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It is widely distributed in tropical and subtropical countries, with few cases reported in Europe, infection being classically considered as an imported dermatosis observed in travellers to endemic areas. The diagnosis is eminently clinical, based on the presence of serpiginous and itchy rash in a patient with history of travel to endemic area.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 39-year-old male who, on 11th November 2014, comes to the clinic due to a 7-week history of intensely pruritic lesions on his right hand. Prior treatment with topical prednicarbate and fusidic acid and oral cloxacillin showed no improvement. The patient reported a progressive advance of the eruption, while resolving through the back end.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Upon examination, a serpiginous eruption was observed in the palm of his right hand, containing clear liquid in the part referred to as the advancing end, and then continued with a discreetly raised, erythematous, serpiginous lesion, about 6<span class="elsevierStyleHsp" style=""></span>cm in length, in the oldest part.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Suspecting cutaneous larva migrans, a random skin biopsy was performed in an area closed to the eruption, prescribing treatment with albendazole 400<span class="elsevierStyleHsp" style=""></span>mg/d for 3 days, orally. Itching resolved completely on the second day of treatment and skin lesion in a week. No parasite was found in the biopsy, showing intraepidermal spongiosis with vesiculation, oedema of the papillary dermis and superficial and deep perivascular inflammatory infiltrate with lymphocytes and abundant eosinophils, compatible with cutaneous larva migrans.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patient denied trips to tropical or subtropical regions. His personal history included performing maintenance work in a wooded and sandy area with sheep and dogs, in the municipal council of Colunga (Asturias).</p><p id="par0030" class="elsevierStylePara elsevierViewall">With these data, we made the diagnosis of cutaneous larva migrans acquired in Asturias.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The cutaneous larva migrans term is applied to a skin infestation by helminth larvae from animals, especially dogs and cats. The most common species is <span class="elsevierStyleItalic">Ancylostoma braziliense</span>, followed by <span class="elsevierStyleItalic">Ancylostoma caninum</span>, although <span class="elsevierStyleItalic">Uncinaria stenocephala</span> (from European dogs) and <span class="elsevierStyleItalic">Bunostomum phlebotomum</span> (cattle) has also been described. Parasites are deposited on the ground, egg-shaped, in the stools of infected animals. These eggs need warm and humid conditions to become infective larvae. If this larva enters the human epidermis, it cannot cross it, rather, it migrates between the stratum corneum and the granular layer without reaching the dermis and without causing visceral involvement, developing the typical signs and symptoms of cutaneous larva migrans.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The diagnosis is eminently clinical, based on the presence of serpiginous, pruritic lesions, which advance through one of their ends, while resolving at their caudal end. A skin biopsy does not usually show the parasite, as by then, the same has generally migrated from the visible area. The differential diagnosis includes other parasitosis causing serpiginous eruptions, which can usually be distinguished by the number of pathways, width, length, speed of migration, site of lesions or accompanying symptoms, which primarily includes larva currens and dracunculiasis before the worm rash.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">It is an endemic process in tropical and subtropical areas. Cases have been reported in temperate areas, mostly from travellers visiting endemic areas, although cases acquired in Europe are progressively increasing in frequency, including Germany, England, Scotland, the coast of Naples, Serbia and Brittany.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Reports of cases recently acquired in Spain draw particular attention.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> In our case, we consider relevant that the last days of August and early days of September 2014 were particularly warm in Asturias, reaching a maximum temperature of 27.7<span class="elsevierStyleHsp" style=""></span>°<span class="elsevierStyleSmallCaps">C</span> on 25th August, with a humidity of 100% on 29th of that month, which would favour the development of the parasite's larval stage.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">We believe it is important to describe this case, given the exponential number of patients diagnosed in our area with no history of travel to endemic areas. This fact should be considered by health authorities in order to establish appropriate preventive measures.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Hidalgo García Y, Fernández Sánchez C, Rodríguez Villar D. <span class="elsevierStyleItalic">Larva migrans</span> cutánea adquirida en Asturias. Med Clin (Barc). 2016;147:567–568.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous larva migrans acquired in Brittany, France" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. Tamminga" 1 => "W.F. 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Available from: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.tiempoviedo.com/wxhistory.php?date=201408">http://www.tiempoviedo.com/wxhistory.php?date=201408</a>." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014700000012/v1_201702040025/S2387020616308002/v1_201702040025/en/main.assets" "Apartado" => array:4 [ "identificador" => "46463" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014700000012/v1_201702040025/S2387020616308002/v1_201702040025/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616308002?idApp=UINPBA00004N" ]
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Vol. 147. Issue 12.
Pages 567-568 (December 2016)
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Vol. 147. Issue 12.
Pages 567-568 (December 2016)
Letter to the Editor
Cutaneous larva migrans acquired in Asturias, Spain
Larva migrans cutánea adquirida en Asturias
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