title: Management of imported cutaneous larva migrans: A case series and mini-review.
abstract: BACKGROUND
  Cutaneous larva migrans (CLM), a zoonotic helminthiasis imported to Canada by travelers to the tropics, causes morbidity due to severe, intractable pruritus. Treatment in Canada is only available through the Special Access Program (SAP) of Health Canada, thus, many patients are prescribed ineffective courses of non-targeted therapy.
  
  
  OBJECTIVE
  We analyzed patients with CLM referred to our specialized Tropical Disease Unit (TDU) having failed non-targeted therapy prior to referral, and characterized demographic and travel related correlates of CLM.
  
  
  METHODS
  Patients with CLM evaluated between June 2012 and December 2014 were identified through our SAP application log, and charts were reviewed for demographic, clinical, and travel-related data following IRB approval.
  
  
  RESULTS
  25 patients with CLM were identified: 12 women, and 13 men. Median age was 35 years (range 4-58 years). Patients had primarily acquired their CLM in the Caribbean (80%), with Jamaica being the most well represented source destination (N = 10, 40%). Reported symptoms included intense, function-limiting pruritus (N = 25, 100%) and loss of sleep (N = 3, 12%). Twelve patients (48%) with CLM had received at least 1 course of non-targeted therapy prior to referral. Non-targeted therapies included topical steroids (N = 7), cryotherapy (N = 3), oral antibiotics (N = 2), and oral mebendazole (N = 11). Median duration of symptoms was 34 days (range 5-226 days). Of 25 patients with CLM, 23 (92%) were prescribed a single 3-day course of albendazole and responded appropriately, and 2 (8%) required a second 3-day course of albendazole.
  
  
  CONCLUSIONS
  Although CLM is non-communicable and of little public health relevance in Canada, it causes significant morbidity. A substantial proportion of patients with CLM referred to our specialized TDU had a prolonged course of illness and were prescribed ineffective and non-targeted therapies. Oral albendazole or ivermectin, or topical thiabendazole, are the drugs of choice for CLM, and should be prescribed as first-line therapy.
authors.affiliation: Division of Dermatology, Department of Medicine, University of Toronto, Canada.
authors.forename: Leah
authors.initials: L
authors.lastname: Kincaid
authors.affiliation: Faculty of Sciences, McMaster University, Hamilton, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Klowak
authors.affiliation: Tropical Disease Unit, Division of Infectious Diseases, UHN-Toronto General Hospital, Toronto, Canada.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Klowak
authors.affiliation: Tropical Disease Unit, Division of Infectious Diseases, UHN-Toronto General Hospital, Toronto, Canada; Public Health Ontario Laboratories, Public Health Ontario, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada. Electronic address: andrea.boggild@utoronto.ca.
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Boggild
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007815:Larva Migrans / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000473:pathology; D055815:Young Adult
keywords: Hookworm-related cutaneous larva migrans; Migratory helminthiasis; Pruritus; Serpiginous rash