gms | German Medical Science

Background: Cutaneous larva migrans (CLM) is a common but neglected parasitic skin disease caused by the migration of animal hookworm larvae in the epidermis. The disease is common in impoverished communities of the developing world; it is associated with considerable morbidity and results in life quality impairment.

Methods: Patients with CLM were identified through active case finding in two slums in Manaus, Amazonas State, Brazil. Patients were diagnosed clinically. Clinical pathology was assessed in a semi-quantitative manner. Patients were treated with ivermectin (200µg/kg) and were followed-up 2 and 4 weeks after treatment.

Results: 92 consecutive patients were included in the study: 69.6% were male and 30.4% were female. Median age was 9.5 years (IQR 5–44). The number of tracks ranged from 1-51 (median: 2, IQR 1–6), 70% of all patients had ≤4 tracks. The mean length of the track was 42 mm. Excoriations were observed in 49%, crusted lesions 62% and superinfection in 13% of all patients. Extremely itching bullous lesions occurred in 8% of all cases. 92% of the patients complained about pruritus and 73% about insomnia due to itching.

Follow-up examinations showed a significant decrease of the number of active lesions two weeks after treatment (p=0.01). The length of the tracks had decreased 9mm (IQR 2–3) after 2 weeks and 20 mm after 4 weeks (IQR 0–3) The proportion of superinfected lesions was reduced from 13% to 2% after 4 weeks (p=0.02). Pruritus significantly decreased in 60.2% of the patients after 2 weeks, and in 83.3% of the patients after 4 weeks. Pruritus-related insomnia decreased in 53.5% and 63.7%, respectively.

Conclusions: In a resource-poor setting most patients with CLM suffered from multiple infestation and showed important clinical pathology. A single dose of ivermectin significantly reduced clinical pathology within 2 to 4 weeks.