Internal Medicine

0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37

440 Cutaneous Larva Migrans

Signs & Symptoms

■Serpiginous, red, often pruritic, slightly raised tracks, usually on feet,

which advance up to 1–2 cm per day

tests

■Basic tests: blood: none helpful

■Basic tests: urine: not helpful

■Specific tests: none

■Other tests: none

differential diagnosis

■Similar tracks can be seen in strongyloidiasis (usually perianal or

on buttocks). Human hookworm can migrate short distance, not in

distinct track.

management

What to Do First

■Reassure patient. Larva does not invade.

General Measures

■Keep foot clean, give tetanus booster. Antibiotics if secondarily

infected.

specific therapy

Indications

■Persistent infestation. Larva eventually dies without treatment, but

can take months.

Treatment Options

■Ivermectin single dose

■Albendazole for 3 days

■Thiabendazole 15% in water-soluble base, applied tid for 5 days

(needs to be compounded, variable results reported)

Side Effects & Complications

■Ivermectin and albendazole: minor intestinal symptoms

■Contraindications to treatment: absolute: pregnancy, except for top-

ical thiabendazole

■Contraindications to treatment: relative: apparently resolving case

follow-up

Routine

■Retreatment needed in around 5–10% of cases