What Is Cutaneous Larva Migrans ( CLM ) ?

What is Cutaneous Larva Migrans ( CLM ) ? Cutaneous larva migrans ( CLM ) is an infection caused by skin worm parasites. The type of worm that usually causes causes this condition is hookworms commonly found in animals, such as cats, dogs, sheep, horses, and others. Humans are commonly infected with parasites while walking barefoot in areas contaminated with animal feces, such as in parks, or beaches. In addition, parasites attached to the skin can also come from moist objects, such as towels.

CLM usually occurs in tropical and sub-tropical countries, such as Southeast Asia, Africa, America, and the Caribbean Islands. CLM can attack anyone, but most of the sufferers are children because of their habit of playing in open space. In addition, CLM is also a high risk for experienced people who often spend time sunbathing on the beach without using a pedestal or workers around the contaminated construction area.

Some types of hookworm parasites that can cause skin worm infections occur are:
  • Ancylostoma braziliense and caninum. This parasite is often the main cause of CLM and is usually found in dogs and cats.
  • Uncinaria stenocephala. This parasite is commonly found in dogs.
  • Bunostomum phlebotomum. This parasite is commonly found in livestock.

As for some other types of parasitic hookworms that are rarely found, but can trigger the occurrence of CLM are:
  • Ancylostoma ceylanicum, which is sometimes found in dogs.
  • Ancylostoma tubaeforme, which is sometimes found in cats.
  • Strongyloides papillosus, which is sometimes found in goats, sheep, or other livestock.
  • Strongyloides westeri, which is sometimes found on horses.

In addition to the above examples, two other types of hookworms, namely necator americanus and ancylostoma duodenale, living in the human body can also cause CLM disease.

Cutaneous Causes of Migrans larvae
CLM is generally caused by a parasitic life cycle that is contagious from animal faeces that have hookworm eggs to human skin, through a warm, moist, and sandy surface. This is because the worm eggs can hatch in the environment and penetrate the exposed skin.

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Broadly speaking, the parasite larvae can penetrate the skin of the animal through the dermis skin layer (between the epidermis and subcutaneous tissue), and enter the lungs through the veins and lymphatic system. In the process of migration or displacement, the larvae can be swallowed and lay eggs in the intestine, which will eventually be excreted through the stool.

When the stool is about humans, the larvae will penetrate the skin surface through hair follicles, cracked skin, or even healthy skin. Unlike the animal cycle, the larvae can not penetrate the dermis. Therefore CLM occurs only in the outer layer of the skin only.

Symptoms of Cutaneous Larva Migrans
Not all CLM sufferers experience symptoms, especially if the condition is mild. If the infection is severe enough, the patient may feel an itchy, amusing or stabbed sensation within the first 30 minutes after contamination. The surface of the skin will be reddened or discolored and a solid lump appears on the skin (papules), until a rough skin surface resembling a snake's skin is 2-3 mm wide after several hours. This rough skin surface can worsen and widen from 2 mm to 2 cm per day, depending on the type of parasite that attacks.

In certain cases, the larvae can spread to the human lungs through the blood vessels and move into the mouth until it is swallowed into the small intestine. If the larvae develop, anemia, cough, pneumonia, and other symptoms may develop.

Diagnosis of Cutaneous Larva Migrans
CLM is not easy to diagnose because there are other skin diseases that have similar symptoms, such as skin inflammation (contact dermatitis), fungal infections (dermatophytosis), Lyme disease , photodermatitis, and scabies.

In conducting the diagnosis, the physician will perform a physical examination as well as ask the work or activity undertaken by the patient (eg whether the patient is often outdoors activities without a pedestal). To confirm the diagnosis, some further tests that might be suggested are:
  • Optical Coherence Tomography (OCT). This is a method of scanning done to identify the type of parasite on the skin surface.
  • Skin biopsy, to monitor the position of the parasite and the potential for inflammation in the dermis layer.

Treatment of Cutaneous Larva Migrans
In general, CLM can recover by itself within 4-8 weeks due to the inability of the parasite to live long in human skin tissue. If required, anticelmintic drugs, such as albendazole or ivermectin , may be prescribed by a physician. To relieve itching, your doctor may prescribe topical antihistamine or corticosterrache.
Under severe conditions, the action of cryotherapy or frozen therapy using liquid nitrogen can be done to halt parasite growth gradually.

Complications of Cutaneous Larva Migrans
Although most skin worms infections can recover by themselves, there are several potential complications that can occur:
  • Secondary skin infection.
  • Loffler's disease, namely the accumulation of infiltrates and eosinophils in the lung due to the presence of worm infection in large quantities.
  • Parasitic migration to other organs.

Prevention of Cutaneous Larva Migrans
Though accidental skinworm infections occur, there are several steps that can be taken to minimize the risks:
  • Always use footwear when walking or sunbathing on the beach.
  • Always maintain the cleanliness of the body after doing the activity from the outside.
  • Avoid bringing pets, such as dogs and cats, to beaches or parks to prevent contamination of public facilities.
  • Provide medication of worms on pets on a regular basis.

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