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Exotic vacations usually entail great emotions. The sun, beautiful views, oriental food or breathtaking monuments. Unfortunately, not every long trip means fond memories. Sometimes it happens that when we return to the country we bring with us something more than just souvenirs. A two-year-old child from a trip to the Dominican Republic brought a peculiar “guest” – a migrating larva, that is, the Brazilian hookworm.
Aleksandra Biernacka, Medonet: How did the infection come about and when did the child come to you?
Dr Bartosz Pawlikowski, specialist in dermatology, pediatrician from the Medevac Clinic in Łódź: The child came to me a month after my return from the Dominican Republic. These regions are home to a large number of stray cats and dogs that are hosts for parasites (parasites go through the full life cycle – from the larva to an adult capable of reproducing). So getting infected is not difficult.
What is this parasite?
Skin lesions of the larva migrans type can be caused by many animal nematodes, most often by Ancylostoma brasiliense – the Brazilian hookworm. Various other species of nematodes penetrating the skin can also cause similar dermatoses. The Brazilian hookworm is the smallest hookworm that can parasitize the human body. The male is 7,8 to 8,5 mm long, the female is 9 to 10,5 mm.
Nematode larvae in the human body do not follow the full life cycle. Threadlike larvae live only in the skin. In tropical and subtropical climates, various species of wild and domestic dogs and cats are a reservoir for the Brazilian hookworm. Its eggs are excreted by animals with faeces and infect the earth’s surface, where, under favorable temperature and humidity conditions, they develop into invasive filarius-like larvae.
Infection with the parasite occurs through undamaged skin that comes into direct contact with contaminated, moist soil. Typically, the source of infection is coastal beaches and sandboxes, where filari-like larvae live at a depth of 1,0 to 1,5 cm, which actively penetrate the reproductive layer of the epidermis. Most often around the feet, less often around the buttocks and hands. An itchy, red lump appears at the site of the parasite’s entry. Then a bubble appears in which the larva “sits”.
Later, the larva begins to move around. It does it very slowly and travels from a few millimeters to several centimeters a day. It leaves behind a day of twisted, raised above the skin surface several or several centimeters long tunnels (called creeping eruption). The movements of the parasite cause a very strong holiday, the sick scratch themselves heavily, which often results in secondary infection. It is also one of the most common complications. The layer of skin under which the tunnel hollowed out by the larva runs is infiltrated, pale pink, raised and clearly different from the rest of the skin. After the parasite has passed through, the tunnels dry out and become scabbed.
It is worth remembering that a characteristic feature of changes caused by animal nematodes is a linear, migrating erythema.
Under what conditions can you become infected?
Cutaneous cutaneous larvae syndrome (CLM) is the most common tropical acquired dermatosis. The infection occurs accidentally by percutaneous penetration and subsequent migration of the parasite nematode larvae. The migratory cutaneous larvae syndrome is most common in tropical and subtropical areas and in the southwestern United States. The infection is endemic to the Caribbean, Central America, South America, Southeast Asia and Africa. Due to the ease of infection and the increasing frequency of foreign travel, the disease is not limited to these areas.
Is it very dangerous?
Mortality from infections has not yet been reported. Most cases of nematode infection heal self-heals without negative long-term effects. Incidence is associated with intense itching, rash, which leads to cellulitis. In the rare cases where the nematodes enter the human final host, the infection may lead to the end of the nematode’s life cycle as adult intestinal worms. This causes diarrhea, malabsorption and malnutrition.
Can I get vaccinated?
There are no vaccinations for this.
How can we protect ourselves?
Contact with risky areas should be avoided and shoes should be worn.
How did this child’s story end? Everything has been removed and what does the procedure look like? Is there any treatment for the baby?
I removed the nematode completely, but because of its small size in fragments. The treatment consisted of a superficial incision in the place of visible, linear elevation of the epidermis. After the procedure, I recommended an antibiotic ointment. Due to the age of the child, the use of antiparasitic drugs effective against this parasite is possible only in the case of failure of the procedure or the occurrence of many individuals and the disseminated nature of the lesions.