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CORRESPONDENCE
Year : 2012  |  Volume : 30  |  Issue : 4  |  Page : 486-487
 

An unusual presentation of cutaneous larva migrans in a male child


1 Department of Microbiology, MKCG Medical College, Berhampur, Orissa - 760 004, India
2 Department of Skin and VD, MKCG Medical College, Berhampur, Orissa - 760 004, India

Date of Submission02-Apr-2012
Date of Acceptance22-May-2012
Date of Web Publication24-Nov-2012

Correspondence Address:
I Mohanty
Department of Microbiology, MKCG Medical College, Berhampur, Orissa - 760 004
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.103787

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How to cite this article:
Mohanty I, Patnaik S, Mohanty P. An unusual presentation of cutaneous larva migrans in a male child. Indian J Med Microbiol 2012;30:486-7

How to cite this URL:
Mohanty I, Patnaik S, Mohanty P. An unusual presentation of cutaneous larva migrans in a male child. Indian J Med Microbiol [serial online] 2012 [cited 2019 Jun 19];30:486-7. Available from: http://www.ijmm.org/text.asp?2012/30/4/486/103787


Dear Editor,

Cutaneous larva migrans (CLM) commonly known as "creeping eruptions" occurs on exposure of the skin to the infective filariform larvae of nonhuman hookworms and strongyloides. [1] CLM can also be caused by Gnathostoma spinigerum and also sometimes by insect larvae. [2] The lesion appears as a raised, reddened, serpiginous eruption usually confined to the skin of the feet, buttocks, or abdomen caused by dog and cat hookworm. It is caused by the invasion and migration of larva of the parasites in the skin. We report a very rare case of CLM confined to the penis.

A 6-year-old male child, weighing 25 kg, from a rural area presented with a progressively spreading itchy lesion on the penis of 3-week duration. The lesion started as a small vesicle on the dorsal side from the distal third of shaft of penis and spread in a serpentine manner. No such lesions were seen elsewhere in the body. There was no history of fever, urticaria or other systemic complains. He had not received any treatment prior to this.

On examination the lesion was slightly raised, flesh coloured, serpentine eruption extending from the distal part of the penis near the corona glandis to the middle-third of the penis [Figure 1]. Complete blood count showed eosinophilia and stool examination did not reveal any parasites. Biopsy is of little value in this case. Based on the history and clinical findings a clinical diagnosis of CLM was made and the boy was treated with ivermectin (200 μg/kg body weight) 6 mg single oral dose before dinner. Ivermectin was preferred for better compliance and low toxicity. Progression of the lesion stopped in 3 days and complete resolution occurred within 7 days.
Figure 1: Serpentine lesion on the dorsal surface of penis

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In this case, the child belonged to a rural area with the habit of playing naked in the soil and sandpits and also had the habit of defecating in the fields. He may have contracted the infection in this process as the genitalia might be in direct contact with soil.

Most cases of CLM are reported from warm humid tropical and subtropical regions. Numerous organisms can cause CLM including Ankylostoma braziliense, Ankylostoma caninum, Ankylostoma ceylonicum, Uncinaria stenocephala, Gnathostoma spp, Bubostomum phlebotomum and Stongyloides stercoralis. [3] It is commonly caused by Ankylostoma braziliense (dog and cat hookworms). Most of the larvae are unable to undergo further development in humans and die within 2-8 weeks time. [4] Activities that increase the risk of infestation include walking barefoot, working in the garden and playing in sandpits. The incubation period varies from 1 to 6 days. The initial lesion starts as an erythematous itchy papulovesicular lesion gradually developing into a slightly raised flesh-coloured swollen lesion. Clinical features ranges from nonspecific dermatitis at the site of penetration to a typical creeping eruption with itching. Hookworm larvae are capable of penetrating unbroken skin, but they most often enter the skin through hair follicles or sweat gland pores. The larvae migrate most often at night, through the epidermis and upper dermis. The larvae produce secretions with hyaluronidase activity that aid in skin penetration and migration. As larvae burrow through the skin, a localized inflammatory reaction is seen due to the antigenicity of the parasite and their proteolytic secretions, resulting in the characteristic pruritic inflammatory serpigenous lesion. [5] Biopsy is of no value as the larva advance ahead of the clinical tract. Epiluminescence microscopy is a noninvasive method to detect the larva and confirm diagnosis. [6] Surgery and cryotherapy are ineffective as the larva is easily missed, being ahead of the serpigenous tract. Single dose ivermectin (150-200 μg/kg) is the best treatment. [7] Albendazole (400-800 mg/day) for 3 days and topical thiabendazole (10%) are also useful.

In this case, CLM confined to the penis is very rare with the mode of entry unclear. The child is from a rural area where children usually have the habit of playing naked on the soil, thus predisposing to the lesions on the penis. The parents should be educated not to allow their children to remain naked and proper toilet training should be imparted to prevent infection.

 
 ~ References Top

1.Meffert JI. Parasitic infestations. In: Dermatology secrets 1 st ed. Fitzpatrick, Aeling J, editors. New Delhi. India: Jaypee Brothers; 1977. p. 217.  Back to cited text no. 1
    
2.Malhotra SK, Raj RT, Pal M, Goyal V, Sethi S. Cutaneous larva migrans in an unusual site. Dermatol Online J 2006;12:11.  Back to cited text no. 2
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3.Vega-Lopez F, Hay RJ. Parasitic worms and protozoa. In: Burns T, Breathnach S, Cox N, Griffith C, editors. Rook's Text book of Dermatology. 7 th Ed. Oxford: Blackwell Science; 2004. p. 32.1-48.  Back to cited text no. 3
    
4.Padmavathy L, Rao LL. Cutaneous larva migrans -- A case report. Indian J Med Microbiol 2005;23:135-6.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.Arora PN, Arora S. Diseases caused by parasitic worms and protozoa. In: Valia RG, Valia AR, editors. IADVL Text book of Dermatology. 3 rd ed. Mumbai, India: Bhalani Publishing House; 2008. p. 450.  Back to cited text no. 5
    
6.Elsner E, Themes M, Worret WI. Cutaneous larva migrans detected by epiluminescent microscopy. Acta Derm Venereol 1997;77:487-8.  Back to cited text no. 6
    
7.Caumes E, Carriere J, Datry A, Gaxotte P, Danis M, Gentilini M. A randomized trial of ivermectin versus albendazole for the treatment of cutaneous larva migrans. Am J Trop Med Hyg 1993;49:641-4.  Back to cited text no. 7
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This article has been cited by
1 Larva migrans in India: veterinary and public health perspectives
Rajnish Sharma,B. B. Singh,J. P. S. Gill
Journal of Parasitic Diseases. 2013;
[Pubmed] | [DOI]



 

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