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strongyloidiasis may also cause this syndrome Infections are common in warm areas, including the southeastern United States They are most common in children The disease is caused by the migration of worms through skin; the nonhuman parasites cannot complete their life cycles, so only cause cutaneous disease Intensely pruritic erythematous papules develop, usually on the feet or hands, followed within a few days by serpiginous tracks marking the course of the parasite, which may travel several millimeters per day Several tracks may be present The process may continue for weeks, with lesions becoming vesiculated, encrusted, or secondarily infected Systemic symptoms or eosinophilia are uncommon The diagnosis is based on the characteristic appearance of the lesions Biopsy is usually not indicated Without treatment, the larvae eventually die and are absorbed Mild cases do not require treatment Thiabendazole (10% aqueous suspension) can be applied topically three times daily for 5 or more days Systemic therapy with albendazole (400 mg once or twice daily for 3 5 days) or ivermectin (200 mcg/kg single dose) is highly effective

Brenner MA et al Cutaneous larva migrans: the creeping eruption Cutis 2003 Aug;72(2):111 5 [PMID: 12953933] Caumes E et al From creeping eruption to hookworm-related cutaneous larva migrans Lancet Infect Dis 2004 Nov;4(11): 659 60 [PMID: 15522674]

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Episodic attacks of lymphangitis, lymphadenitis, and fever Chronic progressive swelling of extremities and genitals; hydrocele; chyluria; lymphedema Microfilariae in blood, chyluria, or hydrocele fluid; positive serologic tests Lymphatic filariasis is caused by three filarial nematodes: Wuchereria bancrofti, Brugia malayi, and Brugia timori, and is among the most important parasitic diseases of man Approximately 120 million people are infected with these organisms in tropical and subtropical countries, about a third of these suffer clinical consequences of the infections, and many are seriously disfigured W bancrofti causes about 90% of episodes of lymphatic filariasis It is transmitted by Culex, Aedes, and Anopheles mosquitoes and is widely distributed in the tropics and subtropics, including subsaharan Africa, southeast Asia, the western Pacific, India, South America, and the Caribbean B malayi is transmitted by Mansonia and Anopheles mosquitoes and is endemic in parts of China, India, southeast Asia, and the Pacific B timori is found only in islands of southeastern Indonesia Humans are infected by the bites of infected mosquitoes Larvae then move to the lymphatics and lymph nodes, where they mature over months to thread-like adult worms, and then can persist for many years The adult worms produce large numbers of microfilariae, which are infective to mosquitoes, and released into the circulation, particularly at night (except for the South Pacific, which microfilaremia peaks during daylight hours)

Anisakiasis is caused by infection with larvae of saltwater fish and squid Multiple species of the family Anisakidae may occasionally infect humans Definitive hosts for these parasites are marine mammals Eggs are passed in the feces and ingested by crustaceans, which are then eaten by fish and squid When ingested by humans in undercooked seafood, larvae penetrate the stomach or intestinal wall but cannot complete their life cycle The disease is most common in Japan Clinical manifestations of anisakiasis follow burrowing of worms into the stomach or intestinal wall, leading to localized ulceration, edema, and eosinophilic granuloma formation Symptoms usually occur within 2 days of parasite ingestion and include severe epigastric or abdominal pain, nausea, and vomiting Intestinal involvement can mimic appendicitis Allergic symptoms, including urticaria, angioedema, and anaphylaxis, have also been attributed to acute infection Acute symptoms generally resolve within 2 weeks, but chronic symptoms may also be seen, suggesting chronic intestinal diseases such as inflammatory bowel disease, diverticulitis, or carcinoma Rarely, worms may migrate to other sites or be coughed up Eosinophilia is usually not seen The diagnosis of anisakiasis is suggested in those with acute abdominal symptoms after ingestion of raw fish Radiographic studies may identify stomach or intestinal lesions, and endoscopy may allow visualization and removal of the worm When surgery is performed due to consideration of other diagnoses, eosinophilic inflammatory lesions and the invading worms are found Specific therapy is not indicated, but endoscopic worm removal hastens recovery The parasites are killed by cooking or deep freezing fish

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