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Creeping eruption

Creeping eruption is a human infection with dog or cat hookworm larvae (immature worm).

Alternative Names

Cutaneous larvae migrans; Zoonotic hookworm; Ancylostoma caninumAncylostoma braziliensisBunostomum phlebotomumUncinaria stenocephala

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 United States, the southeast has 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 are 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) usually occur on the feet and legs

Signs and tests

Your health care provider can often diagnose this condition by looking at your skin. In rare cases, a skin biopsy  is done to rule out other conditions. In very rare cases, a blood test is 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 often goes away by itself over weeks to months. Treatment helps the infection go away more quickly and is successful.

Complications

  • 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 deworming 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 helps prevent infection.

References

Diemert DJ. Intestinal nematode infections. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 365.

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. Philadelphia, PA: Elsevier Churchill-Livingstone; 2009:chap 291.

Updated: 11/10/2012

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 A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.


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