Search

Background Cutaneous larva migrans (CLM) is a neglected parasitic skin disease caused by hookworm larvae such as Ancylostoma braziliense and Ancylostoma caninum. It is more common in tropical and subtropical countries. Evidence regarding clinical profiles, risk factors and outcomes of children with CLM in the Eastern province of Sri Lanka is scarce. Aim The aim of this study was to evaluate demographic profile, risk factors, clinical manifestations and outcomes associated with CLM in children who presented to paediatric and dermatological clinics of the Teaching Hospital, Batticaloa, Sri Lanka. Method A retrospective study was conducted over three years from January 2017 to December 2019 among children who presented with CLM infection to paediatric and dermatological clinics of the Teaching Hospital, Batticaloa, Sri Lanka. Twenty-eight children who were aged between 1 and 14 years were recruited for the study. Detailed information including demographic factors such as age, sex, residence and mother's education, risk factors for infection, main reason for clinic visit, duration of illness, site of lesions, number of lesions, treatment received from out-patients department and/or general practitioner, duration of treatment, associated secondary bacterial infection, family history of similar infections and laboratory investigations were extracted from clinical records. Data were analyzed using SPSS version 19.0 (IBM Corp., Armonk, NY). Results Among 28 children recruited for this study, 19 (67.9%) were male children and 9 (32.1) were female children. The majority of children were below 6 years (n=25, 88.3%). Twenty-six (92.9%) children had residence in rural areas and also belonged to low socioeconomic class. Most cases were detected in Valaichenai (32.1%) and Kattankudy (21.4%) 'Medical Officer of Health' (MOH) regions. The majority of mothers were educated only up to ordinary level or below (n=19, 67.8%). All patients had pets either dogs or cats at home and no pets had been dewormed. Almost 92.9% of children acquired disease whilst playing on the infected soil The main reason for clinic visit had been itchiness and this presentation accounted for 60.7% (n=17). Skin infection accounted for 25% of presenting problems. Majority of them presented late to the clinic with the lesions of more than three weeks of duration (n=17, 60.7%). Single lesion was noted in the majority (n=27, 96.4%) except one child who had three lesions. Buttock lesions were observed in 35.7%, feet in 25%, and 10.7% in legs. Investigations revealed eosinophilia in 50% (n=14) of patients and neutrophil leukocytosis was seen in five patients (17.9%). All patients received treatment either from the general practitioner or outpatient department for variable duration without success before attending the specialist clinic. Fifty percent of patients needed treatment with Albendazole and antihistamine for more than three weeks to achieve complete cure. It was also observed that overall occurrence had been declining over the past three years. Conclusion CLM is a common and unreported disease in Eastern province, Sri Lanka. The majority of children presented from low socio-economic backgrounds. The common risk factors were the presence of dewormed pets at home and contamination with infected soil. The majority of children had a single lesion on presentation. Fifty percent of children needed more than three weeks of treatment to achieve a good response.

Cutaneous larva migrans is a hookworm-related infestation caused by zoonotic nematode larvae such as the Ancylostoma braziliense. Herein a case of a 2-year-old child complaining initially of painfull blisters on her left foot is report. The correct diagnosis was delayed and only confirmed when serpiginous, erythematous tracks and bullae were developed. Patient was treated with fexofenadine oral, topical thiabendazole and a cream with ketoconazole, betamethasone dipropionate and neomycin sulfate. The reported case assumes importance because of the atypical presentation of the disease as a case of bullous cutaneous larva migrans.

9 páginas, 4 tablas, 2 figuras., Dog feces may contain zoonotic parasites that contaminate the environment and serve as a potential source of infection to animals and humans. In this study, microscopic and molecular analyses were used to estimate the prevalence and intensity of gastrointestinal (GI) parasites and assess the risk factors for infection in 948 dogs in three climatically distinct zones of Nigeria. Zoonotic helminths including Strongyloides stercoralis, Ancylostoma braziliense, A. caninum and Toxocara canis were detected either as single or multiple infections in 377 (39.8 %) of dogs examined. At multiple logistic regression analyses, association was found between GI parasite infection and deworming practices and dog management. Regarding A. braziliense, A. caninum and T. canis infections, intensity of egg shedding was statistically associated with the age of the dogs and not with their sex or breed. The majority of GI parasite-positive dogs did not receive regular deworming treatment (59 %) and roamed freely (56 %) thereby constituting public health risk. This is the first nationwide survey and analyses of risk factors of GI parasites of dogs using molecular methods as confirmation of their identity. The zoonotic potential of these parasites is exacerbated by the lack of both operational national policies to control the population of free- roaming dogs and to promote responsible dog ownership, and veterinary public health programs for dogs.

The canine hookworms Ancylostoma braziliense, Ancylostoma ceylanicum, Ancylostoma caninum and Uncinaria stenocephala are not only capable of producing morbidity and mortality in dogs but are also neglected tropical zoonoses. Each hookworm species differs considerably in its geographical distribution, life cycle, biology, pathogenic impacts on both canine and human hosts, zoonotic potential, and response to treatment with anthelminthics. Here we describe the development and validation of two Taq-Man based multiplex PCR assays capable of detecting and differentiating all four canine hookworm species in faeces of naturally infected dogs. The analytical sensitivity of both assays was assessed using 10-fold serial dilutions of synthetic gene block fragments containing individual sequence targets of each hookworm species. The sensitivity of the assays and ability to detect mixed species infections were compared to a conventional PCR-Restriction Fragment Length Polymorphism based-approach when applied to laboratory and field samples from endemic areas. The qPCRs detected at least one species of hookworms in 82.4% of PCR-RFLP-negative but microscopy-positive samples. The qPCRs detected an additional 68% mixed infections with different species of canine hookworms, and additional single species infection with A. caninum (47%), U. stenocephala (33%) and A. ceylanicum (0.02%) that were missed by PCR-RFLP. These multiplex qPCR assays will assist field based epidemiological surveillance studies towards an accurate and sensitive monitoring of canine hookworm infections in dogs, to inform their species-specific zoonotic risks to populations living in endemic areas, globally., Author summary There are four species of blood-sucking hookworms that infect dogs, namely Ancylostoma braziliense, Ancylostoma ceylanicum, Ancylostoma caninum and Uncinaria stenocephala. Each hookworm species differs in its geographical distribution, impact on canine health and more importantly its ability to infect and produce disease in humans. For example, dogs are the primary reservoir for A. ceylanicum, the second most common hookworm species infecting humans in the Asia Pacific. Ancylostoma braziliense is more geographically confined and responsible for chronic skin eruptions in humans. Accurate diagnosis of hookworm species in dogs is therefore essential for understanding the relative risk each species pose to human populations living in close association with dogs. As microscopic methods are unable to distinguish between species of hookworms in stool, highly efficient real time PCR assays capable of detecting and differentiating all four canine hookworm species in canine faeces were developed. These new assays are superior to previously published gel-based PCR assay displaying higher throughput, and ability to correctly identify single and mixed hookworm species infections with higher accuracy.

Cutaneous larva migrans (CLM) is a dermatologic condition caused by the migration of animal nematode larvae, most commonly the larvae of the dog and cat hookworm, Ancylostoma braziliense. The larvae are found in sand or soil where infected animals have defecated; when human skin contacts contaminated sand or soil, the larvae penetrate the skin and migrate in the epidermis leading to marked pruritis and characteristic erythematous serpiginous tracks. Symptoms typically start 10 to 15 days after infection, but delayed onset has been reported. CLM is most often reported in returned travelers who had exposure of unprotected skin to sand or soil in areas where animal hookworms are endemic. CLM can be prevented by wearing shoes and avoiding contact with contaminated sand or soil. Treatment is oral albendazole or ivermectin.

Cutaneous larva migrans is a dermatitis, typically acquired in warm tropical or sub-tropical countries, caused by migration of the larvae of nematodes (hookworm; mainly Ancylostoma braziliense and, occasionally, Ancylostoma caninum or Uncinaria stenocephala), which are parasitic on animals such as cats and dogs, into the patient's skin. The larvae penetrate the skin after contact with infected soil and cause a typical creeping eruption. Patients with cutaneous larva migrans seen in Europe have usually acquired the disease following a stay in a tropical or sub-tropical area. How-ever, some cases of cutaneous larval migrans are acquired in Europe. We report here 5 autochthonous cases in France and give an overview of European autochthonous cases.

All canine hookworms are known to be zoonotic, causing infections ranging from transient skin irritations to prolonged ‘creeping eruptions’, eosinophilic enteritis and even patent intestinal infections. There is little information on canine hookworm species and their public health significance in sub-Saharan Africa. This study determined the prevalence and species of hookworms in dogs from different climatic zones of Kenya. Dog faecal samples were collected from the environment, and hookworm eggs were isolated by zinc chloride flotation and subjected to DNA extraction. Polymerase chain reaction (PCR) assays targeting the internal transcribed spacer (ITS) 1 and 2, 5.8S and 28S ribosomal RNA ofAncylostomaspp. andUncinaria stenocephalawere performed, and hookworm species were identified by PCR-restriction fragment length polymorphism (RFLP) or DNA sequencing. Hookworm eggs were detected by microscopy in 490/1621 (30.23%, 95% CI 28.01–32.54) faecal samples. Estimates of faecal prevalence were high in counties receiving higher rainfall (Narok 46.80%, Meru 44.88%) and low in those with a more arid climate (Isiolo 19.73%, Turkana 11.83%). In a subset of 70 faecal samples,Ancylostoma caninum(n = 59) was the most common species, followed byA. braziliense(n = 10) andA.cf.duodenale(n = 1). This study reports for the first time the detection ofA.cf.duodenalein dog faeces and zoonotic hookworm species in Kenyan dogs. These findings emphasize the need for control measures such as enforcing laws for restraining stray dogs, regular deworming of dogs, and public health awareness programmes aimed at informing communities on outdoor use of footwear.

A number of gastrointestinal parasites have been reported to infect dogs in Nigeria, some of which have zoonotic potential. Of these, hookworms are the most prevalent, with both Ancylostoma caninum and Uncinaria stenocephala reported in the country. In this study, we subjected 203 hookworm microscopy-positive samples of the 885 individual faecal samples collected from dogs in Nigeria to a recently developed multiplex qPCR for the detection and characterisation of canine hookworm species. The qPCR demonstrated a diagnostic sensitivity of 98% (95% CI 95-99.4) allowing the detection of A. caninum and A. braziliense in 81.3% (165/203, 95% CI 75.3-86.1) and 51.2% (104/203, 95% CI 44.4-58) of the microscopy-positive faecal samples of dogs from Nigeria, respectively and 34.5% (70/203, 95% CI 28.3-41.3) of mixed infections with both hookworm species. The finding of A. braziliense is particularly worrisome given this is a well-known agent of persistent cutaneous larva migrans, commonly referred to as "creeping eruptions" in humans. Although this parasite has been diagnosed in locals and in people travelling in Nigeria suffering from dermatological illnesses, this represents the first molecular identification of A. braziliense in its canine reservoir in the country. These results update the occurrence and distribution of hookworm species affecting dogs in Nigeria highlighting the suitability of the newly developed multiplex qPCR assay as a high-throughput tool for the surveillance of zoonotic hookworms, globally.

Cutaneous larva migrans is an acquired, self-limited infestation caused by cat hookworm,Ancylostoma braziliense, and dog hookworm,A. caninum. The disease is acquired by direct contact with contaminated soil. Circumrotation is a religious ritual practised by devotees of Hinduism as a fulfilment of vows taken at the shrine and involves rolling over with uncovered upper body on the sand over a distance of up to 600 m. It is a reported mode of acquisition of cutaneous larva migrans infestation. The authors report a 10-year-old boy who acquired cutaneous larva migrans on his right forearm after circumrotation. The forearm is an unusual site for this infestation, and most reported cases had lesions on the feet, thighs and buttocks following either sitting or playing on contaminated soil. The child made complete recovery following treatment with albendazole for 1 week.

ResumenLarva cutánea migratoria supone una enfermedad ocasionada por larvas de nematodos transmitidos por el suelo contaminado con heces de perros y gatos portadores de la enfermedad. El hombre solo supone un huésped accidental, por lo que la enfermedad queda autolimitada; sin embargo, es necesario tratar la infección con el objetivo de paliar el prurito y las alteraciones cutáneas que pueden desarrollar.Los pies son el lugar en el que con mayor frecuencia asientan las lesiones. El diagnóstico es fundamentalmente clínico y el tratamiento más empleado en la actualidad es la ivermectina por vía oral en monodosis. Las actividades preventivas resultan de gran utilidad, papel que recae sobre la figura de médicos y podólogos.AbstractCutaneous larva migrans is a disease caused by nematode larvae found in cat and/or dog feces and it is transmitted to humans when walking barefoot in contaminated ground. Human beings are only accidental hosts of this parasite, so the disease is self-limiting, although it is necessary to treat the infection in order to relieve the itching and cutaneous alterations that may develop.Lesions are more often found in feet. Diagnosis is essentially clinic and the treatment commonly applied is ivermectin oral monodose. Preventive measures are called for and physicians and podologists should be in charge of implementing them.

The efficacy of oral afoxolaner plus milbemycin oxime combination chewable tablets (NexGard Spectra, Merial) against naturally acquired intestinal nematode infections in dogs was evaluated in six negative control, blinded studies including a total of 114 dogs. Dogs were selected based on a pre-treatment fecal examination indicating patent infections with hookworms (two studies), Toxocara or Toxascaris ascarids (one study each) or Trichuris whipworms (two studies). In each study, dogs were assigned to blocks of two animals each, based on decreasing pre-treatment body weight and were randomly allocated to one of two groups consisting of eight, nine or 10 dogs: untreated (control) or treated with the combination chewable tablet formulation. Chewable tablets were combined to provide doses of actives as close as possible to the minimum effective dose of afoxolaner and milbemycin oxime, i.e., 2.5 mg/kg body weight and 0.5 mg/kg body weight, respectively, once on Day 0. For parasite recovery and count, dogs were euthanized humanely and necropsied seven or eight days after treatment. A single treatment with afoxolaner plus milbemycin oxime chewable tablets provided 94.8% and 90.9% efficacy against adult Ancylostoma braziliense and A. caninum, respectively, 97.8% and 99.4% efficacy against adult Toxocara canis and Toxascaris leonina, respectively, and ≥98.3% efficacy against adult Trichuris vulpis. Compared to untreated controls, nematode counts of the treated dogs were significantly reduced (F-test; p

Cutaneous larva migrans is a tropically acquired parasitic infection caused mostly by the larvae of Ancylostoma braziliense and Ancylostoma caninum. We report a child with an unusual presentation of cutaneous larva migrans infection on her abdominal wall. The reported child with delayed gross-motor development presented to the pediatric clinic with a history of irritable cry and poor sleep for one-month duration. She could only roll-over on cemented floor in her house which had poor infrastructure facilities and also had several pets which frequently entered into the house. Examination revealed linear erythematous lesion on abdominal wall compatible with clinical diagnosis of cutaneous larva migrans. The child responded well to a seven-day course of Albendazole.

Both Strongyloides stercoralis and hookworms are common soil-transmitted helminths in remote Australian communities. In addition to infecting humans, S. stercoralis and some species of hookworms infect canids and therefore present both environmental and zoonotic sources of transmission to humans. Currently, there is limited information available on the prevalence of hookworms and S. stercoralis infections in dogs living in communities across the Northern Territory in Australia. In this study, 274 dog faecal samples and 11 faecal samples of unknown origin were collected from the environment and directly from animals across 27 remote communities in Northern and Central Australia. Samples were examined using real-time polymerase chain reaction (PCR) analysis for the presence of S. stercoralis and four hookworm species: Ancylostoma caninum, Ancylostoma ceylanicum, Ancylostoma braziliense and Uncinaria stenocephala. The prevalence of S. stercoralis in dogs was found to be 21.9% (60/274). A. caninum was the only hookworm detected in the dog samples, with a prevalence of 31.4% (86/274). This study provides an insight into the prevalence of S. stercoralis and hookworms in dogs and informs future intervention and prevention strategies aimed at controlling these parasites in both dogs and humans. A &ldquo, One Health&rdquo, approach is crucial for the prevention of these diseases in Australia.

Hookworm-related cutaneous larva migrans (HRCLM) is caused by the penetration and migration in the epidermis of larvae of Ancylostoma braziliense and Ancylostoma caninum. It is characterized by slightly raised and erythematous tracks, located especially on the feet. These tracks may be single or multiple, serpiginous or linear, ramified and intertwined, accompanied by pruritus. Atypical clinical presentations of HRCLM are currently more frequent than in the past. We present six patients with bullous HRCLM and discuss the possible pathogenetic factors. Furthermore, we present a review of atypical clinical presentations of HRCLM. From 1998 to 2013 we observed approximately 180 patients with HRCLM. In all patients race, nationality, sex, age, country of infestation, location of the disease, clinical picture, laboratory and instrumental examinations and therapy were collected. In six patients (4 males and 2 females), we made a diagnosis, based on the history and clinical picture, of bullous HRCLM. The infestation was characterized by single or multiple blisters, round or oval in shape, of different size, with a clear serous fluid. Some tracks were also visible. All patients complained of pruritus. General physical examination and laboratory and instrumental examinations were normal or negative. Cytological examinations of the blisters showed the presence of lymphocytes and neutrophils, with numerous eosinophils. All patients were successfully treated with oral albendazole. Blisters appear because of the release by the larvae of lytic enzymes (metalloproteases and hyaluronidases). Furthermore, blisters might be the final clinical result of a delayed hypersensitivity reaction due to the release by larvae of unknown antigens. Finally, only in some patients, bullous HRCLM might represent an acute irritant/allergic contact dermatitis caused by topical drugs applied on the lesions. This hypothesis has been excluded in our patients because no topical treatment was made before our observation.

Background Cutaneous larva migrans is one of the most common skin diseases reported in travelers returning from tropical regions. Western physicians, however, are often not familiar of this condition. Objective To review in depth the epidemiology, pathophysiology, clinical manifestations, complications, and treatment of cutaneous larva migrans. Methods A PubMed search was completed in Clinical Queries using the key term "cutaneous larva migrans". The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Patents were searched using the key term "cutaneous larva migrans" from www.google.com/patents, www.uspto.gov, and www.freepatentsonline.com. Results Cutaneous larva migrans is a zoonotic infestation caused by penetration and migration in the epidermis of filariform larva of different kinds of animal hookworms through contact with feces of infected animals. Cutaneous larva migrans is endemic in tropical and subtropical regions. Clinically, cutaneous larva migrans is characterized by an intensely pruritic erythematous migrating tortuous or serpiginous, slightly raised track. The diagnosis is mainly clinical, based on the history of travel to an endemic area and exposure to contaminated soil/sand and the characteristic serpiginous track. Treatment options as well as recent patents related to the management of cutaneous larva migrans are also discussed. Compared with oral antihelminthics, topical treatment over the affected area is less effective. Oral ivermectin is the treatment of choice. Conclusion The pruritic serpiginous track is pathognomonic. Oral ivermectin is the treatment of choice.

Made available in DSpace on 2018-12-11T16:40:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-01-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Hookworm infection stands out for its worldwide distribution and for its veterinary and public health relevance. Based on copromicroscopic examinations and polymerase chain reaction (PCR) amplification of the ITS1-5.8S-ITS2 region, we assessed, respectively, the prevalence of intestinal parasites and the identification of canine hookworm species in faeces recovered from 278 dogs living in households of an inland municipality of São Paulo State, Brazil. Intestinal parasites were found in 67.3% of dogs and hookworm infection was found at the highest prevalence rate (56.6%), followed by Toxocara canis (11.9%), Isospora spp. (11.9%), Giardia spp. (5.8%), Sarcocystis spp. (4.0%), 'Hammondia-like' (1.4%), Dipylidium caninum (1.1%) and Trichuris vulpis (0.7%). Of 158 samples positive for hookworm eggs, 106 (67.1%) were amplified by PCR and, of those, 88 (55.7%) were successfully sequenced for species identification. Single infections with Ancylostoma caninum and Ancylostoma braziliense were recorded in 61.4% and 12.5%, respectively, and mixed infections were found in 26.1%. The nucleotide sequences of both species showed high identity rates (98-100%) when compared with reference sequences. Although A. caninum was the most prevalent hookworm in the dogs assessed, the occurrence of both A. caninum and A. braziliense in single and/or mixed infections poses a potential risk for the local population in a low-income area, especially children, to acquire cutaneous larva migrans (CLM). UNESP - Universidade Estadual Paulista Departamento de Parasitologia Instituto de Biociências UFS - Universidade Federal de Sergipe Departamento de Morfologia Centro de Ciências Biológicas e da Saúde USC - Universidade Do Sagrado Coração Departamento de Ciências Biológicas e da Saúde UNESP - Universidade Estadual Paulista Departamento de Parasitologia Instituto de Biociências FAPESP: 06/56151-3

Introduction : Cutaneous larva migrans is a cutaneous infestation caused by zoonotic nematode larvae commonly due to hookworms such as the Ancylostoma braziliense. Case report : Herein we report a case of a 7-year-old child to the Emergency Department complaining of erythematous papular itching lesions on his right elbow, wrist and knee. He had no previous history of contact with sand or animals. The lesions in his right elbow presented impetiginization. Ivermectin 200mcg/kg/day treatment was initiated and oxacillin associated. On the third day of treatment, the patient was discharged with complete resolution of the lesions. Coclusion : The reported case assumes importance because it is a common and benign disease, but due to an unusual presentation was not diagnosed early. The disseminated form commonly may require hospitalization and prolonged treatment as presented

The objective of this randomized, blinded, placebo controlled laboratory study was to confirm the efficacy of a single oral administration of two marketed formulations of milbemycin oxime (Interceptor(®) Flavor Tabs(®) and Sentinel(®) Flavor Tabs(®)) at a minimum dose of 0.5 mg/kg (0.23 mg/lb) against natural infections of Ancylostoma braziliense in dogs. Thirty-six hookworm infected dogs, a minimum of 10 weeks of age and of various breeds and genders were used. Fecal egg counts were done on three separate days prior to treatment for randomization purposes. Dogs were ranked by descending order of the fecal egg count arithmetic means and randomly assigned to either the two milbemycin treatment groups or the placebo control group in blocks of three dogs each, 12 dogs per group. Dogs were dosed according to the product label with blinding maintained by separation of function. Worm counts were done at necropsy 7 days after treatment. Reduction in A. braziliense worm counts in the milbemycin groups were compared to the placebo control group using analysis of variance of the A. braziliense logarithmic mean worm counts and percent efficacy was based on geometric means. Efficacy was defined as the ability of the test products to significantly (p≤0.05) reduce parasite load by 90% or greater in treated dogs when compared to adequately infected placebo control dogs. The placebo control group had a geometric mean worm count of 19.2. The Interceptor treated group had a geometric mean worm count of 0.38 representing a 98% reduction in parasite load and the Sentinel treated group had a geometric mean worm count of 0.98 representing a 95% reduction in parasite load. Both reductions were highly significant (p0.0001). In this study, milbemycin oxime, when administered as two marketed formulations at a minimum dose of 0.5 mg/kg (0.23 mg/lb), was efficacious for removing adult A. braziliense in naturally infected dogs.

This study compared the course of infection by Ancylostoma caninum and Ancylostoma braziliense in mixed-breed dogs infected with L3 larvae. Dogs infected with A. caninum eliminated more eggs than did those infected with A. braziliense. A total of 38 % of A. caninum and 44 % of A. braziliense larvae were recovered as adult worms. There were no marked clinical abnormalities in dogs with either infection. A. caninum was associated with anemia and an increased number of circulating neutrophils, whereas infection with A. braziliense led to a decrease in the number of leukocytes. The humoral response against excreted and secreted antigens from adult worms was more sensitive and specific than the response induced with the crude antigen. No immune response was observed for either crude or excreted-secreted (ES) antigens from larvae of either species. A nonspecific response against the crude antigen of A. braziliense was found at 0 and 7 days postinfection and maintained throughout the infection period. However, antibody titers against ES antigens were elevated in A. caninum infection at patency and death, showing that this antigen has a higher specificity. The immune response elicited by infection with A. braziliense in dogs has not been described previously. No significant differences were observed in the infection processes of the two Ancylostoma species, except for the higher number of eggs eliminated from dogs infected with A. caninum, which may indicate a better evolutionary adaptation of the parasite to its host in comparison with A. braziliense.

Cutaneous larva migrans (CLM) is an infestation caused by penetration and migration in the epidermis of larvae of nematodes. Ancylostoma braziliense and Ancylostoma caninum are the species most frequently involved. CLM is characterized by slightly raised and erythematous tracks, very often accompanied by pruritus. CLM can sometimes heal spontaneously; on the other hand, a clinical variety characterized by a very long clinical course has been described. Most used therapies are cryotherapy, topical thiabendazole and oral albendazole and ivermectin.

As a result of the rise of mass tourism with increasingly cheap and exotic destinations, tropical diseases are becoming an increasingly important part of dermatology. Infection with cutaneous larva migrans is one of the most common "souvenirs" from the tropics. The disease is caused by the nematode infection with dog or cat hookworm parasites (Ancylostoma braziliense or A. caninum). The characteristic manifestation is a gyrated, serpiginous and in some cases vesicular erythema, which appears after penetration of the epidermis by the parasite and the subsequent intraepidermal migration of the larva. This is often accompanied by intense pruritus in the affected skin. The infection is usually found in those areas of the foot, calf or buttocks exposed by walking or sitting on sand. Although subjectively very unpleasant, the disease is self-limiting and resolves after several weeks; it is treated locally in most cases (e.g. using cryotherapy). The prognosis of the disease is excellent, but a prolonged course or complications have been observed, e.g. due to superinfection.

Ancylostoma braziliense belongs to the family Ancylostomatidae and infects cats and dogs in various parts of the tropical world. It is also a zoonotic parasite causing cutaneous larva migrants in humans. There are very few, either biological or molecular, studies of this species. In this study, differential display was used to identify differentially expressed genes in male and female A. braziliense. Nineteen new sequences were identified and examined by real-time RT-PCR to confirm male-female specificity. Ten were more expressed in males, while two were more expressed in females. Molecules shown to be important in other host-parasite relationships were also found in this study.

The efficacy of oral afoxolaner plus milbemycin oxime combination chewables against induced gastrointestinal nematode infections in dogs was evaluated in six separate studies. Two studies were performed to evaluate the efficacy of the product against Toxocara canis, two studies evaluated the efficacy against Toxascaris leonina, one study evaluated the efficacy against Ancylostoma braziliense, and one study evaluated the efficacy against Ancylostoma caninum. In the A. caninum study, the efficacy of milbemycin oxime alone and afoxolaner alone was also evaluated. Dogs in all studies were inoculated with infective eggs or larvae and confirmed to have patent infections based on a fecal examination prior to allocation to study group and treatment. Each study utilized a randomized block design with blocks based on pre-treatment body weight. All dogs were assigned to blocks based on body weight, and then each dog within a block was randomly assigned to treatment group. There were two groups of 10 dogs each in the T. canis, T. leonina, and A. braziliense studies: 1) an untreated (control) group and 2) a group treated with afoxolaner plus milbemycin oxime chewables (NexGard Spectra(®), Merial). This group was treated at a dose as close as possible to the minimum effective dose of afoxolaner and milbemycin oxime (2.5mg+0.5mg per kg body weight, respectively) once on Day 0 using whole chews. There were four groups of 10 dogs each in the A. caninum study: 1) untreated (control), 2) NexGard Spectra(®) as described above, 3) milbemycin oxime alone (dose of at least 0.5mg per kg of body weight) and 4) afoxalaner alone (dose of at least 2.5mg per kg body weight). For parasite recovery and counts, dogs were euthanized humanely and necropsied seven days after treatment. The efficacy of the afoxolaner plus milbemycin oxime combination was ≥98% against T. canis, ≥95.8% against T. leonina, and 90.2% against A. braziliense. Efficacy of the combination against A. caninum was 99.7%, while the efficacy of milbemycin oxime alone was 99.6% and the efficacy of afoxolaner alone was 2.1%. Dogs treated with afoxolaner plus milbemycin oxime chewables had significantly (p≤0.0002) fewer nematodes than the untreated controls in all studies. There were no adverse events or other health problems that were related to treatment with Nexgard Spectra(®) in these studies. The results of these controlled studies demonstrate the high efficacy of the afoxolaner plus milbemycin oxime chewables against a broad range of canine intestinal nematode infections.

A 32-year-old man living in midwest Brazil presented with a 15-day history of skin eruption with severe itching after lying on a lawn in an amusement park for a few hours. The patient had no previous history of illness or use of medication. Clinical examination revealed a large (20 × 25 cm) erythematous eczematous plaque on the lower half of his back, with serpiginous tracks in some areas (Figures 1 and ​and22 ). The clinical characteristics of the lesions and epidemiological history are very suggestive for the diagnosis of cutaneous larva migrans (CLMs) with severe secondary eczematous reaction, on an atypical location. Therefore, considering the diagnosis, a treatment was prescribed with 5% thiabendazole, three times daily for 15 days, and 400 mg of oral albendazole daily for three consecutive days. The response to an antihelminthic drug and rapid resolution of the lesion supported the initial diagnosis of CLM. Figure 1. Large erythematous eczematous plaque on the lower half of patient's back (20 × 25 cm). Figure 2. Serpiginous tracks in some areas of the erythematous eczematous plaque on the lower half of patient's back. CLM is caused by the accidental larval migration of nematodes (most commonly Ancylostoma braziliense) into the epidermis.1–4 This skin infestation, typical of subtropical and tropical regions, is endemic to the Caribbean, Central and South America, and Africa.1–3 With the growing frequency of travel to these areas, the incidence of the disease has also increased elsewhere. Walking barefoot on beach sand is a common feature.2 The larvae penetrate the corneal layer of human epidermis upon contact with soil contaminated with dog or cat feces containing excreted eggs, which in hot, humid environments become filariform larvae.1,4 These larvae migrate within the epidermis, causing an inflammatory reaction with intense itching, eruptions, and a serpiginous aspect that spreads a few centimeters a day.1–4 Lesions are usually few in number, and commonly affected sites include feet, thighs, and buttocks in adults.1,5 Only 7% of lesions occur on the trunk.5 The presence of multiple larvae may produce bizarre patterns.5 Diagnosis is clinical, based on the appearance of the lesions, with an emphasis on patient epidemiology.1,2 Biopsy is not useful.1–3 Differential diagnosis includes scabies, myiasis, tinea corporis, and contact dermatitis.1 Despite the self-limiting nature of the disease, severe itching, risk of secondary infection, and (in some reported cases) progression to Loeffler's syndrome warrant treatment with antihistamines and anthelminthics. First-line treatments are ivermectin and albendazole.1–3 In cases when oral drugs are contraindicated or not sufficient, topical application of 15% thiabendazole solution or ointments should be considered (not available in the United States or Canada).1–3 Treatment is simple, well tolerated, and effective.1–3

Background Differentiation of canine hookworm species is crucial from both a veterinary and public health standpoint. In Vietnam, three hookworm species, namely Ancylostoma caninum, Ancylostoma braziliense and Uncinaria stenocephala are reported to infect dogs. In light of the emerging distribution of A. ceylanicum in Asia, this study aims to re-evaluate the status of Ancylostoma in dogs in Vietnam. Methods Faecal samples collected from 200 community dogs in Dak Lak province were subjected to faecal floatation for the detection of hookworm eggs. Hookworm-positive samples were subjected to a PCR-Restriction Fragment Length Polymorphism (PCR-RFLP) assay targeting the internal transcribed spacer (ITS) region of rDNA for hookworm species identification. A subset of hookworm-positive samples was also subject to haplotype characterisation at the cytochrome oxidase-1 (COX-1) gene. Detailed morphological criteria were utilised in addition to molecular markers, to identify adult hookworms recovered from necropsied dogs. Results Of 200 canine faecal samples, 111 (55.5 %) were positive for hookworm eggs on faecal flotation. Of these, 94/111 (84.7 %) were successfully amplified and assigned species status by PCR-RFLP targeting the ITS region. In total, 54.3 % (51/94) dogs harboured single infections with A. ceylanicum, 33.0 % (31/94) with A. caninum, and 12.7 % (12/94) harboured mixed infections with both A. ceylanicum and A. caninum. Adult worms recovered from necropsied dogs matched morphological description provided for A. ceylanicum, Looss (1911) for which the mediolateral and posteriolateral rays are parallel. Characterisation of the COX-1 gene placed all Vietnamese canine isolates of A. ceylanicum within the ‘zoonotic’ haplotype. Conclusion Based on this information, it is apparent that the hookworms present in dogs in Vietnam are those of A. ceylanicum and not A. braziliense. Owing to the endemic nature of this significant zoonosis in dogs, the study strongly advocates for specific identification of this hookworm in human hookworm surveys.

Species of Ancylostoma infecting dogs and sometimes humans are sympatric in many parts of the world. The establishment of a specific molecular diagnostic tool is important, not only to refine information for epidemiological studies, but also to evaluate the efficacy of vaccine programmes and assist in the development of specific drug treatments. The ITS region from 20 specimens of A. braziliense, collected from three separate geographical areas of Brazil, and from 10 specimens of A. caninum, collected from the same area in Brazil were sequenced and analyzed. Alignment of sequences showed that this gene is highly conserved. The intraspecific polymorphism for both species was less then 1%, whereas the interspecific polymorphism was 6.2, 7.3 and 9.4% between A. ceylanicum and A. braziliense; A. caninum and A. ceylanicum and A. ceylanicum and A. braziliense, respectively. Among the three species it was 12.3%. This revealed the ITS region as highly conserved and consequently a good molecular marker for diagnostic studies. In this work, four restriction enzymes were used in a PCR-RFLP using the ITS region of rDNA, to establish a differential diagnosis which discriminates between three Ancylostoma species, A. braziliense, A. caninum and A. ceylanicum. The best pattern was given by the HinfI enzyme, which produced different fragment sizes for each of the three species. Furthermore, the diagnostic tool differentiates DNA extracted directly from faeces of Ancylostoma-infected dogs.

An endoparasite survey of a small pride of African lions (Panthera leo) was conducted at Intu Afrika Kalahari Game Reserve, southwestern Namibia, during winter and summer of 2003 and 2004, respectively. Overall, 23 fresh lion scats were collected opportunistically during fieldwork trials. A flotation technique was employed for the diagnosis of parasites. Three nematodes, Ancylostoma braziliense, Gnathostoma spinigerum and Uncinaria stenocephala and two coccidians, Toxoplasma gondii and Isospora felis were recorded. By using the McMaster method for quantification, a maximum number of 14 866 oocysts per gram of faeces was obtained for I. felis during winter 2003. Endoparasite taxa carried by the different individuals in the pride were found to be related to their levels of association. Rates of infection were relatively low as a result of the habitat, semi-captive conditions and earlier sporadic deworming.

The prevalence of gastrointestinal helminth parasites in 135 cats over 1 year of age and inhabiting the metropolitan region of the city of Rio de Janeiro, Brazil was investigated by necropsy. These animals had two distinct origins: 99 cats (29 males and 70 females) were derived by capture in public areas (feral/stray) and 36 (12 males and 24 females) from shelters. The overall prevalence of gastrointestinal helminth parasites was 89.6%. The following parasites, with their respective prevalence in parenthesis, were found: Dipylidium caninum (52.6%), Ancylostoma braziliense (65.9%), Ancylostoma tubaeforme (8.9%), Toxocara cati (25.2%), Toxascaris leonina (11.9%), Physaloptera praeputialis (9.6%). Concurrent infections with two or more parasites were recorded in 59.5% of the individuals. Of the 121 parasitized cats, 94 were feral/strays and 27 were from shelters. Among feral/stray cats, 80 were infected with A. braziliense (85%) and 17 of the shelter felids were infected with D. caninum (63%). Feral/stray cats had higher worm intensities (6411/94-68.2) than shelter cats (992/27-36.7). The helminth parasites most frequently found in feral/stray cats were Ancylostoma braziliense (47.5%) and D. caninum (47%) while in shelter cats, D. caninum was the predominant species (85.2%). Twenty seven cats (22.3%) had only A. braziliense and 19 (15.7%) were parasitized only with D. caninum. Among those cats harboring mixed infections A. braziliense and D. caninum were the species more frequently found (P < 0.001).

Four studies were conducted to examine the efficacy of a novel topical combination of fipronil, (S)-methoprene, eprinomectin, and praziquantel (BROADLINE®, Merial) against Ancylostoma tubaeforme and Ancylostoma braziliense hookworms of cats. In each study, purpose-bred cats were randomly assigned to treatment groups of 10 or 12 cats per group. In three studies the cats were inoculated with A. tubaeforme and in one study with A. braziliense. The inoculations were undertaken on a schedule which resulted in the hookworms reaching the fourth larval stage in two of the studies, or the adult stage in four of the studies, by the day of treatment. In each study there was also an untreated control and 1 or 2 groups treated with the novel combination. In the two studies where efficacy against the fourth larval stage of A. tubaeforme was tested, the efficacy recorded was 100%. In the three studies where efficacy against the adult stage of A. tubaeforme was tested, efficacy of 100% was also confirmed. In the study where efficacy against the adult stage of A. braziliense was tested efficacy was 99.5%.

Besides presenting zoonotic potential, helminths of cats are responsible for gastrointestinal, hepatic, and pulmonary diseases. In order to identify the helminthic fauna, prevalence, mean intensity of parasitism (MIP), and mean abundance population (MAP), 146 cats from the metropolitan area of Cuiabá, Midwestern Brazil, were necropsied. In 98 these animals, 12 species of helminths were identified, comprising (species, prevalence, MIP, and MAP, respectively): nematodes (Ancylostoma braziliense[50,68% - 53,64 - 27,18], Ancylostoma tubaeforme [10,27% - 3,6 - 0,37],Toxocara cati [4,11% - 28,33 - 1,16],Physaloptera praeputialis [2,05% - 6,67 - 0,14], Capillaria feliscati [3,42% - 7,4 - 0,25], and Aelurostrongylus abstrusus[1,37%]); cestodes (Spirometra mansonoides[4,11% - 2,0 - 0,08], Dipylidium caninum[3,42% - 5,2 - 0,18], and Taenia taeniformis[0,68% - 1,0 - 0,01]); trematodes (Platynosomum fastosum [26,03% - 179,53 - 46,73]); acanthocephalans (Centrorhynchus erraticus [3,42% - 3,2 - 0,11]). Ancylostoma spp., and P. fastosum were the most prevalent with the highest MIP and MAP. We observed the presence of species of helminths with zoonotic potential. This is the first time cats parasitized with Centrorhynchus erraticusare reported in the Americas. That genus is commonly observed in wild animals. Helmintos de gatos são causadores de doenças gastrintestinais, hepáticas e pulmonares, além de apresentarem potencial zoonótico. Com objetivo de identificar a helmintofauna, prevalência, intensidade média de parasitismo (IMP) e abundãncia média populacional (AMP) foram necropsiados 146 gatos da região metropolitana de Cuiabá, centro-oeste do Brasil. Foram identificadas em 98 animais 12 espécies de helmintos compreendendo (respectivamente espécie, prevalência, IMP e AMP): nematódeos (Ancylostoma braziliense[50,68% - 53,64 - 27,18], Ancylostoma tubaeforme [10,27% - 3,6 - 0,37],Toxocara cati [4,11% - 28,33 - 1,16],Physaloptera praeputialis [2,05% - 6,67 - 0,14], Capillaria feliscati [3,42% - 7,4 - 0,25] e Aelurostrongylus abstrusus[1,37%]); cestódeos (Spirometra mansonoides[4,11% - 2,0 - 0,08], Dipylidium caninum[3,42% - 5,2 - 0,18] e Taenia taeniformis[0,68% - 1,0 - 0,01]); trematódeos (Platynosomum fastosum [26,03% - 179,53 - 46,73]); acantocéfalos (Centrorhynchus erraticus [3,42% - 3,2 - 0,11]). Ancylostoma spp. e Platynosomum fastosum foram os mais prevalentes e com maior IMP e AMP. Esta é primeira descrição do gênero Centrorhynchus erraticus de gatos parasitados nas Américas.

Diagnosis of feline lungworm, Aelurostrongylus abstrusus, is typically achieved by identifying larvae in feces following concentration through flotation or using the Baermann technique. This work presents observations on the usefulness of an indirect immunofluorescence antibody assay for detection of antibodies to this parasite in the sera of infected cats. Using first-stage larvae of A abstrusus and sera from both experimentally and naturally infected cats, it was determined that the test was fairly sensitive and did not cross-react with serum from an Ancylostoma braziliense (hookworm)-infected cat.

Cutaneous larva migrans (CLM) is a common endemic disease in tropical and subtropical countries. This condition is caused by skin­penetrating larvae ofnematodes, mainly of the hookworm Ancylostoma braziliense and other nematodes of the family Ancylostomidae. We report three cases of CLM acquired duringvacations in different regions of Brazil.IntroductionCutaneous larva migrans (CLM) is the most common tropically acquired dermatosis [1], first reported by Lee in 1874 [2]. This condition is frequently seen in thesouthern United States, Central and South America, and other subtropical areas but rarely in northern climates [3]. The larvae of the nematode Ancylostomabraziliense are most often the causative organisms [3]. During the months of summer vacation we generally see several patients referred to dermatologicaloutpatient clinics related to CLM acquired in several locations. We describe three patients with CLM acquired in different regions of Brazilian territory during thevacation periods.Case 1A 31­year­old previously healthy woman presented to our outpatient clinic with pruritic cutaneous lesions, which had beenprogressing for 3 days, after a vacation at the southeast beaches of Brazil (Ubatuba City). The dermatological exam showeda cutaneous eruption composed of vesicles and papules disposed in a linear and serpiginous pattern on plantar regions of theleft foot (Figure 1: 1A) and on the dorsal aspect of right foot (Figure 1: 1B). This peculiar serpiginous pattern and severeitching lead to the clinical diagnosis of CLM. In the face of extensive cutaneous involvement we introduced ivermectin (200μg/kg single dose) orally. After 7 days the patient returned to our office and reported an alleviation of the pruritus. Thephysical exam demonstrated lesions displaying less erythema, but bullae persisted (Figure 1: 2A and 2B).Case 2A 12­year­old Caucasian girl presented to our private practice reporting severe itching on her left wrist. She recently returnedfrom her summer vacation on Mato Grosso, where she swam in several rivers and walked upon beaches. The dermatologicalexam revealed a linear papulo­vesicle lesion disposed in a serpiginous pattern on the left wrist (Figure 2: 3A and 3B).Because of a single and localized lesion the patient was treated with topical thiabendazole.Case 3A 22­year­old woman was referred to our private practice because of an intense itching in her left foot. The patient reportedthat she had returned from her vacation at the beaches of Camboriu (Santa Catarina). She had been previously treated withKetoconazole 2 percent cream by a general medical practitioner without benefit. On physical exam a linear, erythematous­papulo­vesicle on the plantar area was observed (Figure 3: 4A), which displayed a serpiginous pattern on the dorsum andside of the foot (Figure 3: 4B and 4C). The patient was treated with 200 mg of albendazole orally for 3 days.DiscussionCutaneous larva migrans is a frequent disease in tropical and subtropical countries. The disease is endemic in islands of the the Caribbean and Southeast Asia,Africa, South America, and the central and southeastern states of the United States [1]. The endemic nature of this disease is caused by poor sanitation andsuitable environmental conditions [1]. The clinical appearance of this infestation is a serpiginous cutaneous eruption usually occurring on the skin of the feet,abdomen, buttocks, hands, and genitals [4]. The source of infection is dog and cat feces contaminated by hookworms (i.e., nematodes), most commonlyAncylostoma braziliense, whose larvae penetrate into the skin, resulting in a creeping eruption (i.e., larva migrans) [5]. Eruptions are a result of the skin’shypersensitivity reaction to these worms and their by­products [4]. The most common cause is the larvae of Ancylostoma braziliense. Less common speciesinclude Ancylostoma caninum, Uncinaria stenocephala, and Bunostomum phlebotomum. In rare cases CLM is caused by human hookworms, such asStrongyloides stercoralis, Ancylostoma duodenale, and Necator americanus; exceptionally, insect larvae can produce a similar picture [1].

We report a case of hookworm-related cutaneous larva migrans diagnosed microscopically. Viable hookworm larvae were found by microscopic examination of a skin scraping from follicular lesions. Amplification and sequencing of the internal transcribed spacer 2 allowed the specific identification of the larvae as Ancylostoma braziliense.