#IdBoardReview 25 F recent Caribbean vacation, walked barefoot on sand and now with creepy rash. diagnosis? #idmedEd #MedEd 
Cutaneous larva migrans is a characteristic serpiginous skin lesion which may be seen in travelers Carribean & Americas. most common causative organisms are Ancylostoma braziliense and Ancylostoma caninum.
#CLM most commonly transmitted by animal feces depositing eggs in soil/sand, with larvae entering humans through direct contact with skin. Cutaneous larva migrans is distinguished from cutaneous manifestation of Strongyloides stercoralis infection termed larva currens
classically seen in warmer climates, including southeast 🇺🇸. Latin America, Southeast Asia, and Africa.
progressive migrating serpiginous rash commonly with pruritus. can affect any exposed area butmost common location is feet.
progressive migrating serpiginous rash commonly with pruritus. can affect any exposed area butmost common location is feet.
Adult hookworms live in intestines of 🐕🐈 . Eggs are shed in feces & after deposition into soil hatch w/in 1d. Over proceeding wk:infective larvae. Worms respond to physical vibration &⬆️🔥& move in snake-like fashion.
Upon contacting a host: penetrate corneal layer by secreting a hyaluronidase. Despite burrowing via superficial cutaneous layers: unable to penetrate basal membrane to enter lymphatics & unable to complete lifecycle. Hookworms subsequently die w/o reproducing & dz is self-limited
Diagnosis is clinical & labs & biopsy are not needed. No treatment is required unless multiple lesions or severe infestation: albendazole & ivermectin are first-line systemic therapies. Oral albendazole, 400 mg daily for 3 to 5 days, is very effective with cure rates nearing 100%
Some studies show that a 7-day course of albendazole may decrease the rates of recurrent disease. Oral ivermectin is also effective, and its advantage is a patient only has to take a one-time dose of 12 mg by mouth. Cure rates near 100% with ivermectin administration.
