History and exam

Key diagnostic factors

common

recent travel to tropics or subtropics

Most cases in the US occur in travelers who have recently returned from a beach vacation in the tropics or subtropics, especially the Caribbean, Brazil, Mexico, and Southeast Asia, where CLM is endemic.[4]​​[6] Incubation period is usually a few days after exposure and almost always <1 month.[28]

barefoot beachgoer/sunbather

For tourists visiting beach destinations in the tropics, walking to or on a beach without shoes or sandals has been identified as one of the strongest risk factors for developing CLM.[3] Furthermore, lying on a towel placed directly on the sand while sunbathing also carries a risk because lesions can occur on any unprotected part of the body.

creeping, raised, erythematous track

The characteristic lesion is serpiginous or linear, usually a few millimeters wide, a few centimeters long, and advances by a few millimeters to a few centimeters daily.[29][Figure caption and citation for the preceding image starts]: Typical appearance of cutaneous larva migransFrom the collection of Dr Gregory L. Zalar; used with permission [Citation ends].com.bmj.content.model.Caption@5a781ba5

Larval tracks may be single or multiple, and are located most commonly on the feet, thighs, and buttocks, related to the most common areas to come into contact with contaminated soil.[4]​​[6] However, lesions can occur on any unprotected part of the body, including hands, arms, trunk, scalp, face, breasts, and genitals.[32]

intense pruritus

Universal finding; may be severe and can disrupt sleep.[3][28] Resolves rapidly upon initiation of appropriate treatment, usually before resolution of skin lesions.

Other diagnostic factors

common

vesiculobullous or papular lesions

Have been found to occur along the larval tracks in 10% to 40% of cases; some reports have noted bullae several centimeters in diameter.[3][30]

uncommon

folliculitis

Rarely, a returning traveler may present with folliculitis due to creeping larvae becoming trapped in the sebaceous follicular canal. In such cases, pruritic papules and pustules are found in association with relatively short tracks, primarily on the buttocks.[5]

Risk factors

strong

recent travel to or residence in an endemic area

Most cases of CLM in the developed world are reported in tourists who have recently visited the tropics, especially beach destinations in the Caribbean, Southeast Asia, South America, and Africa.[3][4]​​​[21][23][24][25]​​​ CLM is common in areas where stray dogs and cats are permitted to freely defecate outside such as on beaches or in rural areas.

In endemic areas, most cases occur among children, especially those of low socioeconomic status and those who frequently walk barefoot.[18]

Risk is further increased during the rainy season in these areas because embryonated eggs and larvae survive longer in wet than in dry soil.[12]

walking barefoot and/or sunbathing on contaminated beach

For tourists visiting beach destinations in the tropics, walking to or on a beach without shoes or sandals has been identified as one of the strongest risk factors for developing CLM.[3] Furthermore, lying on a towel placed directly on the sand while sunbathing also carries a risk as lesions can occur on any unprotected part of the body.

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