Epidemiological profile of cutaneous larva migrans in travelers returning to France between 2003 and 2015.

BACKGROUND

Cutaneous larva migrans (CLM) is caused by the penetration and migration of canine or feline hookworm larvae into the skin, and frequently affects travelers from high-income countries returning from tropical and sub-tropical areas. Unfortunately, this pathology is neglected due to poor understanding among both physicians and travelers. This study describes the profile of cases reported in Marseille, France.

PATIENTS AND METHODS

A retrospective study was performed in two specialized hospitals between 2003 and 2015. Data on socio-demographics, clinical aspects and treatment were collected. Diagnosis was based on travel history and symptoms.

RESULTS

Forty-three patients with a diagnosis of CLM were recorded in this study. They were aged between 14 and 70 and 51% were male. They were infected while visiting the Americas (37%), Africa (33%), Asia (28%) and (in the case of one patient) Portugal. The mean timescale for diagnosis was 41 days. Track lesions associated with pruritus in the lower limbs were the most common symptoms. Nine had a history of super-infection. Sixteen patients received treatment prior to referral including six who were administered antiparasitic drugs. A one-day treatment with ivermectin, administered at our facility, resulted, in most instances, in a favorable outcome.

CONCLUSION

This study reports 43 cases of CLM acquired mainly in Africa, Asia and the Americas but also, for the first time, CLM acquired during travel to Portugal. The data show the need for increased awareness of CLM prevention and treatment in order to optimize pre-travel advice and case management. Travelers need to understand how CLM is transmitted and the need to avoid contact with soil and sand contaminated by dogs and cats. In particular, footwear and sun chairs should be used on beaches.