Ecoepidemiology of Ancylostoma spp. in Urban-Marginal and Rural Sectors of the Ecuadorian Coast and Prevalence of Cutaneous Larvae Migrans.

BACKGROUND Ancylostoma spp., including A. duodenale, A. braziliense, A. caninum, and A. ceylanicum, are hookworms that are transmitted from infected soil and by contact with domestic animals and rodent hosts, and can cause systemic disease and cutaneous larva migrans. The objective of this study was to describe the ecoepidemiology of Ancylostoma caninum and Ancylostoma spp. in urban-marginal sectors and in rural sectors located in Ecuador. MATERIAL AND METHODS Through addressed sampling, a total of 498 domestic dogs and 40 synanthropic rodents were analyzed via the following coproparasitic methods: direct, flotation, sedimentation with centrifugation using saline (egg identification), modified Baermann (larval identification), and morphometric methods (confirmation). A total of 236 people were surveyed, and a clinical analysis was performed via physical examination. The environmental variables were obtained through reports from the INAMHI of Ecuador and the use of online environmental programs. Through surveys, data related to social determinants were obtained. Epidemiological indicators (prevalence, morbidity, and mortality) were obtained through microbial analysis and surveys. RESULTS A total of 250 domestic dogs were diagnosed with Ancylostoma caninum (50, 20%), and 41 were diagnosed with Ancylostoma spp. (8.23%). One synanthropic rodent (2.5%) was positive for A. caninum. In the clinical analysis, 3 patients were identified as positive (1.27%) for cutaneous larva migrans (CLM). Likewise, environmental variables and social determinants influence the transmission, prevalence, and nature of parasitism by hookworm. CONCLUSIONS People, domestic dogs, and rodents were infected with these parasites. Consequently, there is a risk of ancylostomiasis and cutaneous larvae migrans spreading.

Cutaneous Larva Migrans as a frequent problem in travellers.

Dermatological disorders are among the most common complaints of patients seeking medical assistance after returning from trips to tropical countries. Among exotic dermatoses, one of the frequently encountered diagnoses is Cutaneous Larva Migrans (CLM), primarily caused by the nematodes Ancylostoma braziliense and A. caninum. Cats and dogs, which serve as the definitive hosts for these nematodes, excrete with their stool parasite eggs into the environment, where they transform into larvae. Human infection occurs through the invasive form of the larvae, which penetrate the skin, causing itching and the characteristic serpiginous, slightly raised, and enlarging lesion at the site of invasion. Diagnosis is made based on the highly characteristic clinical presentation, although in non-endemic countries, diagnostic errors and delays in initiating effective causal treatment are relatively common. Effective therapy includes oral albendazole and ivermectin. Prevention of CLM involves avoiding skin contact with potentially contaminated soil by wearing shoes and using towels and mats on the beach. Due to the high interest in travel and the risk of importing exotic diseases, it is important to promote knowledge of tropical medicine among healthcare professionals as well as the travellers.

Cutaneous larva migrans in the northeastern US.

Cutaneous larva migrans (CLM) is a dermo-epidermal parasitic infection with a disproportionate incidence in developing countries, particularly in, and near tropical areas. It is characterized by erythematous, twisting, and linear plaques that can migrate to adjacent skin. Herein, we present an otherwise healthy 45-year-old woman who acquired a pruritic, erythematous, and serpiginous rash localized to her right medial ankle during a trip to New England. Oral ivermectin, the preferred first-line treatment for cutaneous larva migrans, was administered in combination with triamcinolone. This was followed by removal of the papular area via punch biopsy; treatment was successful with a one-week recovery. Although cutaneous larva migrans has traditionally been considered a tropical disease, clinicians should be cognizant of its expanding geographic spread.

Unusual presentations of cutaneous larva migrans in British military personnel.

Cutaneous larva migrans (CLM) is one of numerous skin diseases that occur in British military personnel on deployments to the tropics and sub-tropics. It is typically managed by military primary healthcare services, but diagnostic uncertainty or unavailability of anti-helminthic medication may prompt referral to UK Role 4 healthcare services. Cases of CLM seen at the UK Role 4 Military Infectious Diseases & Tropical Medicine Service from 2005 to 2020 were identified and their case notes were reviewed to identify learning and discussion points. There were 12 cases identified, of which five came from Brunei and three were from Belize. Causes for referral were due to diagnostic uncertainty (58%) and the unavailability of anti-helminthic medication (42%). Several cases had CLM in an unusual distribution due to specific military activities performed in endemic areas. Telemedicine was very useful in making some of the diagnoses in theatre and avoiding the need for medical evacuation. Military personnel may have unusual presentations of CLM due their unique military activities. In areas that are endemic for CLM, clinicians should maintain high clinical suspicion for CLM, carry appropriate anti-helminthic medications and consider screening cases of CLM and their colleagues for other infections with similar aetiology (eg, human hookworm infection and strongyloidiasis).

Tropical parasitic itch in returned travellers and immigrants from endemic areas.

Itch is the most common skin symptom among tropical parasitic diseases (TPD), but there are limited data about its characteristics in these conditions. In dermatology practices and travellers' health clinics in the developed world, itch is a common complaint among travellers returning from endemic areas, as well among migrants arriving from endemic areas, where they may have been exposed to TPD. Studying aspects of pruritus among TPD may lead to improvements in prompt, accurate diagnosis and management of these conditions. This review examines the major itch-inducing TPDs, including schistosomiasis, echinococcosis, onchocerciasis, scabies, cutaneous larva migrans, larva currens, African trypanosomiasis, dracunculiasis and other causes of travel associated pruritus. We focus on the link between pruritus and other symptoms, aetiology, clinical staging and therapeutic options for these parasitic illnesses. Because some tropical parasitic diseases can present with significant pruritus, we attempt to identify aspects of the pruritus that are characteristic of-or unique to-specific conditions. These diagnostic insights may help clinicians create a rational and focused differential diagnosis and help determine optimal disease management pathways. In this sense, management involves treating the individual, seeking epidemiologically linked cases, preventing recurrences or relapses, and reducing spread of the disease.

Effect of global warming on dermatology practice: The increase in cases of cutaneous larva migrans in the eastern Black Sea region of Turkey.

OBJECTIVE: Cutaneous larva migrans (CLM) is a parasitic disease seen in people in contact with soil in tropical countries. Almost all cases reported in regions without a tropical climate have a history of travel to a tropical region. AIM: In our study, we aimed to investigate the effect of climate change on CLM cases and the demographic characteristics of these cases. For this purpose, the climate information of the period in which we determined the case series and the characteristics of the patients were investigated. MATERIAL AND METHOD: The study was designed retrospectively. Patient files and pre- and post-treatment photographic archives were reviewed retrospectively. In addition, the region's weather history over the last 50 years was examined. RESULTS: The records of patients diagnosed with CLM in 2018 were reviewed retrospectively. In total, 22 cases were detected. The common feature of all cases was that they worked as tea pickers. After examining the weather conditions of the period when the cases were commonly reported, it was determined that there was a sharp temperature increase compared with previous years. CONCLUSION: Due to climate change, an increase in the number of CLM cases is observed in non-tropical regions. Since it is considered a disease-specific to tropical regions, the diagnosis may be overlooked in cases outside these regions. However, CLM should be kept in mind as a diagnostic possibility by clinicians practicing in non-tropical regions as well, especially when treating patients who work with soil, such as tea harvesters.

Occupational risk of cutaneous larva migrans: A case report and a systematic literature review.

Cutaneous larva migrans (CLM) is a parasitic zoonosis of warm tropical and subtropical areas, although autochthonous cases have been increasingly reported in Western European countries. Data on the prevalence of CLM as an occupational disease in workers exposed to potentially contaminated soil or in close contact with dogs and cats are scant. Herein, we report an autochthonous case of CLM in a dog breeder from southern Italy (Apulia region), along with a systematic literature review describing the risk of CLM infection, mainly according to job categories. The patient was referred to the dermatology unit presenting a serpiginous lesion on his hand, raising the suspected CLM diagnosis. In non-endemic areas, CLM might represent a challenge for physicians in terms of diagnosis, treatment, and prevention, particularly in workplaces. The multidisciplinary approach in the diagnosis of CLM with the involvement of different scientific competences (i.e., dermatologists, veterinarians, and occupational physicians) may contribute to further assess the distribution of human CLM and associated risk factors, toward reducing the risk for the infection.

Larva migrans in Votuporanga, São Paulo, Brazil: Where does the danger hide?

Soil samples collected near municipal schools (public/EMEI and private/EPEI schools), clubs (CLB), public squares (PS) and residential condominiums (CND) and samples of animal faeces from the Zoonosis Control Centre (CCZ) of the municipality of Votuporanga/SP were analysed using the Baermann method for the detection of zoonotic helminth larvae. The prevalence rates of the nematode genera identified were determined, and the results were compared using Fisher's exact and chi-square frequency tests. Information about cases of larvae migrans in the population were collected from the Family Health Units and the private health plans. All sites were positive for Ancylostoma spp. and, with the exception of EPEIs and dog faeces, for Strongyloides spp. The prevalence of Ancylostoma spp. was 87.5% for CND samples, 74.29% for EMIEs, 63.64% for CLB, 61.76% for PS and 64.29% for dog's and 42.86% for cats at CCZ. The prevalence of Strongyloides spp. ranged from 14.29% (cats/CCZ) to 41.18% (PS). Cases of cutaneous larva migrans were reported during interviews. Thus, from the public health perspective, the risk of individuals that frequent recreational areas in the municipality, especially children, to be infected by helminth larvae is noteworthy, indicating the need to develop policies aimed at controlling this important zoonosis.

Exploring Tropical Infections: A Focus on Cutaneous Larva Migrans.

GENERAL PURPOSE: To provide information about infection with cutaneous larva migrans (CLM). TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, NPs, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Distinguish the clinical features, diagnosis, and management of CLM.2. Explain the epidemiology of CLM. ABSTRACT: Cutaneous larva migrans is a hookworm infection and one of the most common skin diseases of tourists in tropical countries. Most commonly, the infection is transmitted by contact with feces of dogs and cats containing hookworm eggs. This case-based review explores the epidemiology, diagnosis, clinical features, and management of cutaneous larva migrans infection.

Cutaneous larva migrans is a hookworm infection and one of the most common skin diseases of tourists in tropical countries. Most commonly, the infection is transmitted by contact with feces of dogs and cats containing hookworm eggs. This case-based review explores the epidemiology, diagnosis, clinical features, and management of cutaneous larva migrans infection.

Larva migrans in Votuporanga, São Paulo, Brazil: Where does the danger hide? / Larva migrans em Votuporanga, SP, Brazil: Onde se esconde o perigo?

Abstract Soil samples collected near municipal schools (public/EMEI and private/EPEI schools), clubs (CLB), public squares (PS) and residential condominiums (CND) and samples of animal faeces from the Zoonosis Control Centre (CCZ) of the municipality of Votuporanga/SP were analysed using the Baermann method for the detection of zoonotic helminth larvae. The prevalence rates of the nematode genera identified were determined, and the results were compared using Fisher's exact and chi-square frequency tests. Information about cases of larvae migrans in the population were collected from the Family Health Units and the private health plans. All sites were positive for Ancylostoma spp. and, with the exception of EPEIs and dog faeces, for Strongyloides spp. The prevalence of Ancylostoma spp. was 87.5% for CND samples, 74.29% for EMIEs, 63.64% for CLB, 61.76% for PS and 64.29% for dog's and 42.86% for cats at CCZ. The prevalence of Strongyloides spp. ranged from 14.29% (cats/CCZ) to 41.18% (PS). Cases of cutaneous larva migrans were reported during interviews. Thus, from the public health perspective, the risk of individuals that frequent recreational areas in the municipality, especially children, to be infected by helminth larvae is noteworthy, indicating the need to develop policies aimed at controlling this important zoonosis.

Resumo Amostras de solo colhidas em escolas municipais (ensino público/EMEI e privado/EPEI), clubes (CLB), praças públicas (PP), condomínios residenciais (CND) e de fezes de animais do Centro de Controle de Zoonoses (CCZ) do município de Votuporanga/SP, foram submetidas ao método Baermann para detecção de larvas de helmintos zoonóticos. Foram determinadas as taxas de prevalência dos nematódeos identificados, e os resultados confrontados pelos testes Exato de Fisher e Qui-quadrado. Atendimentos de casos de larvas migrans na população foram levantados em entrevistas realizadas em Unidades de Saúde da Família e em planos de saúde privados. Todos os locais apresentaram positividade para Ancylostoma spp. e, com exceção de EPEIs e de fezes caninas, para Strongyloides spp. Prevalência de Ancylostoma spp. foi verificada em amostras de CNDs (87,50%), EMEIs (74,29%), CLBs (63,64%), PPs (61,76%) e em fezes de cães e gatos do CCZ (64,29% e 42,86%, respectivamente). As prevalências de Strongyloides spp. variaram de 14,29% (gatos/CCZ) a 41,18% (PP). Atendimentos de casos de larva migrans cutânea foram relatados nas entrevistas. Portanto, ressalta-se o risco de frequentadores de áreas de lazer do município, especialmente crianças, de adquirirem infecção por larvas de helmintos, indicando a necessidade da elaboração de propostas de políticas voltadas ao controle dessa importante zoonose.

Análise da ocorrência de parasitos com potencial zoonótico no solo de escolas municipais infantis em dois municípios do Rio Grande do Sul / Analysis of the occurrence of parasites with zoonotic potential in the soil of municipal nursery schools in two municipalities in Rio Grande do Sul state

Introdução: A contaminação de praças ou ambientes de recreação por ovos de geohelmintos constitui um problema de saúde pública. O solo, com relação aos helmintos parasitas se comporta como um hospedeiro intermediário. Recebe fezes ou água contaminada por parasitas em estágios não infectantes, oferecendo-lhes condições para o desenvolvimento e protege os parasitas em estágios infectantes durante certo tempo para, posteriormente, transmiti-lo ao homem. O objetivo é verificar a ocorrência e a contaminação ambiental por parasitas com potencial zoonótico no solo de escolas infantis em dois municípios do Rio Grande do Sul. Métodos: Trata-se de um estudo delineamento transversal, observacional e descritivo. A coleta foi através de amostras de areia em dez escolas de dois municípios, as coletas do material foram de cinco pontos diferentes, tanto da profundidade quanto da superfície, totalizando-se 100 amostras analisadas. As amostras de areia foram processadas em laboratório através dos métodos de Rugai e Hoffman, Pons e Janer. Resultados: Análise total (N=100) dos dois municípios, totalizando 50 amostras de cada. A contaminação das areias, por ovos de Ancylostoma spp., foi de 54% (n=27) no município I, sendo encontrados 56% (n=28) na cidade II. Conclusão: A ocorrência de ovos de Ancylostoma spp. no ambiente de recreação enfatiza a importância da adoção de medidas restritivas rígidas que impeçam a entrada de animais, como cães e gatos em locais de lazer. Além desses parasitas serem capazes de comprometer a saúde de humanos e infectar outros animais. (AU)

Introduction: Contamination of squares or recreational environments with geohelminth eggs is a public health problem. The soil serves as an intermediate host to helminths. It receives feces or water contaminated with parasites in non-infective stages, providing them with conditions for development, and protects parasites in infective stages for some time and then transmits them to humans. The aim was to investigate the occurrence of environmental contamination with parasites with zoonotic potential in the soil of nursery schools in two municipalities of Rio Grande do Sul state. Methods: A cross-sectional, observational and descriptive study was conducted. Soil samples were collected at ten schools in two municipalities, from five different school sites in terms of both depth and surface. Soil samples were processed at a laboratory using the methods of Rugai and Hoffman, Pons and Janer. Results: In total, 100 samples from the two municipalities were analyzed, 50 samples each. Soil contamination with Ancylostoma spp. eggs was 54% (n=27) in city I and 56% (n=28) in city II. Conclusions: The occurrence of Ancylostoma spp. eggs in recreational environments shows the importance of adopting strict restrictive measures to prevent animals, such as dogs and cats, from entering leisure areas. Also, these parasites may compromise human health and infect other animals. (AU)

Global output of research on epidermal parasitic skin diseases from 1967 to 2017.

BACKGROUND: Epidermal parasitic skin diseases (EPSD) occur in most countries and cause a considerable health and economic burden, particularly in the tropics and subtropics. The aim of this study was to assess and analyse peer-reviewed literature on EPSD in humans. The results of this study serve as an indicator of the extent the scientific community, health authorities, and international health agencies interact with EPSD as a health problem that is commonly associated with poverty and poor hygiene. METHODS: A bibliometric analysis methodology was used. The Scopus database was used to retrieve documents about EPSD for the study period (1967-2017). The study focused on scabies, tungiasis, pediculosis, hookworm-related cutaneous larva migrans (HrCLM), myiasis, and cutaneous strongyloidiasis. Documents that specifically and explicitly discuss EPSD in animals, aquatic organisms, and birds were excluded. RESULTS: In total, 4186 documents were retrieved. A fluctuated growth of publications on EPSD in the past five decades was found. The retrieved documents received 43 301 citations, an average of 10.3 citations per article and an h-index of 74. The keywords "scabies" and was the most commonly encountered keyword followed by the keywords "head lice" and "pediculosis". The most active journal involved in publishing articles on EPSD was the International Journal of Dermatology (164; 3.9%). Researchers from 93 different countries published the retrieved articles. The USA led with 735 (17.6%) documents, followed by the UK (274; 6.5%), and Germany (259; 6.2%). In terms of institutions, the Charité - Universitätsmedizin Berlin in Germany was the most active in this field with 78 (1.9%) publications, followed by the Universidade Federal do Ceará in Brazil with 52 (1.2%) publications. CONCLUSIONS: Research on scabies and pediculosis dominated the field of EPSD research to the expense of tungiasis, HrCLM, myiasis, and cutaneous strongyloidiasis. There was an underrepresentation of literature from the tropics and subtropics despite EPSD being common in these areas. This could possibly be explained by the presence of limited number of non-English journals in the Scopus database. International research collaborations and research networking should be strengthened to help advance and prioritize research on EPSD.

Epidemiology and morbidity of hookworm-related cutaneous larva migrans (HrCLM): Results of a cohort study over a period of six months in a resource-poor community in Manaus, Brazil.

BACKGROUND: Hookworm-related cutaneous larva migrans (HrCLM) is a neglected parasitic skin disease, widespread in resource-poor communities in tropical and subtropical countries. Incidence and risk factors have never been investigated in a cohort study. METHODOLOGY/PRINCIPAL FINDINGS: To understand the seasonal epidemiology of HrCLM, an open cohort of 476 children in a resource-poor community in Manaus, Brazil was examined for HrCLM monthly over a period of 6 months. Monthly prevalence and intensity of infection were correlated with the amount of monthly precipitation. Multivariable Cox regression analysis indicated male sex (hazard ratio [HR] 3.29; 95% confidence interval [CI] 1.95-5.56), walking barefoot on sandy ground (HR 2.30; 95% CI 1.03-5.16), poverty (HR 2.13; 95% CI 1.09-4.17) and age between 10 and 14 years (HR 1.87; 95% CI 1.01-3.46) as predictors of HrCLM. Monthly incidence rates ranged between 0.21 and 1.05 cases per person-year with an overall incidence of 0.52 per person-year. CONCLUSIONS/SIGNIFICANCE: HrCLM is a frequent parasitic skin disease in this resource-poor community. Every second child theoretically becomes infected during one year. Boys, 10 to 14 years old, belonging to the poorest households of the community, are the most vulnerable population group. Even in the tropical monsoonal climate of Amazonia there is a considerable seasonal variation with monthly incidence and number of lesions peaking in the rainy season.

Epidemiological profile of cutaneous larva migrans in travelers returning to France between 2003 and 2015.

BACKGROUND: Cutaneous larva migrans (CLM) is caused by the penetration and migration of canine or feline hookworm larvae into the skin, and frequently affects travelers from high-income countries returning from tropical and sub-tropical areas. Unfortunately, this pathology is neglected due to poor understanding among both physicians and travelers. This study describes the profile of cases reported in Marseille, France. PATIENTS AND METHODS: A retrospective study was performed in two specialized hospitals between 2003 and 2015. Data on socio-demographics, clinical aspects and treatment were collected. Diagnosis was based on travel history and symptoms. RESULTS: Forty-three patients with a diagnosis of CLM were recorded in this study. They were aged between 14 and 70 and 51% were male. They were infected while visiting the Americas (37%), Africa (33%), Asia (28%) and (in the case of one patient) Portugal. The mean timescale for diagnosis was 41 days. Track lesions associated with pruritus in the lower limbs were the most common symptoms. Nine had a history of super-infection. Sixteen patients received treatment prior to referral including six who were administered antiparasitic drugs. A one-day treatment with ivermectin, administered at our facility, resulted, in most instances, in a favorable outcome. CONCLUSION: This study reports 43 cases of CLM acquired mainly in Africa, Asia and the Americas but also, for the first time, CLM acquired during travel to Portugal. The data show the need for increased awareness of CLM prevention and treatment in order to optimize pre-travel advice and case management. Travelers need to understand how CLM is transmitted and the need to avoid contact with soil and sand contaminated by dogs and cats. In particular, footwear and sun chairs should be used on beaches.

Cutaneous Larva Migrans.

BACKGROUND: Cutaneous larva migrans is one of the most common skin diseases reported in travelers returning from tropical regions. Western physicians, however, are often not familiar of this condition. OBJECTIVE: To review in depth the epidemiology, pathophysiology, clinical manifestations, complications, and treatment of cutaneous larva migrans. METHODS: A PubMed search was completed in Clinical Queries using the key term "cutaneous larva migrans". The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Patents were searched using the key term "cutaneous larva migrans" from www.google.com/patents, www.uspto.gov, and www.freepatentsonline.com. RESULTS: Cutaneous larva migrans is a zoonotic infestation caused by penetration and migration in the epidermis of filariform larva of different kinds of animal hookworms through contact with feces of infected animals. Cutaneous larva migrans is endemic in tropical and subtropical regions. Clinically, cutaneous larva migrans is characterized by an intensely pruritic erythematous migrating tortuous or serpiginous, slightly raised track. The diagnosis is mainly clinical, based on the history of travel to an endemic area and exposure to contaminated soil/sand and the characteristic serpiginous track. Treatment options as well as recent patents related to the management of cutaneous larva migrans are also discussed. Compared with oral antihelminthics, topical treatment over the affected area is less effective. Oral ivermectin is the treatment of choice. CONCLUSION: The pruritic serpiginous track is pathognomonic. Oral ivermectin is the treatment of choice.