Cause:
Cutaneous, "creeping eruption": Ancylostoma brazilienseand caninum
Visceral: Toxocara canis and raccoon ascaris
Pathophys:
Cutaneous: larvae in skin cause local inflammation; can't penetrate dermal/epidermal junction
Visceral: worms invade viscera where permanent granulomas form
Cutaneous: dog and cat hookworm larvae penetrate skin but never get into circulation; children get when crawl under buildings
Visceral: ingestion of dog feces w eggs; 20% of US dogs have it. Eggs survive several winters. 10% of adults in US have serologic evidence of it
Sx:
Cutaneous: raised itchy areas of skin up to 2 wk after exposure
Visceral: age 1-4 yr usually; often asx or erratic fever, anorexia, rash, seizures, wheezing, cough
Si:
Cutaneous: rash
Visceral: hepatosplenomegaly, tumor-like growths in eye in older children
Visceral: eosinophilic meningoencephalitis (Nejm 1985;312:1619)
Lab:
Hem:Eosinophilia in both types
Path:Visceral: bx (usually not justified since benign crs) of liver, lungs, CNS, muscle show eosinophilic granulomas
Serol:Visceral: titer 1/32 (98% sens, 92% spec) get kit from CDC
Stool:No eggs in either type
Rx:
Cutaneous: ivermectin or albendazole
Visceral: diethylcarbamazine 2 mg/kg tid × 7-10 d; or albendazole; or mebendazole. Steroids for eye disease