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Creeping eruption

Definition

Creeping eruption is an infection with dog or cat hookworm larvae.

Alternative Names

Cutaneous larvae migrans; Ancylostoma braziliense

Causes, incidence, and risk factors

Hookworm eggs are found in the stool of infected dogs and cats. When the eggs hatch, the larvae infest any contaminated soil and vegetation.

When you come into contact with this infested soil, the larvae can burrow into your skin. They cause an intense inflammatory response that leads to a rash and severe itching.

Creeping eruption is more common in countries with warm climates. In the U.S., the southeastern states have the highest rates of infection. The main risk factor for this disease is contact with damp, sandy soil that has been contaminated with infected cat or dog feces. More children than adults become infected.

Symptoms

  • Blisters
  • Itching, may be more severe at night
  • Raised, snakelike tracks in the skin that may spread over time, usually about 1 cm per day (severe infections may cause several tracks)

Signs and tests

Your health care provider will usually diagnose this condition by looking at your skin. Rarely, a skin biopsy may be done to rule out other conditions.

Rarely, a blood test may be done to see if you have increased eosinophils.

Treatment

Anti-parasitic drugs such as thiabendazole, albendazole, or ivermectin may be used to treat the infection.

Expectations (prognosis)

Creeping eruption may go away by itself over a period of weeks to months. Treatment helps the infection go away more quickly and is highly successful.

Complications

  • Secondary bacterial skin infections caused by scratching
  • Spread of the infection through the bloodstream to the lungs or small intestine (rare)

Calling your health care provider

Make an appointment with your health care provider if you or your child have skin sores that are snakelike, itchy, or moving from one area to another.

Prevention

Public sanitation and de-worming of dogs and cats have decreased hookworm infestation in the United States.

Hookworm larvae often enter the body through bare feet, so wearing shoes in areas where hookworm infestations are known to occur will help prevent infection.

References

Kazura JW. Nematode infections. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 378.

Nash TE. Visceral larvae migrans and other unusual helminth infections. In: Mandell GL, Bennett JE, Dolan R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Orlando, FL: Saunders Elsevier;2009:chap 291.


Review Date: 12/7/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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