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[土耳其的皮肤幼虫移行症:一例输入性病例报告]

[Cutaneous larva migrans in Turkey: an imported case report].

作者信息

Sönmezer Meliha Çağla, Erdinç Şebnem, Tülek Necla, Babür Cahit, Büyükdemirci Ayşe, İlgar Tuba, Ertem Günay

机构信息

Ankara Educational and Research Hospital, Department of Infectious Diseases, Ankara, Turkey.

出版信息

Mikrobiyol Bul. 2017 Jan;51(1):94-99. doi: 10.5578/mb.34189.

Abstract

Cutaneous larva migrans (CLM) is a parasitic infection most commonly found in tropical and subtropical areas. However, with the ease and increase of foreign travel to many countries around the world, the infection is not limited to these areas. CLM is an erythematous, serpiginous infection with skin eruption caused by percutaneous penetration of the larvae to the skin. In this report, a case diagnosed as imported CLM after an Amazon trip and treated with albendazole was presented. A 36 year-old male patient admitted to infectious diseases clinic with intense itching, erythematous, raised, streaklike serpiginious eruptionand some redness at bilateral foot especially at the right foot for about one week. The patient was living in Turkey, and travelled to Brazil for an Amazon trip three months ago and the lesions began immediately after this occasion. CLM was diagnosed with the typical lesions in the patient and oral albendazole treatment 2 x 400 mg/day for 3 consecutive days was carried out with oral amoxicillin/clavulanat 3 x 1 g/day for the secondary bacterial infection. The patient responded very well to oral albendazole treatment with a result of a rapid improvementof pruritus in days and no side effect was observed during the treatment period.After discharge, during his controlit was seenthat the lesions were regressed with leaving hyperpigmentation. In cases with cutaneous larva migrans, diagnosis is often made by the presence of pruritic typical lesions and tunnels, travel story to endemic regions, the story of barefoot contact with sand and soil in these regions, and the sun tanning story on the beach. The lesions are often seen in the lower extremities, especially in the dorsal and plantar surface of the foot. Laboratory findings are not specific. Temporary peripheral eosinophilia can be seen and biopsy can be done to confirm the diagnosis but usually no parasite is seen in the histopathological examination. Contact dermatitis, bacterial and fungal skin infections and other parasitic diseases should be considered in differential diagnosis. For the treatment ivermectin 1 x 200 mg/kg single dose or albendazole 400 mg/day for three days is recommended. As a result, cutaneous larva migrans should be kept in mind especially in patients with a history of travel to endemic areas and a history of bare feet contact with sandy beaches and soil in this region and with itchy, red and serpiginous skin lesions.

摘要

皮肤幼虫移行症(CLM)是一种寄生虫感染,最常见于热带和亚热带地区。然而,随着前往世界许多国家的国外旅行变得轻松且人数增加,这种感染并不局限于这些地区。CLM是一种由幼虫经皮肤穿透引起的、伴有皮肤疹的红斑性、匐行性感染。在本报告中,介绍了一例在亚马逊旅行后被诊断为输入性CLM并接受阿苯达唑治疗的病例。一名36岁男性患者因剧烈瘙痒、红斑、隆起、条纹状匐行疹以及双侧足部尤其是右脚约一周的发红症状入住传染病诊所。该患者居住在土耳其,三个月前前往巴西进行亚马逊之旅,此后立即出现了这些病变。根据患者典型的病变诊断为CLM,并给予口服阿苯达唑治疗,剂量为每日2次,每次400mg,连续3天,同时给予口服阿莫西林/克拉维酸治疗继发性细菌感染,剂量为每日3次,每次1g。患者对口服阿苯达唑治疗反应良好,数天内瘙痒迅速改善,治疗期间未观察到副作用。出院后复查时发现病变消退,但留有色素沉着。对于皮肤幼虫移行症病例,诊断通常依据瘙痒性典型病变和隧道的存在、前往流行地区的旅行史、在这些地区赤脚接触沙子和土壤的经历以及在海滩上晒太阳的经历。病变常出现在下肢,尤其是足部的背侧和足底。实验室检查结果不具有特异性。可出现暂时性外周嗜酸性粒细胞增多,可进行活检以确诊,但组织病理学检查通常未见寄生虫。鉴别诊断时应考虑接触性皮炎、细菌性和真菌性皮肤感染以及其他寄生虫病。对于治疗,推荐单剂量服用伊维菌素1次,剂量为200mg/kg,或阿苯达唑每日400mg,连用3天。因此,尤其是对于有前往流行地区旅行史、有在该地区赤脚接触沙滩和土壤史且有瘙痒、红色匐行性皮肤病变的患者,应牢记皮肤幼虫移行症。

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