Unusual presentations of cutaneous larva migrans in British military personnel

Cutaneous larva migrans (CLM) is one of numerous skin diseases that occur in British military personnel on deployments to the tropics and sub-tropics. It is typically managed by military primary healthcare services, but diagnostic uncertainty or unavailability of anti-helminthic medication may promp...

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Bibliographic Details
Published in:BMJ military health 2023-05, Vol.169 (e1), p.e78-e81
Main Authors: Inglis, David Michael, Bailey, M S
Format: Article
Language:English
Subjects:
Bacterial infections
Belize
dermatology
Drug dosages
Histamine
Humans
Infections
Infectious diseases
infectious diseases & infestations
Larva Migrans - diagnosis
Larva Migrans - drug therapy
Larva Migrans - epidemiology
Military Personnel
Monkeys & apes
Parasites
parasitology
Personal view
Pruritus
Serology
Skin diseases
Strongyloidiasis
Telemedicine
Tropical diseases
tropical medicine
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Description
Summary:Cutaneous larva migrans (CLM) is one of numerous skin diseases that occur in British military personnel on deployments to the tropics and sub-tropics. It is typically managed by military primary healthcare services, but diagnostic uncertainty or unavailability of anti-helminthic medication may prompt referral to UK Role 4 healthcare services. Cases of CLM seen at the UK Role 4 Military Infectious Diseases & Tropical Medicine Service from 2005 to 2020 were identified and their case notes were reviewed to identify learning and discussion points. There were 12 cases identified, of which five came from Brunei and three were from Belize. Causes for referral were due to diagnostic uncertainty (58%) and the unavailability of anti-helminthic medication (42%). Several cases had CLM in an unusual distribution due to specific military activities performed in endemic areas. Telemedicine was very useful in making some of the diagnoses in theatre and avoiding the need for medical evacuation. Military personnel may have unusual presentations of CLM due their unique military activities. In areas that are endemic for CLM, clinicians should maintain high clinical suspicion for CLM, carry appropriate anti-helminthic medications and consider screening cases of CLM and their colleagues for other infections with similar aetiology (eg, human hookworm infection and strongyloidiasis).
ISSN:2633-3767
2633-3775
DOI:10.1136/bmjmilitary-2020-001677