Abstract
Background
Cutaneous larva migrans (CLM) is endemic in tropical and sub-tropical regions and occurs in travelers returning from those regions. The epidemiology of CLM within the United States (U.S.) population is not well-described. We seek to describe the epidemiology of CLM, association with international travel, and clinical presentation within the U.S. Military Health System (MHS).
Methods
We performed a retrospective cohort study within the MHS between October 2012 and September 2018. Cases were identified by billing data diagnosis code of ‘hookworm.’ Demographic data were collected and individual chart review verified the diagnosis of CLM and identified risk factors, clinical presentation, and management. Comparative statistical analysis was performed as applicable.
Results
Of the initial 272 cases with the diagnosis of hookworm, 72 (26.4%) were confirmed CLM. Only 30.6% of CLM cases had documented preceding international travel associated with their diagnosis, primarily to the Latin America and Caribbean region (68.2%). Most CLM cases (69.4%) were diagnosed within the U.S. without documented preceding international travel within 3 months of diagnosis. 80% of these autochthonous cases occurred within the South region of the U.S. The most common exposures were spending time on the beach, exposure to pet dog(s), or walking barefoot outdoors, symptom onset usually occurred within two weeks after suspected exposure, and CLM most frequently involved the foot. Over 90% of cases were treated for CLM, however 36.7% of cases received ineffective anti-helminthic medication.
Conclusions
CLM should be considered in the U.S. even in patients without preceding international travel. Our findings are useful in providing nationwide data on the epidemiology of CLM and allowing for informed preventative counseling to travelers and non-travelers within the U.S. Appropriate treatment for CLM should include anti-helminthic therapy that is both appropriately dosed and systemically absorbed.
Cutaneous larva migrans (CLM) is endemic in tropical and sub-tropical regions and occurs in travelers returning from those regions. The epidemiology of CLM within the United States (U.S.) population is not well-described. We seek to describe the epidemiology of CLM, association with international travel, and clinical presentation within the U.S. Military Health System (MHS).
Methods
We performed a retrospective cohort study within the MHS between October 2012 and September 2018. Cases were identified by billing data diagnosis code of ‘hookworm.’ Demographic data were collected and individual chart review verified the diagnosis of CLM and identified risk factors, clinical presentation, and management. Comparative statistical analysis was performed as applicable.
Results
Of the initial 272 cases with the diagnosis of hookworm, 72 (26.4%) were confirmed CLM. Only 30.6% of CLM cases had documented preceding international travel associated with their diagnosis, primarily to the Latin America and Caribbean region (68.2%). Most CLM cases (69.4%) were diagnosed within the U.S. without documented preceding international travel within 3 months of diagnosis. 80% of these autochthonous cases occurred within the South region of the U.S. The most common exposures were spending time on the beach, exposure to pet dog(s), or walking barefoot outdoors, symptom onset usually occurred within two weeks after suspected exposure, and CLM most frequently involved the foot. Over 90% of cases were treated for CLM, however 36.7% of cases received ineffective anti-helminthic medication.
Conclusions
CLM should be considered in the U.S. even in patients without preceding international travel. Our findings are useful in providing nationwide data on the epidemiology of CLM and allowing for informed preventative counseling to travelers and non-travelers within the U.S. Appropriate treatment for CLM should include anti-helminthic therapy that is both appropriately dosed and systemically absorbed.
| Original language | American English |
|---|---|
| Journal | Open Forum Infectious Diseases |
| State | Accepted/In press - 26 Jan 2026 |
Cite this
- APA
- Author
- BIBTEX
- Harvard
- Standard
- RIS
- Vancouver