CUTANEOUS LARVAE MIGRANS

Dewi M.Darlan
Parasitology Department
Medical Faculty of USU
Cutaneous larva migrans
(CLM)

Due to:
Ancylostoma ceylanicum,
A.caninum
Strongyloides stercoralis

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Cutaneous larva migrans (CLM)
Pathogenese

This condition is caused by contact with soil containing
infective larvae (filariform larvae) that are capable of
penetrating the skin.

This can’t occur after first exposure but follows re-
infection only after several weeks, this suggests that the
disease is due to hypersensitivity to larval secretions
(Provic and Croese, 1996)

The larva produces a number of enzymes which may
assist in dermal invasion; such as metaloprotease, minor
protease and hyluronidase (Hotez, Hawdon and Capello,
1995)

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 Cutaneous larva migrans (CLM)
Clinical features

The lower extremities are more often affected

with eruption on the feet, making up almost ⅔ of
all cases.

A pruritic erythematous papule develops initially
at the site of each larvae entry.

After 2-3 days, severely pruritic, serpiginous,
reddish-brown lesions appear

Larvae migrate at a rate of several mm/ day

Lesions are intensely itchy, red, and oedematous
and show a worm-like migratory pathway under
the skin
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 Cutaneous larva migrans (CLM)
Clinical features

Lesions may also become vesiculated,

encrusted, or secondarily infected.

The larvae eventually die and become
absorbed without treatment.

The cutaneous symptoms typically last
For days to months.

Only 29% of patients had lesions that
persisted for 1 month, but in occasional
patients had lesions in follicles and cause
disease for as long as 2 years.
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Cutaneous larva migrans (CLM)
Diagnosis

The diagnosis of CLM is made on the basis of the
characteristic clinical features

The laboratory has no role to play in diagnosis

Eosinophilia is only a feature of minority of
cases. Titer IgE is usually normal

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Cutaneous larva migrans (CLM)
Treatment

CLM is readily treated by application of 15%
thiabendazole paste for 5 days.

In severe cases, systemic treatment with
albendazole or ivermectin may also be used
(Caumes
Caumes et al.,1993
al.,1993)

Biopsy, surgical excision or liquid nitrogen is
contraindicated (Stephen
Stephen H.Gillespie
H.Gillespie,, in Principle
and practice of clinical parasitology,2001)
parasitology,2001

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