Cause
- Parasitic skin infection caused by hookworm larvae
- Hookworm species include:
- Ancylostoma braziliense: found in wild and domestic dogs and cats in central and southern US, Central and South America, and the Caribbean
- Ancylostoma caninum: dog hookworm in Australia
- Uncinaria stenocephala: dog hookworm in Europe
- Bunostomum phlebotomum: cattle hookworm
Risk Factors
- Affects people of all ages, sexes, and races
- Common in tropical or subtropical regions
- At-risk groups include:
- Barefoot beachcombers and sunbathers
- Children in sandpits
- Farmers
- Gardeners
- Plumbers
- Hunters
- Electricians
- Carpenters
- Pest exterminators
- Often seen during overseas holidays, rarely reported in those who haven’t traveled
Infection Mechanism
- Parasite eggs in animal feces contaminate warm, moist, sandy soil
- Larvae hatch and penetrate human skin through hair follicles, cracks, or intact skin
- In humans, larvae migrate beneath the skin but rarely penetrate deeper layers
Signs and Symptoms
- Non-specific eruption at the penetration site
- Tingling or prickling sensation within 30 minutes of penetration
- Snakelike tracks (2-3 mm wide) stretching 3-4 cm from penetration site, causing intense itching
- Tracks advance daily, forming loops and tortuous tracks
- Commonly affected sites: feet, spaces between toes, hands, knees, buttocks
Treatment
- Self-limiting, usually resolves within 4-8 weeks without treatment
- Anthelmintics:
- Tiabendazole, albendazole, mebendazole, ivermectin
- Topical thiabendazole for early, localized lesions
- Oral treatment for widespread infection or failed topical treatment
- Itching reduces within 24-48 hours of starting treatment
- Lesions/tracts resolve within 1 week
- Physical Treatments:
- Liquid nitrogen cryotherapy
- Carbon dioxide laser
- Symptomatic Relief:
- Antihistamines
- Topical corticosteroids
- Secondary Infection:
- Treat with appropriate antibiotics if bacterial infection occurs
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