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The symptoms, medical history, and treatment of 98 patients with cutaneous larva migrans (creeping eruption) who attended a travel-related-disease clinic during a period of 4 years are reviewed. This condition is caused by skin-penetrating larvae of nematodes, mainly of the hookworm Ancylostoma braziliense and other nematodes of the family Ancylostomidae. Despite the ubiquitous distribution of these nematodes, in the investigated group only travelers to tropical and subtropical countries were affected; 28.9% of the patients had symptoms for > 1 month, and for 24.5% the probable incubation period was > 2 weeks. The efflorescences typically were on the lower extremities (73.4% of all locations). The buttocks and anogenital region were affected in 12.6% of all locations, and the trunk and upper extremities each were affected in 7.1%. Only a minority of patients presented with eosinophilia or an elevated serum level of IgE. No other laboratory data appeared to be related to the disease. Therapy with topical thiabendazole was successful for 98% of the patients. Systemic antihelmintic therapy was necessary in two cases because of disseminated, extensive infection.

Of the estimated one billion people infected with the anthropophilic hookworms, Ancylostoma duodenale and Nectar americanus, about 10% Iive in South-East Asia, where N. americanus greatly predominates (CARROLL & WALKER, 1990). Hence, in published reports (e.g., RAHMAN, 1994; RAJ et al., 1997), the identity of the parasite is assumed, but rarely confirmed. Studies based on faecal microscopy can only presume the hookworm species, unless adult worms have been examined (expelled by anthelmintic treatment); faecal culture for larvae distinguishes only between Ancylostoma and Necator, without providing a species identification. Even when adult worms have been recovered, they have almost invariably been assumed to be N. americanus, without morphological confirmation (e.g., HASWELL-ELKINS et al., 1987).We suspect that human infection with A. ceyhicum is far more prevalent than reports indicate, with many cases presently being attributed to N. americanus. This matter could be resolved by simple but careful studies in hookworm-infected human populations.