Author(s): Susan Montgomery, Mary Kamb

Infectious Agent

Larval stages of dog and cat hookworms (usually Ancylostoma spp.) can cause skin infections.

Transmission

Hookworm infections occur through direct skin contact with contaminated sand or soil.

Epidemiology

Zoonotic hookworms associated with cutaneous larva migrans (CLM)—also known as creeping eruption—have a worldwide distribution, but most cases are reported in travelers to Africa, South America, Asia, and the Caribbean. Beaches and sandboxes where free-roaming dogs and cats defecate are common sources of infection. Infection occurs in short-term and long-term travelers.

Clinical Presentation

Creeping eruption usually appears 1–5 days after skin penetration, but the incubation period may be ≥1 month. Typically, a serpiginous, erythematous track appears in the skin and is associated with intense itching and mild swelling. Usual locations are the feet, lower legs, and buttocks, but any skin surface (e.g., trunk, upper extremities) that contacts contaminated soil can be affected (see Sec. 11, Ch. 8, Dermatologic Conditions).

Diagnosis

CLM is diagnosed clinically based on a history of potential exposure and characteristic skin lesions. Biopsy is not recommended. Clinicians can obtain diagnostic assistance from the Centers for Disease Control and Prevention (CDC)’s Division of Parasitic Diseases and Malaria DPDx laboratory (dpdx@cdc.gov), or from the Parasitic Diseases Hotline for Healthcare Providers (404-718-4745; parasites@cdc.gov).

Treatment

CLM is self-limiting; migrating larvae usually die after 5–6 weeks. Albendazole is a very effective treatment. Ivermectin is effective but not approved by the US Food and Drug Administration for this indication. Symptomatic treatment can help relieve severe itching and reduce the chance of bacterial superinfection.

Prevention

Instruct travelers to reduce their contact with contaminated sand and soil by wearing shoes and protective clothing and using barriers (e.g., blankets, towels) when seated on the ground or sandy beaches, particularly in areas with free-roaming dogs and cats.

CDC website: Zoonotic hookworm