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Chapter 207. Helminthic Infections

Kathryn N. Suh; Jay S. Keystone

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    AMA Citation
    Suh KN, Keystone JS. Suh K.N., Keystone J.S. Suh, Kathryn N., and Jay S. Keystone.Chapter 207. Helminthic Infections. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. Goldsmith L.A., Katz S.I., Gilchrest B.A., Paller A.S., Leffell D.J., Wolff K Eds. Lowell A. Goldsmith, et al.eds. Fitzpatrick's Dermatology in General Medicine, 8e New York, NY: McGraw-Hill; 2012. http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138938. Accessed January 18, 2019.
    MLA Citation
    Suh KN, Keystone JS. Suh K.N., Keystone J.S. Suh, Kathryn N., and Jay S. Keystone.. "Chapter 207. Helminthic Infections." Fitzpatrick's Dermatology in General Medicine, 8e Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. Goldsmith L.A., Katz S.I., Gilchrest B.A., Paller A.S., Leffell D.J., Wolff K Eds. Lowell A. Goldsmith, et al. New York, NY: McGraw-Hill, 2012, http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138938.

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Helminthic Infections at a Glance
  • Helminthic infections are a major cause of morbidity and mortality, particularly in tropical and developing countries.
  • The majority of infected individuals have a low worm burden and are asymptomatic.
  • Dermatologic symptoms and cutaneous findings may be associated or presenting features of helminthic infections.
  • Dermatologic manifestations may differ in returning travelers and in immigrants from endemic areas.
  • Migratory lesions, subcutaneous masses, papular eruptions, urticaria, and pruritus are the most common presenting dermatologic symptoms of helminthic infections.
  • Cutaneous larva migrans is the most common helminthic dermatosis identified.
  • Recognition of skin findings or helminthic infections and an appropriate epidemiologic history can guide appropriate investigations and effective therapy.

Helminths (worms) are variably sized multicellular parasites that can infect a wide range of mammals, including humans. Those causing human disease belong to three groups: (1) nematodes (roundworms), (2) trematodes (flukes), and (3) cestodes (tapeworms) (Table 207-1); trematodes and cestodes are collectively referred to as platyhelminths (flatworms). This chapter focuses only on those helminths that more commonly cause dermatologic disease.

Table 207-1 Helminths Causing Infection in Humans
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Table 207-1 Helminths Causing Infection in Humans

Helminth

Disease

Portal of Entry

Source of Infection

Nematodes (Roundworms)—Intestinal

   Ancylostoma duodenale, Necator americanus

Hookworm

Skin

Larvae in soil, occasionally in food

   Ascaris lumbricoides

Ascariasis

Gastrointestinal

Eggs from contaminated food, soil

   Enterobius vermicularis

Enterobiasis (pinworm)

Gastrointestinal

Eggs in environment

   Strongyloides stercoralis

Strongyloidiasis

Skin

Larvae in soil

Nematodes (Roundworms)—Tissue

   Ancylostoma braziliense, Ancylostoma caninum

Cutaneous larva migrans

Skin

Larvae in soil

   Dirofilaria spp.

Dirofilariasis

Skin

Infective mosquitoes

   Dracunculus medinensis

Dracunculiasis

Gastrointestinal

Infective copepods in water

   Filariae

     Brugia malayi, Brugia timori

Filariasis

Skin

Infective mosquitoes

     Mansonella ozzardi, Mansonella perstans, Mansonella streptocerca

Filariasis

Skin

Infective midges and/or flies

     Loa loa

Loiasis

Skin

Infective deer flies

     Onchocerca volvulus

Onchocerciasis

Skin

Infective black flies

     Wuchereria bancrofti

Filariasis

Skin

Infective mosquitoes

   Gnathostoma spinigerum, others

Gnathostomiasis

Gastrointestinal

Larvae in animal flesh (raw fish, amphibians)

   Toxocara canis, Toxocara cati

Visceral larva migrans

Gastrointestinal

Eggs in contaminated food, soil

   Trichinella spiralis

Trichinosis

Gastrointestinal

Larvae in animal flesh (usually pork, bear)

Trematodes (Flukes)

   Clonorchis sinensis

Clonorchiasis

Gastrointestinal

Metacercariae in seafood (raw fish)

   Fasciola hepatica, others

Fascioliasis

Gastrointestinal

Metacercariae on watercress, in water

   Fasciolopsis buski

Fasciolopsiasis

Gastrointestinal

Metacercariae on plants, in water

   Heterophyes heterophyes

Heterophyiasis

Gastrointestinal

Metacercariae in seafood (raw fish)

   Metagonimus yokogawai

Metagonimiasis

Gastrointestinal

Metacercariae in seafood (raw fish)

   Paragonimus westermani, others

Paragonimiasis

Gastrointestinal

Metacercariae in seafood (crabs, crayfish)

   Schistosoma mansoni, Schistosoma japonicum, others

   Schistosomes, non-human (avian)

Schistosomiasis

Cercarial dermatitis

Skin

Skin

Cercariae in water

Cercariae in water

Cestodes (Tapeworms)

   Diphyllobothrium latum (fish tapeworm)

Diphyllobothriasis

Gastrointestinal

Larvae in seafood (raw fish)

   Echinococcus spp.

Echinococcosis (hydatid disease)

Gastrointestinal

Eggs in contaminated food

   Hymenolepis nana (dwarf tapeworm)

Hymenolepiasis

Gastrointestinal

Eggs in contaminated food, water

   Spirometra mansonoides, others

Sparganosis

Gastrointestinal

Larvae in contaminated water or animal flesh (snakes, amphibians, fish)

   Taenia multiceps, others

Coenurosis

Gastrointestinal

Eggs in contaminated food, water

...

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