Hookworms, hookworms everywhere!

Cutaneous larva migrans is the second most common helminthic infection and the most common tropically acquired skin complaint. If you get it, it's rather a nuisance but no reason for major concern. It can strike all around the world, especially if you're barefoot. Depending on where you are, you'll get a different causative critter though.

As the name suggests, this is an annoying skinrash usually caused by a hookworm that has accidentally chosen you lucky thing to be its host. After entering your skin through a follicle or a cut in your skin with the help of a protein dissolving enzyme, it sheds its cuticle and starts migrating around the upper layer of your epidermis, causing intense itching and the characteristic linear or gyrated raised skinrash that tracks the hookworms passage through your tissue. As you are not the intended host, the worm is not able to penetrate the basal cell layer of your skin and hence does not make it to your lungs, where it really wants to be. The most common causative agents and its playgrounds are:

  • Ancylostoma braziliense (hookworm of wild and domestic dogs and cats): Southern United States, Central America, South America, and the Caribbean
  • Ancylostoma caninum (dog hookworm): Australia
  • Uncinaria stenocephala (dog hookworm): Europe
  • Bunostomum phlebotomum (cattle hookworm)
  • As you are not the worm's intended host, it will soon wither away and die, but if you're unlucky, that might take up to a year. Prevention is the key here, so if you're somewhere with warm, hot, sandy soil, wear something on your feet. As the itch can be quite annoying, treatment might be necessary: albendazole, metronidazole and ivermectin might be used (depending on where you are). Try not to scratch it, as it might become infected with some nosocomial bacteriae, and things usually get worse from then on.

    References:
    Roble, DT et al. (2020): Cutaneous Larva Migrans. Medscape, https://emedicine.medscape.com/article/1108784-overview accessed 23.3.21
    Ngan, V. (2003): Cutaneous Larva Migrans. Dermnet NZ, https://dermnetnz.org/topics/cutaneous-larva-migrans accessed 23.3.21