Indian Pediatrics 2002; 39:1164-1165

Larva Migrans Eruption in an Infant

An 11 month old male infant was brought with itchy eruption over the back for 5 days. The eruption was extending by a few cm per day. The child was uncomfortable and frequently crying. The family was living in a kaccha house in the seashore area and cats were frequent visitors to their home. The child used to play on the ground and sleep on its back. On physical examination, an irregular, linear, thin thread like erythematous lesion was seen over the lumbar area (Fig 1). The advancing edge was shiny, but trailing end was showing scaling. The hair, nail and mucous membranes were normal. Systemic examination was unremarkable. The child was put on oral suspension of albendazole (200 mg/5mL) 2.5 mL twice daily for three days. On fourth day of follow-up examination, the advancing of the eruption had stopped and child had shown symptomatic improvement.

Fig.1. Thin, linear and serpentine erythematous eruption of larva migrans

Larva migrans eruption is usually caused by filariform larvae of the dog and cat hookworms, mainly Ancylostoma braziliensis and rarely A. caninum, Uncinaria stenochepala, Bunostomum phlebotomun, or the human larvae of Necator americanus and Ancylostoma duodenale. Adult hookworms live in the intestines of dogs and cats and their ova are deposited in the animals’ faeces. Under favorable conditions of humidity and temperature, the ova hatch into infective larvae, which may penetrate human skin. It is commonly known as creeping eruption for its distinctive feature that the lesion creep or migrate and is due to the presence of moving parasite in the skin. The larva moves a few mm to a few cm per day. The eruption is self-limited because humans are abnormal hosts. The feet and buttocks are the areas most commonly involved. The treatment of choice is the topical application of 10% thiabendazole (not available in India). Even the oral preparation of thiabendazole or two tablets of 500 mg thiabendazole crushed and formulated in 10 g petrolatum may be applied twice daily. Systemic use of thiabendazole, though effective, is contraindicated due to its possible poorly tolerated side effects. Albendazole daily by mouth for 3 days is safe and often effective.

Significance in the context of India is its occurrence in the coastal areas of the country where suitable conditions for this entity exist. Children may be advised not to sit, lie, or walk barefoot on wet soil or sand of beaches. The ground should be covered with impenetrable material when sitting or lying on the ground.

E-mail: [email protected]