Life Quality Impairment Caused by Hookworm-Related Cutaneous Larva Migrans in Resource-Poor Communities in Manaus, Brazil

Abstract

BackgroundHookworm-related cutaneous larva migrans (CLM) is a common but neglected tropical skin disease caused by the migration of animal hookworm larvae in the epidermis. The disease causes intense pruritus and is associated with important morbidity. The extent to which CLM impairs skin disease-associated life quality has never been studied.MethodsA modified version of the Dermatology Life Quality Index (mDLQI) was used to determine skin disease-associated life quality in 91 adult and child patients with CLM, living in resource-poor communities in Manaus, Brazil. Symptoms and signs were documented and skin disease-associated life quality was semi-quantitatively assessed using mDLQI scores. The assessment was repeated two and four weeks after treatment with ivermectin.ResultsNinety-one point five percent of the study participants showed a considerable reduction of skin disease-associated life quality at the time of diagnosis. The degree of impairment correlated with the intensity of infection (rho = 0.76, p<0.001), the number of body areas affected (rho = 0.30; p = 0.004), and the presence of lesions on visible areas of the skin (p = 0.002). Intense pruritus, sleep disturbance (due to itching) and the feeling of shame were the most frequent skin disease-associated life quality restrictions (reported by 93.4%, 73.6%, and 64.8% of the patients, respectively). No differences were observed in skin disease-associated life quality restriction between boys and girls or men and women. Two weeks after treatment with ivermectin, skin disease-associated life quality improved significantly. After four weeks, 73.3% of the patients considered their disease-associated life quality to have returned to normal.ConclusionsCLM significantly impaired the skin disease-associated life quality in child and adult patients living in urban slums in North Brazil. After treatment with ivermectin, life quality normalised rapidly.

Mini review: hookworm-related cutaneous larva migrans

“…By using this figure, it may be possible to infer the time point, and, hence, the location, where the exposure took place in travelers with HrCLM returning from a holiday. A study in individuals living in an endemic area and frequently affected by HrCLM shows that the quality of life was considerably impaired [40].…”

Hookworm-related cutaneous larva migrans in patients living in an endemic community in Brazil: Immunological patterns before and after ivermectin treatment

“…The socioeconomic and environmental characteristics of these communities have been described previously [6]. In this setting, the prevalence of cutaneous larva migrans is up to 18% in children during the rainy season, and patients frequently have several larval tracks simultaneously present at multiple body sites [6].…”

“…In this setting, the prevalence of cutaneous larva migrans is up to 18% in children during the rainy season, and patients frequently have several larval tracks simultaneously present at multiple body sites [6]. Recruitment of patients, diagnostic procedures, estimation of the severity of Hr-CLM by using a severity score (1-10 points), and assessment of skin-associated life quality impairment using the modifi ed Dermatology Life Quality Index (mDLQI) have been described previously [6].…”

“…In exceptional situations, prevalence may reach 50% [3][4][5]. In resource-poor communities, Hr-CLM is associated with considerable morbidity, such as intense itching, pain, and itching-associated sleep disturbance [6]. In addition, excoriated tracks may become infected by bacteria [3].…”

“…In addition, excoriated tracks may become infected by bacteria [3]. This explains why Hr-CLM signifi cantly impairs the quality of life of affected individuals [6,7].…”