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A Review of Clinical Presentation and Management of 60 Cases Presenting to a Tropical Disease Unit

Herbert D. Davies, MD, FRCPC; Peter Sakuls, MD; Jay S. Keystone, MD, MSc(CTM), FRCPC

Arch Dermatol. 1993;129(5):588-591.

Abstract
• Background and Design.—
Cutaneous larva migrans is an infection with a larval nematode, most frequently by dog or cat hookworms. It has a characteristic presentation that is easily recognizable. We reviewed the charts of 60 patients with cutaneous larva migrans who presented to the Tropical Disease Unit, Toronto (Ontario) Hospital, during a 6-year period.

Results.—
Ninety-five percent of the patients were Canadians who had recently returned from the tropics or subtropics, notably the Caribbean. Almost all patients had a linear or serpiginous, very pruritic larval track. Topical thiabendazole was efficacious in 52 (98%) of 53 patients treated. Albendazole cured six (88%) of seven patients treated. Because of adverse effects, oral thiabendazole and liquid nitrogen were not utilized.

Conclusion.—
We conclude that topical thiabendazole and oral albendazole are very effective and safe modalities for the treatment of cutaneous larva migrans.

(Arch Dermatol. 1993;129:588-591)

Cutaneous larva migrans (CLM) is a ubiquitous selflimited skin eruption, most frequently caused by third-stage larvae of dog and cat hookworms (Ancylostoma caninum and Ancylostoma brazilensis, respectively).¹ Adult worms reside in the intestines of these domestic animals where they shed eggs into the environment during defecation. The eggs undergo development into infectious larvae in soil that is protected from desiccation and temperature extremes. Usual sites include sandy, shady areas around beaches or under houses.² Although CLM has a worldwide distribution, infection is most frequent in warmer climates such as the Caribbean, Africa, South America, Southeast

Author Affiliations
From the Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario (Dr Davies), and The Tropical Disease Unit, Division of Infectious Diseases, The Toronto (Ontario) Hospital (Drs Sakuls and Keystone).

Footnotes
Accepted for publication January 27, 1993.

Reprint requests to The Toronto Hospital, Toronto, Ontario, Canada, M5G 2C4 (Dr Keystone).

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