous larva migrans, scabies, pediculosis capitis and pediculosis corporis in the context of travel and migration, and to identify risk factors for infection. The PUBMED database was searched using the terms tungiasis, cutaneous larva migrans, scabies, pediculosis capitis, pediculosis corporis in combination with travel, migrant, or refugee from 2000 to 2022. Tungiasis and cutaneous larva migrans were the epidermal parasitic skin diseases most commonly reported in travelers. Outbreaks with up to 36 cases occurred in groups of adventure-travelers. The clinical manifestation differed from those in inhabitants of endemic areas and were usually circumscript and moderate. Scabies was very rarely reported in travelers but causes a high disease burden in migrants and refugees. The infestation of refugees with body and head lice caused louse-borne relapsing fever in refugees arriving by boat from Africa. Travel advice concerning prevention of epidermal parasitic skin diseases requires knowledge on their epidemiology in the settings they are endemic.

A coprological survey on helminths of Jackal Canis aureus Linnaeus 1758 in Kashmir Himalaya

A coprological examination was carried out between February 2017 and January 2019 to determine the prevalence of gastrointestinal helminths in jackals of Kashmir Himalaya, India. Fecal floatation and sedimentation technique revealed helminths in 215 scats out of 879 examined scats, with overall helminth prevalence of 24.45%. In the study, five different species of helminths were detected in scats of jackal: Toxocara canis (22.86%), Ancylostoma caninum (20.47%), Dipylidium caninum (17.17%), Trichuris vulpis (19.34%), and taeniid eggs (13.65%). One helminth species was found in (0.11%) of the jackal scats, two were in (1.25%), three were in (4.77%), four were in (16.38%), and five were in (1.92%). Toxocara canis, a nematode with great zoonotic significance, was most common helminth found in scats of jackal during the study. We observed significant seasonal fluctuation (p < 0.05) in the prevalence of gastrointestinal helminths, with summer having high frequency followed by autumn, spring, and winter having lowest prevalence. The study area's jackal population's preponderance of zoonotic helminth species suggests a high risk of zoonotic infection by canine intestinal helminths. This study will aid veterinarians in better plan preventative strategies with regard to wild animal intestinal parasites.

Cutaneous larva migrans: A case report diagnosed using teledermatology

Teledermatology is a branch of dermatology that transmits medical data over several miles using telecommunications technologies. It involves the diagnosis of skin lesions using digital photographs and related patient data, and it can be especially helpful for patients in remote areas who might not have convenient access to dermatologists. Cutaneous larva migrans (CLM) is a zoonotic parasitic disease found in tropical and subtropical areas that are sunny and hot; however, cases of allocated resources have been disclosed in Saudi Arabia. There is little information about the frequency of CLM as a work-related illness among employees who are exposed to potentially polluted soil or have close contact with pets. In this paper, we present an ancestral case of CLM in Saudi Arabia, explaining the hazards of CLM infection. CLM may pose a challenge for physicians in non-endemic areas regarding assessment, therapeutic interventions, and protection, especially at work. The holistic strategy to CLM assessment, which includes the participation of numerous science competencies (e.g., veterinarians, dermatologists, and occupational physicians), may contribute to a better understanding of the expansion of human CLM and related risk factors, lowering the chance of infection.

Molecular Detection and Genetic Characterization of Zoonotic Hookworm in Semi-Domesticated Cats Residing in Monasteries in Bangkok, Thailand

Hookworms are the most common parasitic nematodes in the genus of Ancylostoma that infect both humans and animals in subtropical and tropical South East Asia. The common hookworm species in cats is Ancylostoma ceylanicum which is emerging in Thailand. However, the genetic characterization of hookworms in cats is outdated and insufficiently studied in Thailand. We aimed to investigate the prevalence, risk factors and genetic characterization of hookworm infection in semi-domesticated temple cats in Bangkok, Thailand. A total of 500 temple cat fecal samples were collected from 43 monasteries in 24 districts of Bangkok, Thailand. Polymerase Chain Reaction (PCR) was performed by amplifying the internal transcribed spacer (ITS) gene and mitochondrial cytochrome oxidase c subunit I (cox 1) gene. The infection prevalence of hookworm in temple cats was 13.2% (66/500). The highest prevalence was 34.6% in the Bang Khun Thian district, which is located in a suburban area. The risk factor analysis revealed that cats older than one year (OR 2.4, 95% CI 1.1-5.5, p < 0.05), lack of veterinary attention (OR 2.9, 95% CI 1.7-4.9, p < 0.001) and Bangkok zone (suburban vs. inner city; OR 2.9, 95% CI 1.6-5.4, p < 0.001) were significantly increasing hookworm infection risk. All hookworm positive samples were identified as A. ceylanicum by ITS gene. Moreover, genetic characterization of cox 1 gene in A. ceylanicum isolates indicated a mix of isolates from humans, cats and dogs. The findings show that temple cats can act as a potential source of zoonotic hookworm parasites for the human and animal population in Bangkok, Thailand. Therefore, appropriate control measures for hookworms in semi-domesticated temple cats as well as prevention measures for hookworms in pet cats and humans should be promoted.

Sudden emergence and spread of cutaneous larva migrans in Sudan: A case series calls for urgent actions

Cutaneous larva migrans (CLM) is a self-limiting dermatosis parasitic disease that is caused by zoonotic hookworm mainly infects cats, dogs, and accidentally humans. The disease affects hosts through the invasion and the migration of the hookworm larva into top layers of the skin. The disease occurs in tropical and subtropical regions; where people commonly are infected when sitting or barefoot walking on places contaminated with feces of infected cats or dogs. Due to self-limiting nature of the disease, the exact burden and prevalence are commonly underestimated. In this communication, we investigated all cases presented to the skin-diseases outpatient clinic' at the reference hospital of Tropical Diseases Medicine in Khartoum state between January 2019 and January 2021. This is the first-ever a case series report of cutaneous larva migrans in Sudan. We identified 15 cases of CLM presented with rash (100 %), redness of skin (67 %), and only adults were presented with larva crawling under their skins (27 %). Infection sites were (53 %) leg, (40 %) foot, only 7 % showed abdominal infection. The majority of patients were children or young adults, 47 % of them are ≤5 year-old, male to female ratio is 2.75:1. Duration of infection was one to three weeks and all patients fully recovered after treatment with albendazole. This urges for One Health interventions including deworming cats and dogs, improving water, sanitation, and hygiene, community-engagement and raising awareness in area with risk of infection.

Investigation of Parasitic Nematodes Detected in the Feces of Wild Carnivores in the Eastern Qinghai-Tibet Plateau, China

Wildlife shares grazing areas with herders in the eastern Qinghai-Tibet Plateau, and humans can be infected by zoonotic nematodes through direct contact with animals or contaminated water. In this study, fecal samples (n = 296) from wild carnivores were collected to explore the infection rate and molecular genetic characteristics of nematodes by stratified random sampling in the survey areas. Host species and the nematodes they carried were then identified using 16S rRNA and 18S rRNA gene sequencing, respectively. Statistical analysis, neutrality tests, genetic diversity analysis and Bayesian inferred trees were performed to complete the study. In total, 10 species of nematodes were detected in 240 feces from six species of carnivores identified (including dominant Vulpes ferrilata and Vulpes vulpes), namely Uncinaria stenocephala, Toxascaris sp., Crenosoma vulpis, Parapharyngodon bainae, Oesophagostomum muntiacum, Aspiculuris tetraptera, Mastophorus muris, Nematodirus spathiger, Muellerius capillaris, and Molineus patens. Among these nematodes, U. stenocephala (35.83%, 86/240) and Toxascaris sp. (14.58%, 35/240) were detected at higher rates than the other nematodes (χ2 = 516.909, p < 0.05). Of 17 and 18 haplotypes were found based on the ITS1 gene for U. stenocephala and nad1 gene for Toxascaris sp., respectively. For the first time, using molecular methods, we report the infection of V. ferrilata by U. stenocephala, a potential zoonotic parasite, and suggest Toxascaris sp. may be a newly discovered nematode that lives within the fox intestine.

Cutaneous larva migrans: A case report successfully treated with albendazole

Introduction

Cutaneous larva migrans (CLM) is helminthic infection that is mostly found in tropical and subtropical areas [1]. It is commonly seen with those who have contact with soil that is contaminated by cat and dog's hookworm larvae. CLM present as erythematous, serpiginous, pruritic cutaneous eruption that is caused by accidental percutaneous penetration and subsequent migration of larvae.

Case

We present a case of 45 year old male with erythematous, serpiginous, pruritic eruption over the dorsum of foot.Clinical findings and investigations: Patient had a 2-3 cm linear, erythematous, serpiginous localized lesion characteristic of a papular tip on the dorsal surface of the right foot. Total and differential blood counts, peripheral blood smear and chest x-ray were sent for investigations.

Intervention and outcome

Patient was prescribed Albendazole at a dose of 400mg, once a day for seven days. After treatment, the lesion and pruritus had regressed significantly.

Conclusion

Hookworm-related CLM is diagnosed clinically based on the typical clinical presentation (skin findings). Clinicians should be aware of the possibility of hookworm-related CLM with history of travel to tropical areas, specially walking barefoot.

Cutaneous Larvae Migrans Treated with a Single Dose of Ivermectin

Hookworm-related cutaneous larva migrans (HrCLM) is a clinical diagnosis based on a history of exposure to contaminated soil and is associated with a characteristic red serpiginous lesion that migrates within the epidermis. Our patient presented with a red, tortuous migratory rash with localized pruritus on the left plantar foot of 1-month duration. He lacked recent travel history outside the southeastern United States. Upon admission, he presented with peripheral blood eosinophilia, an uncommon feature of HrCLM. A single dose of ivermectin was sufficient for treatment, and symptoms resolved within 3 days. This case highlights the increased incidence of domestically acquired hookworm infections, explores this epidemiological shift, and emphasizes relevant differential diagnoses.

Occupational risk of cutaneous larva migrans: A case report and a systematic literature review

Cutaneous larva migrans (CLM) is a parasitic zoonosis of warm tropical and subtropical areas, although autochthonous cases have been increasingly reported in Western European countries. Data on the prevalence of CLM as an occupational disease in workers exposed to potentially contaminated soil or in close contact with dogs and cats are scant. Herein, we report an autochthonous case of CLM in a dog breeder from southern Italy (Apulia region), along with a systematic literature review describing the risk of CLM infection, mainly according to job categories. The patient was referred to the dermatology unit presenting a serpiginous lesion on his hand, raising the suspected CLM diagnosis. In non-endemic areas, CLM might represent a challenge for physicians in terms of diagnosis, treatment, and prevention, particularly in workplaces. The multidisciplinary approach in the diagnosis of CLM with the involvement of different scientific competences (i.e., dermatologists, veterinarians, and occupational physicians) may contribute to further assess the distribution of human CLM and associated risk factors, toward reducing the risk for the infection.

Ancylostoma in dogs in the Caribbean: a review and study from St. Kitts, West Indies

Background

Little is known about the prevalence of Ancylostoma in dogs in the Caribbean. In view of the number of owned free-roaming and feral dogs within the islands and the ideal subtropical climate for parasite development and environmental survival, Ancylostoma could pose a threat to the health of the dogs as well as a zoonotic risk to people.

Methods

To determine whether generalities about Ancylostoma in dogs in the Caribbean could be made and to obtain a better understanding of the prevalence, published (Scielo, Scopus, and PubMed databases) and gray (e.g., student theses, conference presentations) literature was reviewed. Retrieved manuscripts were screened, and relevant data (year, location, dog population, method of diagnosis, positivity rate) were extracted. Data from two dog populations on St. Kitts also were included: a 2014 field study involving dogs with limited veterinary care and data from the Ross University School of Veterinary Medicine’s Veterinary Clinic records for 2018–2019.

Results

Fourteen manuscripts from the 1950s to 2019, representing ten of the Caribbean islands/countries and the Bahamas, were identified. Methods of diagnosing infection status ranged from simple qualitative or quantitative flotation methods to centrifugation with Sheather’s sugar flotation solution or necropsy. Dog populations sampled included stray, owned free-roaming, and owned confined. Reported rates of Ancylostoma infection ranged from 10 to 91%. Studies from the last 10 years indicate positivity rates of 21 to 73%. Ancylostoma positivity rates in the St. Kitts’ populations were 61% and 10% for the 2014 and 2018–2019 populations, respectively.

Conclusions

There was no indication that hookworm prevalence has changed over time in the Caribbean, and there were no obvious differences between owned and unowned dogs or free-roaming and confined dogs. The data from St. Kitts were on par with positivity rates from the other islands within the last 10 years and reflective of the impact that veterinary care, including anthelmintic treatment, is expected to have on parasites in pets. There is a clear need to expand the available data for the region and improve control programs for Ancylostoma infections to protect both canine and human health.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-022-05254-2.

Development of a New LAMP Assay for the Detection of Ancylostoma caninum DNA (Copro-LAMPAc) in Dog Fecal Samples

Ancylostoma caninum is a zoonotic nematode which is able to affect animals and humans. Diagnosis in the definitive host and environmental detection are key to prevent its dissemination and achieve control. Herein, a new coprological LAMP method for the detection of A. caninum (Copro-LAMPAc) DNA was developed. DNA extraction was performed using a low-cost method and a fragment of the cox-1 gene was used for primer design. The analytical sensitivity, evaluated with serial dilutions of genomic DNA from A. caninum adult worms, was 100 fg. A specificity of 100% was obtained using genomic DNA from the host and other pathogens. The Copro-LAMPAc was evaluated using environmental canine fecal samples. When compared with gold standard optical microscopy in epidemiological studies, it proved to be more sensitive. This new LAMP assay can provide an alternative protocol for screening and identification of A. caninum for epidemiological studies in endemic areas.

Zoonotic hookworms of dogs and cats - lessons from the past to inform current knowledge and future directions of research

The early-to-mid 1900s was an era that marked the first published reports of clinical cases and experimental human infections that provided valuable evidence to inform our current knowledge on the zoonotic nature of the canid and felid hookworms. To this day, descriptions of the pathognomonic syndromes produced in humans by these early pioneers provide vital information on the putative geographical distribution of these hookworm species, even before their discovery in dogs and cats. Cases of hookworm-related cutaneous larvae migrans and Ancylostoma caninum-induced eosinophilic enteritis continue to be reported in the medical literature, most commonly in recent migrants or returned travellers who have spent time in regions in which these canine and feline hookworms remain highly endemic. Ancylostoma ceylanicum, now recognised as the second most common hookworm infecting humans in the Asia Pacific region, is also being reported in regions of Africa and South America previously assumed free of this parasite. Despite the substantial technological progress made in the field of parasite diagnostics, our knowledge on the epidemiology and population-level morbidity impacts of these zoonotic hookworms in humans has remained relatively stagnant over the last few decades, with 'covert' infections continuing to remain undetected by currently available forms of routine diagnostics. Improved diagnostic tools that enable accurate and rapid species-specific diagnosis of zoonotic hookworm infections in humans are required to provide the necessary evidence to advocate for future investments in One Health-based intervention strategies.

A longitudinal survey of gastrointestinal parasites of the black-eared opossum Didelphis aurita at an urban-sylvatic interface area in Southeast Brazil: a morphological and ecological characterization based on helminth eggs

Parasites are important organisms in ecosystem dynamics and take part in the regulation and structure of host populations. The prevalence, abundance, and distribution of parasites in their host species may be affected by biotic and abiotic factors. Most studies of helminths of Brazilian marsupials are taxonomic descriptions or re-descriptions and records of occurrence. The use of noninvasive techniques for studying parasitic worms of vertebrate hosts is more common in large or threatened species. The aims of this study were to describe and identify the helminth morphotypes and to analyse the parasitological parameters of gastrointestinal helminth eggs obtained in faecal samples of marsupial Didelphis aurita at the Fiocruz Atlantic Forest Biological Station and surroundings, municipality of Rio de Janeiro, southeast Brazil. The common opossums were sampled during a capture-mark-recapture study. Faecal samples collected from each animal were analysed for helminth egg diagnosis using the methods of flotation in sugar solution and sedimentation. Eggs were compared with samples obtained from the uterus of adult worms obtained from a previous study carried out in the same area. Eleven helminth egg morphotypes were found. Among them, seven were identified at the species level. The highest values of parasitic load and prevalence were observed for the families Viannaiidae and Trichuridae. A significant relationship was found between the number of morphotypes and host body size in females. The influence of parasite load on host condition factor or body size was not observed.

Cutaneous larva migrans in a beach volleyball player

Athletes playing beach volleyball come into contact with sand and may contract skin parasites. We present a case of cutaneous larva migrans in a 20-year-old Polish female beach volleyball player. The athlete participated in The World Tour in Asia (China, Malaysia, Cambodia) a month before. In the beginning, her skin lesions were misdiagnosed as allergic reactions and treated with antihistamines. The disease in the form of a pruritic, migratory serpiginous skin eruption on legs was diagnosed during routine medical examination at the National Centre for Sports Medicine in Warsaw. She was treated successfully with albendazole and cetirizine. The skin lesions resolved entirely within two weeks.

Clinical Profile, Risk Factors and Outcomes of Children With Cutaneous Larva Migrans Infection: A Hospital-Based Study

Background Cutaneous larva migrans (CLM) is a neglected parasitic skin disease caused by hookworm larvae such as Ancylostoma braziliense and Ancylostoma caninum. It is more common in tropical and subtropical countries. Evidence regarding clinical profiles, risk factors and outcomes of children with CLM in the Eastern province of Sri Lanka is scarce. Aim The aim of this study was to evaluate demographic profile, risk factors, clinical manifestations and outcomes associated with CLM in children who presented to paediatric and dermatological clinics of the Teaching Hospital, Batticaloa, Sri Lanka.  Method A retrospective study was conducted over three years from January 2017 to December 2019 among children who presented with CLM infection to paediatric and dermatological clinics of the Teaching Hospital, Batticaloa, Sri Lanka. Twenty-eight children who were aged between 1 and 14 years were recruited for the study. Detailed information including demographic factors such as age, sex, residence and mother's education, risk factors for infection, main reason for clinic visit, duration of illness, site of lesions, number of lesions, treatment received from out-patients department and/or general practitioner, duration of treatment, associated secondary bacterial infection, family history of similar infections and laboratory investigations were extracted from clinical records. Data were analyzed using SPSS version 19.0 (IBM Corp., Armonk, NY). Results Among 28 children recruited for this study, 19 (67.9%) were male children and 9 (32.1) were female children. The majority of children were below 6 years (n=25, 88.3%). Twenty-six (92.9%) children had residence in rural areas and also belonged to low socioeconomic class. Most cases were detected in Valaichenai (32.1%) and Kattankudy (21.4%) 'Medical Officer of Health' (MOH) regions. The majority of mothers were educated only up to ordinary level or below (n=19, 67.8%). All patients had pets either dogs or cats at home and no pets had been dewormed. Almost 92.9% of children acquired disease whilst playing on the infected soil The main reason for clinic visit had been itchiness and this presentation accounted for 60.7% (n=17). Skin infection accounted for 25% of presenting problems. Majority of them presented late to the clinic with the lesions of more than three weeks of duration (n=17, 60.7%). Single lesion was noted in the majority (n=27, 96.4%) except one child who had three lesions. Buttock lesions were observed in 35.7%, feet in 25%, and 10.7% in legs. Investigations revealed eosinophilia in 50% (n=14) of patients and neutrophil leukocytosis was seen in five patients (17.9%). All patients received treatment either from the general practitioner or outpatient department for variable duration without success before attending the specialist clinic. Fifty percent of patients needed treatment with Albendazole and antihistamine for more than three weeks to achieve complete cure. It was also observed that overall occurrence had been declining over the past three years. Conclusion CLM is a common and unreported disease in Eastern province, Sri Lanka. The majority of children presented from low socio-economic backgrounds. The common risk factors were the presence of dewormed pets at home and contamination with infected soil. The majority of children had a single lesion on presentation. Fifty percent of children needed more than three weeks of treatment to achieve a good response.

Cutaneous larva migrans in a young child following circumrotation as a cultural ritual

Cutaneous larva migrans is an acquired, self-limited infestation caused by cat hookworm, Ancylostoma braziliense, and dog hookworm, A. caninum The disease is acquired by direct contact with contaminated soil. Circumrotation is a religious ritual practised by devotees of Hinduism as a fulfilment of vows taken at the shrine and involves rolling over with uncovered upper body on the sand over a distance of up to 600 m. It is a reported mode of acquisition of cutaneous larva migrans infestation. The authors report a 10-year-old boy who acquired cutaneous larva migrans on his right forearm after circumrotation. The forearm is an unusual site for this infestation, and most reported cases had lesions on the feet, thighs and buttocks following either sitting or playing on contaminated soil. The child made complete recovery following treatment with albendazole for 1 week.

Cutaneous Larva Migrans Infestation Over Buttocks and Perineal Region: A Case Series of Five Toddlers From Sri Lanka and Literature Review

Cutaneous larva migrans (CLM) is a cutaneous infestation caused by a hookworm larva. We report five toddlers who presented to the pediatric clinic with characteristic cutaneous lesions of CLM over the buttock and perianal region over periods of variable duration. Lesions of four children were typical and linear and one child had an atypical lesion. All were diagnosed as cutaneous larva migrans based on clinical history and examination. Complete recovery in all five children was achieved following treatment with oral albendazole.

Exploring Tropical Infections: A Focus on Cutaneous Larva Migrans

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.

Soil and Sand Contamination with Canine Intestinal Parasite Eggs as a Risk Factor for Human Health in Public Parks in Niš (Serbia)

Regarding geographical distribution and clinical relevance, the most common canine geohelminths are Toxocara canis, ancylostomatids, and Trichuris vulpis. Canine intestinal parasites from the soil and sand present an important potential serious human health hazard, especially for the children preschool and school - age. This paper aimed to establish the degree of contamination of soil and sand with zoonotic parasites from the canine feces and the degree of risk they could pose for human health in public places and playgrounds in the city of Niš. Our parasitological study involved 200 soil samples and 50 sand samples from the public parks in the city of Niš in southeastern Serbia (43°19'15″N, 21°53'45″ E). From several locations, about 100 g of soil and sand was collected based on the bioclimatic indices. Parasitological diagnosis was performed using conventional qualitative and quantitative coprological methods, abiding by the recommendations about the diagnosis of parasitic diseases. In 38 - 46 % of soil samples and 40 % of sand samples seven species of endoparasites were diagnosed. In the samples of soil, a medium and high degree of contamination with the ascarid T. canis (14 - 22 %) was detected, as well as a low and medium degree of contamination with ancylostomatids (4 - 12 %), and in the samples of sand, a variable degree of contamination with the helminths T. canis (26 %) and A. alata (16 %) was found. A statistically significant difference was found in the contamination with A. alata eggs between the samples of sand and samples of soil. The studied public surfaces represent the reservoir of zoonotic parasites, which is a public health problem requiring a synergistic action of several factors to be successfully resolved, i.e. the implementation of prevention, surveillance, and control measures.

High prevalence of Ancylostoma caninum infection in black-eared opossums (Didelphis aurita) in an urban environment

Marsupials of the genus Didelphis, such as black-eared opossums (Didelphis aurita), are common synanthropic animals in urban areas of Brazil. These marsupials are frequently parasitized by numerous helminth species, including ancylostomatid nematodes. This study aimed to report the occurrence of Ancylostoma caninum in black-eared opossums captured in an urban environment of Southeastern Brazil and discuss the potential impact of these findings for public health. From January to June 2019, we collected fecal samples from 49 restrained opossums and evaluated by a simple flotation method; Helminth eggs were observed at different magnifications and identified according to morphological and morphometric features. Genomic DNA was extracted from Ancylostomatidae eggs and screened by duplex PCR for Ancylostoma spp. and Necator americanus using primers that amplify a region of internal transcribed spacer 2 and the 28S ribosomal RNA (ITS2-28S rRNA). Ancylostoma spp. eggs were detected in 65.3% (32/49) of the animals. Sequence analysis revealed 100% homology with A. caninum sequences from GenBank. Our results demonstrate a new host-parasite interaction for A. caninum, suggesting that black-eared opossums may participate in the zoonotic cycle of this parasite in urban areas of Brazil.

Prevalence of intestinal parasites in fecal samples and estimation of parasite contamination from dog parks in central Oklahoma

Domestic dogs commonly harbor intestinal parasites in Oklahoma and throughout the world. We tested fecal samples from dog parks to determine the prevalence of intestinal parasites and reported use of parasite control in park-attending dogs and assess potential health risks posed by fecal contamination of public dog parks in this region. Fecal samples (n = 359) were collected from five public access dog parks in central Oklahoma from February to July 2019. Fecal samples were collected immediately after defecation with a corresponding canine lifestyle questionnaire completed by the owner (n = 134) or collected from the ground from unknown animals to assess potential parasitic contamination of the parks (n = 225). Sugar centrifugal flotation and saline sedimentation were performed on all samples for parasite diagnosis. Group comparisons were conducted using the Χ² test and 95% binominal confidence intervals were calculated for each proportion. One or more parasites were identified in 24.0% (86/359) of samples, including 38/134 (28.4%) fresh samples and 48/225 (21.3%) environmental samples; 6.1% were co-infected. Parasites detected included Ancylostoma spp. (14.5%), Trichuris vulpis (6.7%), Cystoisospora spp. (3.6%), Sarcocystis spp. (1.7%), and Giardia duodenalis (1.4%). A small number of samples had Cryptosporidium spp., Toxocara canis, Alaria sp., Taeniidae eggs, or Heterobilharzia americana. Owners reported 73.1% (98/134) of dogs were maintained on heartworm preventive. Intestinal nematodes, but not all parasites, were significantly less commonly detected in dogs reportedly on heartworm preventive (11.2%) compared to dogs not on heartworm preventive (27.8%; P = .0194). These data suggest dogs and people visiting dog parks are at risk of parasite exposure and that an owner-reported history of heartworm preventive use is associated with decreased prevalence of intestinal nematodes.

Soil contamination of a public park by human and canine mastadenovirus, as well as hookworms and Toxocara spp eggs

Public parks are leisure environments widely used by both, adults and children, often accompained by their pets. Soil contamination of these environments by enteric viruses and intestinal parasites occurs through these animals feces. The aim of this work was to detect Carnivore protoparvovirus 1 (CPV-1) and different species of Mastadenovirus in soils samples from a park located in a medium-sized city in Brazil and evaluate the presence of helminth eggs and larvae in 18 points of a public park soil samples, as well as feces found on this site during six months. Parasitological analyzes were conducted through flotation and sedimentation techniques, and polymerase chain reaction (PCR) was used for viral detection. Of the 216 soil and 16 feces samples, 49% (106/216) and 12% (2/16) were positivefor nematodes larvae, respectively, through sedimentation techniques. Toxocara spp eggs were found in one soil sample and one feces sample, Trichuris spp eggs were found in only one feces sample and Hookworms eggs were found in four soil samples. After reconstruction work in the streets near the park, 30% (64/216) of the samples were positive for Human Mastadenovirus C (HAdV-C), 1.4% (3/216) for HAdV-E and 0.4% (1/216) for Canine Mastadenovirus A (CAdV-A). The parasitic forms found in this study have demonstrated that the contamination of the park’s soil pose a threat to human and animal health. This was the first study to report the presence of HAdVs and CAdVs in soil samples.

Contamination of Italian parks with canine helminth eggs and health risk perception of the public

The contamination of public areas by dog faeces is a social behaviour and public health problem. In fact, the most frequently isolated intestinal helminths in dogs are distributed worldwide, and most of them have zoonotic potential (i.e., ascarids and ancylostomatids). The aims of this survey were to evaluate citizen awareness of health risks for animals and humans related to canine faecal pollution and to estimate the presence and prevalence of intestinal helminths in dog faeces collected in green public areas in three municipalities of Italy (Padua, Rome and Teramo). The awareness of citizens about the health risks related to faecal pollution was evaluated using questionnaires submitted to 313 dog owners and 159 non-dog owners in Padua (n = 341) and Rome (n = 131). Most dog owners (85.4%) declared they picked up their dog's faeces every time, and these data were confirmed by operators secretly observing dog owners. Moreover, 84.3% participants were aware of the existence of a municipal regulation concerning the correct management of animals in public areas with no significant differences between dog owners and non-dog owners, whereas Rome citizens were significantly more aware than Padua citizens. Nonetheless, only 10.9% (51/469) of responders knew the health risks related to canine faecal pollution, with no significant differences between dog and non-dog owners. A total of 677 dog stool samples were collected and copromicroscopically analysed. Forty-eight (7.1%) samples were positive for at least one parasite species, with significantly lower prevalence values in Padua (2.2%) than in Rome (11.9%) and Teramo (8.6%). The highest prevalence was detected for Trichuris vulpis (4.4%), followed by Toxocara canis (1.9%); T. vulpis presented significantly lower prevalence in Padua than in the other cities. Other helminths were found with values under 0.5% in the investigated cities. This survey shows that most citizens are unaware of the health risk related to abandoned canine faeces on public soils. Nevertheless, laboratory results suggest a limited risk for dog and human health, but the zoonotic risk due to the high vitality of infective helminths eggs in the soil should always be considered.

A Case of Cutaneous Larva Migrans in a Child from Vinces, Ecuador

BACKGROUND Cutaneous larva migrans (CLM) is caused by nematode parasites of the hookworm family of Ancylostomatidae. Ancylostomiasis is a zoonosis found in cats and dogs, and humans are an accidental host. This report presents a case of CLM in an 8-year-old boy, which was due to the zoonotic transmission of Ancylostoma caninum from domestic dogs in an urban area of Vinces, Ecuador, and demonstrates how awareness and early diagnosis contributed to the timely treatment of CLM. CASE REPORT An 8-year-old boy from the urban area of Vinces city in the Los Ríos province of Ecuador presented with a serpiginous palpable lesion on the sole of the right foot, consistent with a diagnosis of cutaneous larva migrans (CLM). He was infected through contact with the soil where canine Ancylostoma larvae were found. Twenty samples of feces were analyzed from the soil, and Ancylostoma larvae were found in 100% of these samples. Also, 120 dog stool samples were examined, and 75 (62.5%) contained Ancylostoma larvae, which were identified using the modified Willis and Baermann method. CONCLUSIONS CLM is a zoonotic disease that can affect the population in endemic areas. In this case, CLM was identified in the sole of the foot of a child. The presence of Ancylostoma larvae were identified in the soil and in the feces of dogs, indicating that the community was exposed to a significant environmental risk from this zoonotic disease.

An unusual case of extensive truncal cutaneous larva migrans in a Cameroonian baby: a case report

BACKGROUND

Cutaneous larva migrans is a neglected zoonotic helminthic disease which is paradoxically underreported in low-income and middle-income countries from where a majority of the cases emanate. It presents as migratory, raised, erythematous serpentine lesions, responsive to treatment with antihelminthics. It is common in children, but rare in babies. We report an unusual case of cutaneous larva migrans in a Cameroonian baby.

CASE PRESENTATION

We report the case of a 9-month-old Cameroonian baby girl, whose mother had the habit of drying the child's clothes on the grass in her courtyard. The child was brought to our hospital after she developed itchy, snake-like, slowly progressing lesions on her abdomen and chest. An examination revealed multiple raised serpentine and erythematous skin lesions consistent with cutaneous larva migrans which subsided on antihelminthic and antihistaminic therapy.

CONCLUSIONS

Cutaneous larva migrans is an endemic disease with predilection for poor and vulnerable persons. Preventive efforts such as wearing of slippers, usage of drying lines, and deworming of pets are crucial in preventing the occurrence of this disease and should be encouraged.

Global output of research on epidermal parasitic skin diseases from 1967 to 2017

Background

Epidermal parasitic skin diseases (EPSD) occur in most countries and cause a considerable health and economic burden, particularly in the tropics and subtropics. The aim of this study was to assess and analyse peer-reviewed literature on EPSD in humans. The results of this study serve as an indicator of the extent the scientific community, health authorities, and international health agencies interact with EPSD as a health problem that is commonly associated with poverty and poor hygiene.

Methods

A bibliometric analysis methodology was used. The Scopus database was used to retrieve documents about EPSD for the study period (1967–2017). The study focused on scabies, tungiasis, pediculosis, hookworm-related cutaneous larva migrans (HrCLM), myiasis, and cutaneous strongyloidiasis. Documents that specifically and explicitly discuss EPSD in animals, aquatic organisms, and birds were excluded.

Results

In total, 4186 documents were retrieved. A fluctuated growth of publications on EPSD in the past five decades was found. The retrieved documents received 43 301 citations, an average of 10.3 citations per article and an h-index of 74. The keywords “scabies” and was the most commonly encountered keyword followed by the keywords “head lice” and “pediculosis”. The most active journal involved in publishing articles on EPSD was the International Journal of Dermatology (164; 3.9%). Researchers from 93 different countries published the retrieved articles. The USA led with 735 (17.6%) documents, followed by the UK (274; 6.5%), and Germany (259; 6.2%). In terms of institutions, the Charité – Universitätsmedizin Berlin in Germany was the most active in this field with 78 (1.9%) publications, followed by the Universidade Federal do Ceará in Brazil with 52 (1.2%) publications.

Conclusions

Research on scabies and pediculosis dominated the field of EPSD research to the expense of tungiasis, HrCLM, myiasis, and cutaneous strongyloidiasis. There was an underrepresentation of literature from the tropics and subtropics despite EPSD being common in these areas. This could possibly be explained by the presence of limited number of non-English journals in the Scopus database. International research collaborations and research networking should be strengthened to help advance and prioritize research on EPSD.

Electronic supplementary material

The online version of this article (10.1186/s40249-018-0456-x) contains supplementary material, which is available to authorized users.

Epidemiology and morbidity of hookworm-related cutaneous larva migrans (HrCLM): Results of a cohort study over a period of six months in a resource-poor community in Manaus, Brazil

Background

Hookworm-related cutaneous larva migrans (HrCLM) is a neglected parasitic skin disease, widespread in resource-poor communities in tropical and subtropical countries. Incidence and risk factors have never been investigated in a cohort study.

Methodology/Principal findings

To understand the seasonal epidemiology of HrCLM, an open cohort of 476 children in a resource-poor community in Manaus, Brazil was examined for HrCLM monthly over a period of 6 months. Monthly prevalence and intensity of infection were correlated with the amount of monthly precipitation. Multivariable Cox regression analysis indicated male sex (hazard ratio [HR] 3.29; 95% confidence interval [CI] 1.95–5.56), walking barefoot on sandy ground (HR 2.30; 95% CI 1.03–5.16), poverty (HR 2.13; 95% CI 1.09–4.17) and age between 10 and 14 years (HR 1.87; 95% CI 1.01–3.46) as predictors of HrCLM. Monthly incidence rates ranged between 0.21 and 1.05 cases per person-year with an overall incidence of 0.52 per person-year.

Conclusions/Significance

HrCLM is a frequent parasitic skin disease in this resource-poor community. Every second child theoretically becomes infected during one year. Boys, 10 to 14 years old, belonging to the poorest households of the community, are the most vulnerable population group. Even in the tropical monsoonal climate of Amazonia there is a considerable seasonal variation with monthly incidence and number of lesions peaking in the rainy season.

Hookworm-worm related cutaneous larva migrans (HrCLM) is a parasitic skin disease caused by hookworm larvae of cats and dogs occurring in many countries with a tropical or subtropical climate. Humans are a biological impasse for these helminths as the larvae cannot pass the basal membrane of the epidermis and hence migrate haphazardly in the skin causing local inflammation and intense itching. In scientific literature HrCLM is generally described as a disease of travellers returning from endemic areas. In contrast, epidemiological data is scanty. In a previous study, we had examined an entire resource-poor neighbourhood in Manaus (Brazil) and showed, that HrCLM is an important individual and public health problem, affecting up to 8% of the population, in particular children. In this study, we followed a cohort of children for six months. We found a significant seasonal variation in incidence and morbidity between dry and rainy season. Extrapolated, every second child in this population will be affected at least once within one year. The longitudinal study design enabled us to validate previously identified risk factors. Children aged 10–14 years, in particular boys, and those walking barefoot on sandy ground had the highest infection rates. Children from the poorest families in the resource-poor community were most vulnerable to HrCLM.

Gastrointestinal Parasites in Shelter Dogs: Occurrence, Pathology, Treatment and Risk to Shelter Workers

Dogs entering shelters can carry gastrointestinal parasites that may pose serious risks to other animals, shelter staff and visitors. Shelters provide an environment that could facilitate the spread of parasitic infections between animals. Nematodes and protozoa that transmit through ingestion or skin penetration are major enteric parasites of concern in shelter settings. Ancylostoma spp., Uncinaria stenocephala, Toxocara canis, Toxascaris leonina, Trichuris vulpis and Dipylidium caninum are the major helminths while Giardia, Cryptosporidium, Isospora spp. and Sarcocystis spp. are the most prevalent protozoan parasites in shelter dogs. The prevalence of gastrointestinal parasites in shelter dogs is typically higher than in owned dogs. A range of cost-effective drugs is available for prevention and control of helminths in shelters, notably fenbendazole, pyrantel, oxantel, and praziquantel. Parasiticide options for protozoan parasites are often cost-prohibitive or limited by a lack of veterinary registration for use in dogs. Environmental control measures reliant upon hygiene and facility management are therefore a mainstay for control and prevention of protozoan parasites in shelters. This philosophy should also extend to helminth control, as integrated parasite control strategies can allow anthelmintics to be used more sparingly and judiciously. The purpose of this article is to comprehensively review the current knowledge on the prevalence of gastrointestinal parasites most commonly found in dogs in shelters, canvass recommended treatment programs in shelter dogs, and to explore the likelihood that parasiticide resistance might emerge in a shelter environment.

Cutaneous Larva Migrans – Report of 2 new Cases Locally Acquired in Serbia

Cutaneous larva migrans (CLM) is a parasitic skin disease caused by the accidental percutaneous penetration and subsequent intraepidermal migration of larvae of various nematode parasites of the hookworm family. The hookworms responsible for CLM are spread worldwide, but the infection occurs mostly in tropical and subtropical climates. Nowadays, because of ever increasing foreign travel, the disease is no longer confined to these areas. Moreover, a significant increase of autochthonous cases in southern Europe has been observed in recent years. We report two new patients from Serbia who acquired CLM, none of them having traveled abroad. As the recommendations for the treatment of CLM are not uniform, two different treatment modalities were applied in these patients, both with an excellent response.

[Zoonotic intestinal nematodes in dogs from public parks in Yucatán, México]

INTRODUCTION

Dogs represent a potential public health risk because of the natural transmission of zoonotic parasitic infections.

OBJECTIVE

To estimate the frequency and to determine factors associated with the presence of intestinal nematode eggs in dog feces collected in public parks of Mérida,Yucatán, México.

MATERIALS AND METHODS

A total of 100 dog fecal samples collected from 20 public parks in two areas of Mérida were analyzed. Samples were processed by the centrifugation-flotation and the McMaster techniques to confirm the presence and to quantify the excretion of intestinal nematode eggs per gram of feces. The factors associated with the presence of nematode eggs were identified using the chi square univariate analysis.

RESULTS

We found an 11% frequency of fecal samples positive for intestinal nematode eggs. Eggs of three species of parasites were identified: Ancylostoma caninum was the most common (10%), followed by Toxocara canis (10%), and Trichuris vulpis (1%). Most positive samples were infected with only one intestinal nematode (10%), and only 1 % was positive for a mixed infection by A. caninum and T. vulpis. The presence of stray dogs in public parks was an associated factor (p=0.046) with a higher number of fecal samples positive for intestinal nematode eggs.

CONCLUSIONS

The frequency of intestinal nematodes in dog feces with zoonotic potential was high in parks of Mérida, Yucatán, México; samples from parks where there were stray dogs had a higher possibility of being positive.

A Unique Case of Cutaneous Larva Migrans Acquired Within the Province of Quebec and Successfully Treated With Topical Ivermectin

Cutaneous larva migrans (CLM) is a zoonotic helminthiasis frequently imported to Canada by travellers to beach destinations in the tropics. The preferred treatment is oral ivermectin. We present a case of CLM acquired within the province of Quebec, a first in our provincial health records. Our case also puts forward the use of topical ivermectin as a possibly effective CLM treatment approach as our patient was successfully treated with 1 month of an ivermectin 1% cream applied locally twice daily.