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Creeping Eruption

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The creeping eruption is a prevalent disease in the warm climate areas especially the southeastern states of America, central and South America, southeastern Asia and Africa. In general anybody exposed to warm, moist sand or soil, is at risk of infection. It was, therefore, necessary to study the disease. The information sources are secondary materials and past research on the topic. The method in research is mainly observation. I analyzed peer reviews of dermatology to gain most of my understanding of the disease. Creeping eruption also referred to as cutaneous larva milgrans (CLM) is a disease from hookworms found in the feces of pets like dogs and cats. The parasites accidentally enter the skin but are unable to penetrate the dermis in most cases. The paper explores Pathophysiology, treatments and education to the patient. My recommendation is patient education to sensitize him/her on the causes, medical treatment, preventive measures and alternative treatments, to minimize the numbers of victims of the disease. There is also a gap to stakeholders to new and efficient drugs to help cure the disease. Drugs taken orally have side effects to the patient: therefore, there is a need to emphasize on application drugs such as Benadryl.

According to the Nebraska medical center (NMC), Creeping eruption is a skin infection due to human contact with feces of cats, dogs and pigs. The hookworms in the feces spread through the human skin, causing snakelike lesions characterized by a severe itching. They inflammations usually occur on the hands and legs, but they can also occur on back, face, thigh and arms (NMC online, 2012).

Another term used to refer to the disease is cutaneous larvae milgrans (CLM). According to Webster’s online dictionary, the condition is most prevalent in the warm climate areas and mostly affects children rather adults (Webster’s online, 2012). It is most prevalent in the southeastern states of United States of America, Africa, Caribbean, central and South America and southeastern Asia. A reported outbreak in Florida State was due to an exposure to cat feces in a playground sandbox (Expertconsultbook online, 2012).

The journal of the American medical association (JAMA) concedes that until two years ago, accurate information was not available. Creeping eruption was due to the spread of the bot fly larva within the human skin and in rare circumstances due to the pig nematodes and larvae of the cattle (heel fly) (JAMA online, 2012). These causative agents, however, did not explain the high prevalence in the gulf and Atlantic states. The dermatologists of these states, however, concede that exposure to damp sand is common in most cases reported.

The first case to be reported of the creeping eruption disorder was in England in 1875 and another case in 1885, according to the Singapore medical journal (SMJ) (SMJ online, 2012). The disease rarely affects Asians but is prevalent among the Europeans. According to a study undertaken by Khoo in Singapore in 1954, it found no traces of this disease at all, while an earlier study dove  in 1932 in Jacksonville, Florida found out that infections in the black population by the disease was 7.66%  although, most of the people living the city were black Americans. Sandosham (1955) reported that most of the cases occurring during the pre-war period were mostly Europeans (SMJ online, 2012). These studies show that the creeping eruption is rare among blacks and Asians and prevalent among the Europeans and other white populations. However, cutaneous larva milgrans (CLM) cannot be limited to a race, as it depends on exposure to the parasites. It cannot also be limited to a certain sex, but it is more prevalent in children than in adults.

The cutaneous larva milgrans cause an itching feeling on the skin. Upon first penetration of the larvae, the patient will experience a stinging sensation on the skin. An erythematous papule develops on the area of penetration of the larvae after some hours. According to Robert w. Tolan jr, MD of medscape, 39% of the infections occur on the feet due to walking on the sand bare feet, 18% of the cases on the buttocks due to sitting on the sand and 16% of  the infections occurring on the abdomen (Medscape online, 2012). The John Hopkins guide warns travelers to tropical location of the necessary precautions to prevention from the infection and steps to take if the traveler contacts the infection (hopkinsguide online, 2012).

Pathophysiology

According to Lydia A.Juzych MD of the Henry Ford services center (Medscape online, 2012), in the creeping eruption infection, the life cycle of the parasites, begin when the eggs in feces of cats, dogs and other domesticated animals passes onto warm, moist sandy soil either on beaches or in other areas. The larva hatch and undergo molting twice while feeding on the bacteria in the soil. The larvae reach the dormant third stage in the metamorphosis process. They stay in the state for a while to enable them reach maturity to penetrate the follicle that encloses them.

They use enzyme proteases, to decompose the follicle enclosing them, fissures or the skin of their new host. They shed their natural cuticle after penetrating the stratum corneum and begin spreading within the next few days (Medscape online, 2012). The hookworm parasites penetrate the dermis of the skin of their natural animal host. They migrate to the lungs via absorption into the lymphatic system where they enter the veins and then move to the lungs. The next step is to enter the alveoli where they migrate to the trachea and then swallowed. They enter the stomach and then finally enter the small intestine. The parasites reproduce sexually to excrete an egg which undergoes the full cycle again and again. If not treated the parasites keep on reproducing multiplying in number.

The larvae causing cutaneous larva milgrans (CLM) rarely reach the intestines in humans as they do not have the capability to penetrate beyond the dermis. They just burrow below the skin, causing red snakelike lesions that cause painful itching.  Therefore, people are accidental host of the parasites as they lack the enzyme collagenase needed to penetrate the basement membrane and invade the dermis (Medscape online, 2012). Therefore, the parasites stay in the skin where they cause the creeping eruption infection.

A human is a coincidental host of the parasites. On exposure to the parasites, they can penetrate the outer layer of the skin but not into the dermis. The parasites move to the lymphatic system. Through absorption, they migrate in the veins to the lungs. This is the reason why the instance of the parasites reaching the small intestine is rare. They take one to six days to incubate with creeping eruption occurring if the parasites stay in the skin, but secondary infections may occur as when the parasites reach the small intestine causing a condition called eosinophilicenteritis (Dermatology online journal, 2012).

Medical Treatments

Medical treatment is the best for those suspecting to be suffering from the infection. Patients should seek medical treatment from a qualified physician. The firstly, treatment process begins with the diagnosis of infection by the medical expert. The diagnosis is usually using medical history of the patient or using a physical examination of the patient. The dermatologist, to diagnose the disease, may request  blood test, microscopic examinations or skin scrapings from the medical laboratory (Webhealth online, 2012).

The Singapore medical journal warns that a biopsy may be ineffective in diagnosing the infection, if there is a secondary infection, which characterized by bullous eruption or linear erythema (sjm online, 2012). An epiluminiscence microscopy may be the effective method to detect the infection if the larvae are beyond the clinical tract (Dermatology online journal, 2012).

After diagnosis, the infection can then be treated medically using many prescribed ways. It can be treated by freezing. This involves freezing the leading point of the burrow using freezing agents like liquid nitrogen and ethyl chloride. The method of treatment involves cooling the regions affected by the larva, which lead to tissue destruction killing the parasites. The treatment is cheap and straightforward as it involves spraying the infected area with ethyl chloride or liquid nitrogen for 3-5 minutes. However, the method may be ineffective if there is wrong area treatment leading to treatment failure (Dermatology online journal, 2012). Therefore, dermatologists are to ensure removal of the larva in the regions infected.

Another method for the treatment of the creeping eruption infection is by the use of oral dosages such as albendazoleandivermectin. An oral swallowing of albendazole 400 grams for 3 days may be effective in curbing the infection. A single dose of ivermectin is best for treating the disorder, with the patient advised to take a single dose of 200 µg/kg bodyweight (Dermatology online journal, 2012). However, these drugs cause feelings of nausea and vomiting in the patient.

If the patient detests these side effects due to the use of oral drugs, he/she can be administered with application drugs, which he/she applies directly to the affected area. The applications creams include Benadryl, cortisone and calamine lotion. Application of 10% topical thaibendazole suspension applied four times for two days consecutive can also be effective (dermatology online journal, 2012). The other oral drugs can also be applied directly by crushing the tablets and coating them on the affected area with a plaster. This method of treatment is more effective has it causes less toxicity and side effects.

According to the dermatology online journal, the lesions on the skin disappear within two to eight weeks, with some rare cases reported of persistency of lesions for two years (Dermatology online journal, 2012). Mostly, medications have been able to cure the infection. However, there are other medications, which failed to cure, the creeping eruption disease like hetrazan. Hetrazan failed to cure the condition in some patients, and ethyl chloride spray is recommended in its place (SJM online, 2012).

Alternative Treatments for the Creeping Eruption

According to Vashon organics, alternative remedies to the creeping eruption can be achieved by improving nutrition and immune system of people by using herbal remedies and ayurvedic medicine (Vashonorganics online, 2012). The herbal medicine contains anti-parasitic agents, which are effective in killing all the parasites exposure. However, the patient should seek advice from a medical expert before giving them to children or using herself. According to Vashon organics herbal therapy should be used with dietary treatment and continued until eradication of all worms. It involves the use of drugs like melaleuca altenifolia oil Artemisia annua and citrus seed extract or berberine containing herbs (Vashonorganics online, 2012).

Nutritional steps to protect against creeping eruption include: eating a well balanced diet, avoiding foods that are not well cooked, supplementing with multivitamins and minerals and limiting dairy foods, sugar and fats (Vashonorganics online, 2012). The use of ayurvedic medicine involves the use of bitter lemon and other Chinese herbal combinations to kill the parasites. Allopathic treatments for the infection involve the use of insecticides and general attention to cleanliness as the treatment and prevention against the parasites causing the disease respectively (vashonorganics online, 2012).

Patient Education

Patient education involves teaching the patient and the general population of ways in which they can prevent being infected, cure it and steps to take if infected by the infection. The john Hopkins medical facility issues guidelines to travelers to states and countries prone to creeping eruption infection (hopkinsguide online, 2012). They advise travelers to take precautions, and watch out for signs, and symptoms of the infection.

To prevent exposure to the parasites causing the disease, Vashon organics proposes preventive measures. They propose; washing hands before eating and after using the restroom. One should not allow pets to lick children, wash fruits, and vegetables well before eating them. One should not eat undercooked foods especially meat, use gloves when gardening, pregnant women not to use a cat litter and use insect repellants to avoid bites when in the woods (vashonorganics online, 2012).

The other recommendation is Education to the People who are at most risk of infection by the creeping eruption infection. Medscape online warns fishermen, sunbathers, constructions workers, gardeners, pest exterminators, hunters, children and anyone in contact with sand or soil in warm areas to be at danger of contracting the disease (Medscape online, 2012).

Patients should be advised to seek medical advice when infected. Patients should be warned of infection and not seeking medical advice, as the infection may develop other secondary infections. They should also be educated not to try to cure the infection on their own. Patients may not possess the relevant knowledge to do so, therefore, escalating the infection.

In conclusion, the people in the most prone areas to creeping eruption infections, for example, southeastern states of America, Caribbean, central and South America should be sensitized on the disease (Expertconsultbook online, 2012). They should be educated on the causes, treatment, preventive measures and physicians to consult.

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