Due to difficulty accessing albendazole and ivermectin, many patients are initially prescribed ineffective courses of non-targeted therapy such as mebendazole, ...
Management of Imported Cutaneous Larva Migrans: A Case Series Leah Kincaid1, Michael Klowak2, Stefanie Klowak3, Andrea K. Boggild3,4,5 1 Division of Dermatology, Department of Medicine, University of Toronto, Canada; 2Faculty of Science,
McMaster University, Hamilton, Canada; 3Tropical Disease Unit, Division of Infectious Diseases, UHN‐ Toronto General Hospital, Toronto, Canada; 4Public Health Ontario Laboratories, Public Health Ontario, Toronto, Canada; 5Department of Medicine, University of Toronto, Toronto, Canada
Results Background & Objectives • Cutaneous larva migrans (CLM) is a zoonotic helminthiasis frequently imported to Canada by travelers to beach destinations in the tropics. • CLM causes morbidity due to severe, intractable pruritus arising from cutaneous larval migration of dog or cat hookworms, which have penetrated intact skin while walking on beaches. • CLM causes an intensely pruritic rash that leads to impaired concentration and sleep and mood disturbance. • Targeted treatment for CLM includes either oral albendazole or oral ivermectin, yet, in Canada these medicines are only available through the Special Access Program (SAP) of Health Canada. • Due to difficulty accessing albendazole and ivermectin, many patients are initially prescribed ineffective courses of non‐targeted therapy such as mebendazole, a medication effective against intestinal helminths but not useful for CLM due to poor systemic absorption. • We analyzed the proportion of patients with CLM referred to our specialized Tropical Disease Unit (TDU) having failed non‐targeted therapy prior to referral, and characterized the demographic and travel related factors associated with imported CLM in this population.
Methods • Patients with CLM seen in the TDU from June 2012 through December 2014 were identified through our SAP application log • Patient charts were retrospectively reviewed • Demographic, clinical, and travel‐related data were collected and anonymized • Descriptive statistics were performed for all variables • Comparisons were made between those patients who had received at least 1 course of mebendazole prior to referral to the TDU versus those who had not • Comparison of continuous variables was made using the Mann Whitney Rank Sum test (level of significance set at p
