Syndrome larva migrans skin form. Clinical observation of a case of larva migrans in a resident of the city of Surgut

Larva migrans (migration of larvae) is a helminthiasis caused by migration under the skin or into the internal organs of a person of parasite larvae unusual for him. The natural final hosts of such helminths are animals (dogs, cats and others), and in the human body they do not grow to sexually mature individuals. The larva migrans syndrome is visceral and cutaneous.

Skin syndrome Larva migrans call the complex of symptoms that manifests itself during such a migration of larvae under the skin. Most often, these are serpentine (winding linear) lesions of the skin, resulting from their movement. Blisters, erythematous rashes (reddening as a result of capillary expansion), and edema may also occur.

The article deals with the skin form, not the visceral form. In the first case, the larvae of roundworms penetrate the skin and move under it, and in the second case, the larvae of some tape or roundworms from the intestine migrate through the bloodstream to various organs and tissues, including muscles, eyes, brain, heart, causing certain diseases, such as, .

The infection is transmitted mainly through the faeces of dogs and cats on beaches in warm climates.

The reasons

The causative agents of the larva migrans syndrome of the skin form (Larva migrans cutanea) are:

from the family Ancylostomatidae:
- Ancylostoma braziliense (Brazilian hookworm) - the most common in America, the owners are cats and dogs;
- Ancylostoma tubaeforme - found throughout the world, the owners are cats;
- Ancylostoma caninum - all over the world, especially where there is enough moisture, the owners are dogs;
- Bunostomum phlebotomum - cattle.

Nematodes of the genus Strongyloides:
- Strongyloides myopotami - their hosts are large and small cattle, pigs, rabbits, rats;
- Strongyloides westeri - horses, donkeys, possibly pigs;
- Strongyloides papillosus - sheep and goats.

Sometimes (rarely) dermatosis caused by birds from the Schistosomatidae family is also called larva migrans syndrome. Another such infection is called "avian schistosomiasis."

In the vast majority of cases, the skin form of larval migration syndrome is caused by two types of helminths from the genus: Ancylostoma braziliense (Brazilian hookworm) and Ancylostoma tubaeforme.

As a result of the development of the infection, red, severely itchy bumps appear on the skin. Such formations can be very painful and, if scratched, the development of a secondary bacterial infection is not excluded.

Symptoms of Larva migrans appear in 40% of cases on the legs, 20% on the buttocks and genitals, and 15% on the abdomen. This is due to the most likely places of penetration of the pathogen larvae.

A photo

On the hands and palms

On finger and hand

On the foot

On the buttocks

A less pronounced manifestation of the larva migrans syndrome on the foot of a teenager in the form of a severely itchy rash.

Rash on the buttocks of an 18-month-old child, caused by the migration of larvae. The infection occurred on a beach in Australia.

Diagnostics

Diagnosis is not always easy, as some of the symptoms are similar to those of scabies or other skin conditions. Scrapings from the surface of crusts or papules sometimes make it possible to identify larvae.

Treatment

The larva migrans syndrome usually resolves on its own within a few weeks or months, but a case of the disease has been known to last for one year.

Both general and local therapy is carried out. Treatment includes the use of anthelmintic drugs (,), which are recommended for oral administration. Also, the doctor may recommend lubricating the affected areas with 10% solutions of iodine in alcohol (5%), phenol or ether.

To relieve itching, it is recommended to use special tablets or creams. Another method of treatment is mechanical action. The affected areas are lubricated with vaseline oil, and then with a needle or by dissecting the skin, the larvae are removed through the wound. Such an operation must be carried out by a doctor.

If you choose the right treatment, the symptoms of larva migrans can disappear after 48 hours.

Prevention

For prevention, it is recommended to wear shoes in places where there is a high risk of infection. It is advisable to avoid contact with infected soil. In some endemic areas, it is illegal to walk dogs on beaches. Swimming in freshwater endemic areas and contact with untreated water should be avoided.

The growing interest in tropical dermatoses is due to the increased number of patients with helminthic skin manifestations after visiting endemic areas. In the KVD of the Surgut municipality (Khanty-Mansiysk Autonomous Okrug, Western Siberia), single observations of tropical dermatoses, such as jellyfish stings, insect stings of tropical countries and geohelminthiases, are registered. Patients with migratory larvae arrived mainly from Vietnam and Thailand. In the current situation of population migration, the need for a dermatovenereologist to know skin diseases in hot countries increases.

The term "syndrome" larva migrans”, or “migrating larva syndrome” (MLS), proposed by P. C. Beaver (1956). LSU is polyetiological and develops in humans when infected with eggs or larvae of animal helminths.

The cutaneous form of FMS is most commonly caused by larvae that have penetrated the skin. Ancylostomacaninum, A. brasiliense.

According to various authors, about 25% of the world's population is infected with ankylostomiasis. This disease is most common in areas with poor sanitation. Ankylostomidosis is a disease that is common on all continents. The centers of these helminthiases are found in South and Central America, Africa, Hindustan, Indochina and on the islands of the Malay Archipelago. In addition, hookworms are found in the Caucasus, in Turkmenistan, Kyrgyzstan, the Black Sea coast of the Krasnodar Territory, on the border with Abkhazia.

LSU is more commonly a disease of children, utility workers, gardeners, beach sunbathers, and others who have direct contact with sandy soil contaminated with dog and cat feces.

The structure of the pathogen: a sexually mature individual of a red-brown color, a female 9-15 mm long, a male up to 10 mm. The eggs are oval, colorless with a thin shell, 66 × 38 µm in size. In the center of the eggs are 4-8 germ cells. When examining a day later, you can see the larva.

Once embedded in the skin, the larvae move under the epidermis from a few millimeters to several centimeters (1–5 cm) per day. The activity of the larvae can continue for several weeks or months. Along the way they move, itching occurs and a “garland-shaped” trace remains. In some cases, at the site of localization of the larvae, even after their death, episodes of urticarial rash and foci of skin inflammation occur. Sometimes patients have subfebrile temperature, eosinophilia in the peripheral blood, and there may be a cough.

Clinical picture

The diagnostic test should be considered the presence of a "garland-like" intradermal located lesion of a linear shape, accompanied by itching and / or urticaria. Since 1993, the Committee of the American Academy of Pediatrics (AAP) has recommended that such a set of features be considered pathognomonic for the cutaneous form of migratory larvae syndrome.

Specific diagnostics:

chest x-ray;
seroimmunological methods - complement fixation reaction, indirect hemagglutination reaction, enzyme immunoassay, etc.;
during the migration phase, the detection of larvae in the blood and sputum;
during the chronic phase:
- ovoscopy of feces, less often - duodenal contents; the eggs of ankylostomy and a necator close to it are morphologically the same, which makes it possible to make only a general diagnosis - ankylostomiasis (ankylostomiasis);
- larvoscopy - detection of larvae in feces;
- cultivation on filter paper (method of Harada and Mori);
- helminthoscopy of feces - with a high degree of invasion, hookworms in feces can be detected with the naked eye.

Differential diagnosis: with dyshidrotic eczema, fungal infections, contact dermatitis, atopic dermatitis.

Treatment

Diet: There is no specific diet for the disease. Given such a complication as anemia, nutrition should include a sufficient amount of proteins, fats, carbohydrates, minerals and vitamins.

Cryodestruction - the application of liquid nitrogen to the "growing" end of the intradermal passage.

Description of the clinical case

Patient A., born in 1987, turned to the dermatovenereologist of the outpatient department of the KhMAO-Yugra SKKVD on his own.

Complaints at the time of examination on rashes on the skin of the left foot, accompanied by recurrent itching, mainly at night. From the anamnesis of the disease: sick for two months, when the rash first appeared on the lateral surface of the left foot, then the rash spread to the plantar surface of the foot. Independently used external antifungal drugs without effect.

Epidemiological history: living conditions are satisfactory. The appearance of rashes is associated with a trip to Thailand and walking without shoes on sand and earth. Contact with patients with infectious diseases denies.

Objectively: general condition is satisfactory. Body temperature 36.5 °C. The physique is correct, satisfactory nutrition. Peripheral lymph nodes are not enlarged. In the lungs, vesicular breathing, no wheezing. The heart sounds are clear, the rhythm is correct. Liver - at the edge of the costal arch, the spleen is not enlarged. Stool and diuresis - without features.

Local status: pathological skin process is limited. It is localized on the skin of the plantar surface of the left foot in the form of a cyanotic "garland-like cord" up to 3.0 cm in length, protruding above the skin surface, ending in a pink papule up to 0.8 cm; on palpation, the papule is slightly painful, soft-elastic consistency (Fig. 1a, b). Temperature, pain and tactile sensitivity in the focus is preserved. The nail plates of the feet are not changed. There are no other rashes on the skin and visible mucous membranes.

Dermatoscopically, the contents of the rashes are not visualized.

Based on the history, clinical manifestations and epidemiological data, a provisional diagnosis was made: "B76.9 Ankylostomiasis, unspecified. Migration of larvae in skin NOS".

The therapy was carried out together with an infectious disease doctor: mebendazole (Vermox) 100 mg per day after meals for 3 days, externally Castellani paint 2 times a day for 7 days.

Against the background of the therapy, there was a positive trend in the form of regression of rashes, the absence of pain and induration on palpation. Fresh rashes on the skin and visible mucous membranes were not detected at subsequent examinations (Fig. 2a, b).

Conclusion

For an accurate diagnosis and the exclusion of possible systemic complications, a thorough history taking, features of the localization of rashes is necessary. Treatment of patients with geohelminthiases must be carried out under the supervision of an infectious disease specialist.

E. V. Pavlova*, 1
I. V. Ulitina*
Yu. E. Rusak**,doctor of medical sciences, professor
E. N. Efanova**,Candidate of Medical Sciences

* BU KhMAO-Yugra SKKVD, Surgut
** GBOU VPO SurGU KhMAO-Yugra, Surgut

Syndromelarvamigrans

The larvae of some nematodes, penetrating into the human body, make a complex migration, damaging the skin and internal organs on their way. Convoluted "growing" rashes (erythema, papules, vesicles) appear on the skin, the pattern of which repeats the subcutaneous movements of the helminth larvae.

Synonyms: diseases caused by migrating larvae of helminths; migratory larva.

Epidemiology and etiology

Etiology

Infection

Helminth eggs mature in soil or sand, usually in warm, shady places. The larvae released from the eggs enter the human body through the skin.

At-risk groups

Outdoor workers exposed to warm, moist, sandy soil: farmers, gardeners, plumbers, electricians, carpenters, fishermen, health workers. Lovers of spending their leisure time on the beach.

Anamnesis

Itching at the site of the introduction of the larva occurs a few hours after infection.

Physical examination

Rash elements. A twisted, slightly rising strip 2-3 mm wide above the skin surface is an intradermal passage filled with serous fluid (Fig. 30-10). The number of moves corresponds to the number of larvae that have entered the body. The migration rate of larvae reaches many millimeters per day, so the lesion has a diameter of several centimeters. With massive infection, numerous passages are visible (Fig. 30-11). Color. Red.

Localization. Exposed areas of the body, usually feet, shins, buttocks, hands.

Clinical forms

Larva currens. The causative agent is Strongyloides ster-coralis (intestinal eel), the larvae of which are distinguished by their speed of movement (about 10 cm / h). Papules, papulovesicles, urticaria appear at the site of introduction of the larva (Fig. 30-11); characterized by severe itching. Localization: perianal region, buttocks, hips, back, shoulders, abdomen. From the skin, the larvae migrate into the blood vessels, and then the itching and rashes disappear. The helminth multiplies in the intestinal mucosa. Visceral form of larva migrans syndrome. Migrating larvae of dog and cat Toxocara (Toxocara canis, Toxocara cati) and human roundworm (Ascaris lumbricoi -des) affect internal organs. Manifestations: persistent eosinophilia, hepatomegaly, sometimes pneumonitis.

Differential Diagnosis

Bizarre red streaks Phytodermatitis (allergic contact dermatitis caused by plants); photo-phytodermatitis; Lyme disease (chronic erythema migrans); burns caused by jellyfish tentacles; epidermomycosis; granuloma annulare.

Diagnosis

Enough clinical picture.

Flow

For most helminths, a person is a “dead-end” host: the larvae die before reaching puberty, and the disease goes away on its own. The rash disappears after 4-6 weeks.

Figure 30-10. Syndromelarvamigrans. A narrow red convoluted strip, slightly rising above the surface of the skin, repeats the subcutaneous course of a migrating helminth larva

Treatment

Symptomatic treatment

Corticosteroids for external use, under an occlusive dressing.

Anthelmintics

Thiabendazole. Appoint inside in a dose

50 mg / kg / day every 12 hours for 2-5 days.

The maximum daily dose is 3 g. The drug can be applied topically, under an occlusive dressing.

Albendazole. Highly efficient. Assign 400 mg / day for 3 days.

Cryodestruction

Liquid nitrogen is applied to the "growing" end of the intradermal passage.

Picture30-11. Syndromelarva migrans: larva currens. Eruption on buttocks: swirling red streaks, papules, small blisters, vesicles. It was the tortuosity of the elements of the rash that made it possible to suspect skin damage by migrating larvae of Strongyloides stercoralis.

larva migrans syndrome

Synonyms:diseases caused by migrating larvae of helminths; migratory larva.

Epidemiology and etiology

Etiology

Infection

Helminth eggs mature in soil or sand, usually in warm, shady places. The larvae released from the eggs enter the human body through the skin.

At-risk groups

Outdoor workers exposed to warm, moist, sandy soil: farmers, gardeners, plumbers, electricians, carpenters, fishermen, health workers. Lovers of spending their leisure time on the beach.

Anamnesis

Itching at the site of the introduction of the larva occurs a few hours after infection.

Physical examination

Localization. Exposed areas of the body, usually feet, shins, buttocks, hands.

Clinical forms

Larva currens. Pathogen - Strongyloides stercoralis (intestinal eel), the larvae of which are distinguished by their speed of movement (about 10 cm / h). Papules, papulovesicles, urticaria appear at the site of introduction of the larva (Fig. 30-11); characterized by severe itching. Localization: perianal area, buttocks, hips, back, shoulders, abdomen. From the skin, the larvae migrate into the blood vessels, and then the itching and rashes disappear. The helminth multiplies in the intestinal mucosa. Visceral form of the syndrome larva migrans. Migratory larvae of canine and feline toxocara(Toxocara canis, Toxocara cati)and human roundworm(Ascaris lumbricoi-des) damage internal organs. Manifestations: persistent eosinophilia, hepatomegaly, sometimes pneumonitis.

Differential Diagnosis

Diagnosis

Enough clinical picture.

Flow

For most helminths, a person is a “dead-end” host: the larvae die before reaching puberty, and the disease goes away on its own. The rash disappears after 4-6 weeks.

Figure 30-10. Syndrome larva migrans.A narrow red convoluted strip, slightly rising above the surface of the skin, repeats the subcutaneous course of a migrating helminth larva

Treatment

Symptomatic treatment

Corticosteroids for external use, under an occlusive dressing.

Anthelmintics

Thiabendazole. Assign orally at a dose

50 mg / kg / day every 12 hours for 2-5 days.

The maximum daily dose is 3 g. The drug can be applied topically, under an occlusive dressing.

Albendazole. Highly efficient. Assign 400 mg / day for 3 days.

Cryodestruction

Liquid nitrogen is applied to the "growing" end of the intradermal passage.

Figure 30-11. Syndrome larva migrans: larva currens.Eruption on buttocks: swirling red streaks, papules, small blisters, vesicles. It was the tortuosity of the elements of the rash that made it possible to suspect skin damage by migrating larvae. Strongyloides stercoralis

Tungiosis

The disease is caused by a sand flea, penetrating into the skin of the feet, usually in the interdigital spaces or under the free edge of the nail. A painful papule appears at the site of the flea's introduction. Infection is possible when walking barefoot on the beach.

Synonyms:tungiosis - sarcopsillosis; sand flea - earthen flea, penetrating flea.

Epidemiology and etiology

Etiology

Fleas are jumping, and although they most often affect the feet, in natives who squat for a long time, the perineum and buttocks are affected.

Geography

Central and South America, the Caribbean, Equatorial Africa, the Seychelles, Pakistan, the west coast of India. It is believed that in the middle XIX century, the flea was brought from South America to the west coast of Africa. From there, she came to the island of Zanzibar and India.

Anamnesis

Residents of developed countries have a recent trip to the tropics or subtropics.

Incubation period

8-12 days after the introduction of the flea into the skin.

First missing. While the flea burrows into the skin, many experience discomfort. As the flea grows, pain, itching, and swelling occur. As a rule, the foot or lower leg is affected, but any localization is possible. The subungual lesions are especially painful.

General state

If a secondary infection joins, fever is possible.

Physical examination

Rash elements. Papule or vesicle with a diameter of 6-8 mm (Fig. 30-12). In the center is a black dot, this is the tip of the flea's abdomen. As the eggs mature and the abdomen enlarges, the papule brightens and turns into a pea-sized knot. In case of hemorrhage, the node turns black (Fig. 30-12). In a massive infection, the skin becomes similar to a honeycomb. If the node is squeezed, eggs, excrement and internal organs of the flea are released through the central hole. Color. Red, bluish, white, black. Location. Messy. There is either one element or many elements. Localization. Feet, especially under the free edge of the nail, in the interdigital spaces, on the soles (with the exception of the supporting areas of the foot). If the infection occurred on the beach - any open areas of the body.

Differential Diagnosis

Paronychia (causative agents -Staphylococcus aureus, Candida spp.),myiasis, schistosomiasis, scabies, sting ant stings(Soleno-psis richteri, Solenopsis invicta), folliculitis.

Additional Research

Microscopy

Eggs and body parts of the sand flea are found in the material squeezed out of the knot.

Microscopy of a Gram-stained smear

Indicated to rule out secondary infection.

Figure 30-12. Tungiosis. On the little toe next to the nail - necrotic node; the finger is edematous and hyperemic. If you remove the crust, you can see a sand flea

Skin pathologyThe body of the flea is located in the epidermis, and the head is immersed in the dermis. The flea has a thick cuticle, internal organs, eggs, a wide striated muscle (stretches from the head to the opening at the end of the abdomen), a tiny head, almost invisible against the backdrop of a giant body. Infiltration of the dermis with lymphocytes, plasma cells and eosinophils.

Diagnosis

Clinical picture and microscopy of material extruded from the node.

Pathogenesis

A fertilized female flea travels through the epidermis to the border with the dermis. It feeds on blood from the vessels of the papillary layer of the dermis. When the flea increases in size up to 5-8 mm, pain occurs. Mature eggs (150-200 pieces) are isolated one by one from the hole on the flea's end-abdomen within 7-10 days. Soon after the eggs are laid, the female dies, and an ulcer often forms at the site of the lesion. If body parts of the flea remain in the skin, inflammation and secondary infections develop.

Course and forecast

As a rule, the disease proceeds easily, without complications. However, a secondary streptococcal or staphylococcal infection (abscess, phlegmon), tetanus, gas gangrene, self-amputation of the fingers is possible. Immunity in those who have been ill does not develop.

Treatment and prevention

Prevention

Wear closed shoes and protective clothing; avoid skin contact with soil. Heavily contaminated soil is treated with insecticides.

Figure 30-13. body lice - Pediculus humanus corporis.Synonym: pediculosis corporis. The body louse is similar to the head louse, but somewhat larger in size. The body louse lives in bedding and on clothes (see inset in the upper left corner of the photo), it only feeds on the body of the owner. As a rule, people who do not observe personal hygiene get sick. On examination, you need to pay attention to the patient's clothes - nits can be found in the seams. In places of bites - hyperemic spots, papules or small blisters (papular urticaria), in the center of which there is a tiny bloody crust. Due to itching and scratching, excoriations, acute itchy dermatitis, and limited neurodermatitis occur. Frequent secondary bacterial infections

Figure 30-14. Bed bug bites. Bed bugs(Cimex lectularius) live in the crevices of floors and walls, in furniture and bed linen. Bedbugs feed once a week, and even less often in cold weather. In search of a host, they move long distances and are able to live without food for 6-12 months. Bedbug bites are more common on open areas of the body (face, neck, hands). Groups of 2-3 elements of the rash are characteristic, located in one row (“breakfast, lunch and dinner”). If the patient has never been bitten by bedbugs before, only red itchy spots appear on the skin. In sensitized patients, intensely itchy papules, papular urticaria, vesicles, or blisters develop. Scratching causes excoriations, acute itchy dermatitis, secondary infections

Figure 30-15. Schistosomiasis. Synonyms:cercarial dermatitis, bather's itch. The disease is caused by trematodes of the genus Schistosoma. Helminth larvae (cercariae) enter the human body through the skin during bathing, washing clothes, and other contacts with fresh and sea water. Together with the penetration of cercariae (in open areas of the body), itchy papules appear, and in sensitized patients - papular urticaria. In severe cases, inflamed, itchy plaques, large blisters, and vesicles occur. Rashes reach a maximum in 2-3 days after infection and resolve in a week

Figure 30-16. Sponge catcher disease. Synonym:coral ulcers. The disease is a contact dermatitis caused by floating larvae (planulae) of anemones. Edwardsiella lineata. A few hours or days after swimming in the sea, a rash appears on parts of the body covered by swimming trunks or a swimsuit. (In schistosomiasis, the rash appears on exposed areas of the body.) Some patients remember a burning or tingling sensation during bathing. Rash monomorphic- red papules or papulovesicles, less often - vesicles, pustules, papular urticaria. The rash lasts 1-2 weeks. Due to sensitization, each subsequent contact with anemone larvae causes an increasingly severe injury. Corticosteroids (topical or oral) provide significant relief

Figure 30-17. Miaz. Synonym: myasis. The disease is caused by larvae of non-blood-sucking Diptera insects - flies. Flies sit on open wounds, festering abrasions, ulcers, feed on exudate and lay eggs, from which larvae develop. The larvae of some flies (gadflies) penetrate the dermis through the epidermis and make long winding passages there (migratory myiasis or "creeping disease"). Myiasis can affect any part of the body, including ears, nose, paranasal sinuses, oral cavity, eyes, anal canal, vagina, any wound surface, trophic leg ulcers, basal cell and squamous cell skin cancer, hematomas, umbilical wound in newborns. In the wound, the larvae first feed on necrotic tissues, and then move on to healthy ones. When healthy skin is affected, an itchy papule appears at the site of introduction of the larva, which gradually grows and after a few weeks turns into a dome-shaped node. The node looks like a boil, and the back of the larva periodically protrudes from the central hole. If you lubricate the knot well with pork fat or petroleum jelly, the larva leaves its shelter.

Larva migrans is a helminthiasis, a dangerous disease characterized by the presence of animal helminth larvae in the tissues, epidermis and internal organs. The larvae in the human body increase in size and begin to migrate, causing poor health. The disease is unpredictable, the lack of treatment can lead to spontaneous recovery or deterioration and death. Treatment is prescribed by a doctor depending on the form of larva migrans.

The reasons

Warm, shady and humid places become a favorable environment for the reproduction of larvae. Ponds are dangerous in the summer, especially if pets graze nearby or dogs roam. In the sand near the water, under the spreading branches of trees, eggs can accumulate and turn into larvae, running barefoot on contaminated soil can become infected. At risk are people of agricultural professions who come into contact with the soil.

Infection in the visceral form occurs by ingestion of helminth eggs into the human body through the oral cavity, for example, when swallowing water from a reservoir while bathing or eating unwashed food.

Symptoms

Both in the cutaneous and visceral form of the disease, fever may appear - high fever, trembling in the body, nausea and dizziness.
Symptoms of the disease may not appear immediately after infection, but after a few months.

Diagnostics

With the cutaneous form of larva migrans, it can be difficult to diagnose the disease due to the fact that some clinical cases resemble scabies or other skin diseases. However, with a careful examination of an experienced doctor, this is still possible.

Treatment

Prevention

The main prevention of larva migrans is hygiene: wash fruits and vegetables thoroughly before eating, do not swim in water bodies whose water is in doubt, work in the field in protective clothing.