Worm infections skin signsB65-B83
Synonym(s)
DefinitionThis section has been translated automatically.
Infections caused by worms are a worldwide medical problem that mainly affects Third World countries. With increasing tourism, however, they are also playing an increasingly important role in European countries and are thus gaining in importance for differential diagnosis.
PathogenThis section has been translated automatically.
ClassificationThis section has been translated automatically.
Basically, 2 pathogenetically different constellations can be defined from a dermatological point of view:
- Nonspecific, reactive skin signs (dermadromas) to internal worm infestation:
- Chronic recurrent urticaria (caused by oxyuriasis, ascariasis, strongyloidosis, schistosomiasis, trichinosis, echinococcosis, among others).
- Angioedema: triggered by oxyuriasis, ascariasis, strongyloidosis, schistosomiasis, trichinosis, echinococcosis, among others.
- Periorbital oedema: e.g. in trichinosis.
- Eosinophilic skin lesions
- Dermatomyositis-like phenomena: e.g. in trichinosis or cysticercosis.
- Dicrocoeliasis: jaundice of the skin.
- Mansonelliasis: allergic reactions with pruritus, maculo-papular exanthema, urticaria, subcutaneous edema, lymph node swelling.
- Specific skin signs due to worm invasion of the skin:
- Skin manifestations due to external skin invasion:
- Larva migrans cutanea syndrome: including larvae of various roundworms.
- Larva currens: special form of larva migrans caused by Strongyloides spp e.g. Strongyloides stercoralis.
- Ankylostomiasis: common; caused by Ancylostoma duodenale[Old World hookworm] or Ancylostoma braziliense and Necator americanus [New World hookworm]; clinical: abdominal discomfort withiron deficiency anemia; dermatitis at site of larval penetration. In primarily animal pathogenic Ancylostama species, the clinical picture is that of larva migrans cutanea syndrome .
- Cercarial dermatitis: larvae of mostly avian pathogenic trematodes as causative agent of the harmless swimmer`s itch (= bathing-trouser dermatitis) occurring in Europe and North America.
- Cercarial dermatitis: by larvae of Schistosoma species as causative agent of schistosomiasis.
- Skin signs due to "secondary internal" skin invasion from a worm-infested other organ (e.g., intestinal tract or bladder):
- Anal pruritus and pruritus vulvae: e.g. due to oxyuria(see below Oxyuriasis).
- Dracunculosis: nematode infection with medina worm.
- Cysticercosis: rare settlements of the pig tapeworm in the skin with formation of inflammatory nodules.
- Filariasis: infections with tissue nematodes (threadworms) that parasitize in the skin.
- Gnathostomiasis: infection by the nematode (roundworm) Gnathostoma spinigerum and/or Gnathostoma hispidum.
- Echinococcosis: rare settlement of the dog tapeworm in the skin with formation of cysts up to the size of a fist.
- Bilharzia: secondary skin infestation: usually genital and perigenital regions are affected with indolent, soft nodules and fistulas.
- Skin manifestations due to external skin invasion:
Clinical featuresThis section has been translated automatically.
- Non-specific (often allergic) skin signs of internal worm infestation.
- Specific skin signs due to invasion of the worms into the skin
- Skin symptoms due to external skin invasion
- Skin symptoms due to "internal" skin invasion from another organ affected by the worm (e.g. intestinal tract)
TherapyThis section has been translated automatically.
TablesThis section has been translated automatically.
Important pathogens of worm infections
Helminths in the digestive tract |
Lifespan/localization |
Special features/ detection in stool or stool suspension/ infection route in endemic areas |
|
Nematodes (roundworms or nematodes, 90% of diagnoses) |
Ascaris lumbricoides (roundworm) |
Months/ small intestine |
Worm can be seen macroscopically (10-40 cm). Eggs not found until 9 weeks after infection, float in suspension. Infection often through consumption of uncooked leafy plants in endemic areas! |
Trichuris trichiura (whipworm) |
several years/colon |
Eggs float in suspension. Infection often through consumption of uncooked leafy plants in endemic areas! |
|
Enterobius vermicularis (pinworm) = oxyuras |
Weeks/(re-infection!) Ileocecum |
Worm to be detected macroscopically (10 mm). Eggs detectable by adhesive tape test at anus, float in suspension. |
|
Ancylostoma duodenale (hookworm) |
several years/small intestine |
Check for eggs after 8 weeks. Route of infection: skin-soil contact (warm, moist soils). |
|
Strongyloides stercolaris (dwarf nematode). |
Small intestine |
Do not use corticosteroids! Route of infection: skin-soil contact (warm, moist soils). |
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Cestodes (tapeworms, 9% of diagnoses). |
Taenia saginata (bovine (fin) tapeworm) |
several years/small intestine |
Worm macroscopically detectable. |
Hymenolepis nana (dwarf tapeworm) |
days (re-infection!)/Ileum |
Infection by ingestion of eggs with contaminated food or as smear infection in poor hygienic conditions. Eggs can be detected microscopically. |
|
Diphyllobothrium latum (fish tapeworm) |
several years/small intestine |
Worm detectable macroscopically. |
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Trematodes (sucking worms or flukes, 1% of diagnoses). |
Schistosoma mansoni, Schistosoma haematobium (couple flukes) |
Decades/ mesenteric vessels. |
Infection during bathing in fresh water. |
Clonorchis sinensis (Chinese liver fluke) |
Decades/ bile ducts |
Infection through consumption of raw fish. |
|
Fasciola hepatica (large liver fluke) |
Decades/ bile ducts |
Infection through contaminated drinking water or food (e.g., fallen fruit). |
|
Heterophyes heterophyes (dwarf intestinal fluke) |
Decades/ small intestine |
Infection through consumption of raw fish. |
|
Therapy of worm diseases (modified after Simon/Stille)
Worm species |
Antihelminthics |
Comments |
Alternatives |
Ascaris |
Pyrantel (e.g. Helmex) 10 mg/kg bw as single dose (max. 1 g) |
NW: diarrhea, nausea, vomiting, not in pregnancy |
Mebendazole (e.g. Vermox forte) |
Enterobius |
Pyrantel 10 mg/kg bw/day (max. 1 g), repeat after 1 week. |
Frequent recurrences, treat family as well |
Mebendazole, pyrvinium (e.g. Molevac) |
Trichuris (whipworm) |
Mebendazole adults and children: 2 times/day 100 mg for 3 days |
NW: diarrhea, abdominal pain, not in gravidity. |
Albendazole (e.g., Eskazole), ivermectin (e.g., Mectizan). |
Trichinella |
Mebendazole adults and children: 300 mg 3 times/day for 3 days, then 500 mg 3 times/day for 10 days. |
Herxheimer reaction. Glucocorticoid porphylaxis e.g. prednisolone 40-60 mg/day. |
Ivermectin |
Hookworm (Ankylostoma duodenale) |
Pyrantel (e.g., Helmex) once 10 mg/kg bw/day (max 1 g). |
Gastrointestinal upset, fever, exanthema. Do not use pyrantel in liver dysfunction! |
Mebendazole, Bephenium (Alcopar), Ivermectin |
Larva migrans |
10% Tiabendazole (e.g. Mintezol). Apply suspension locally |
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|
Toxocara |
Diethylcarbamazepine (e.g., Hetrazan) 0.5 mg/kg bw/day for 3 days, then lgs. increase to 3 mg/kg bw/day for 21 days. |
Only in severe disease and unfavorable localization (e.g., eye), if necessary additionally prednisolone in medium dosages (e.g., in hypoxia due to lung involvement) |
Tiabendazole |
Strongyloides (dwarf nematode) |
Tiabendazole 2 times/day 25 mg for 3 days (max. 3 g/day). |
Also treat asymptomatic forms |
Mebendazole, albendazole |
Filariae |
Diethylcarbamazepine 3 times 2 mg/kg bw/day for 3 weeks. |
Allergy due to lysis of parasites (fever, urticaria), possibly glucocorticoids internally. |
Ivermectin |
Dracunculus (Medina worm) |
Metronidazole (e.g. Clont) 2 times/day 5 mg/kg bw/day for 1020 days or 2 times/day 25 mg/kg bw/day. |
If possible, extraction of the worm |
Tiabendazole |
Taenia saginata, Taenia solium |
Niclosamide (e.g., Yomesan) once 2 g; children 28 yrs.: 1 g; children < 2 yrs.: 0.5 g. |
No purging, shedding of worm head necessary |
Praziquantel |
Cysticerci (fins of Taenia solium). |
Praziquantel: 17 mg/kg bw/day in 3 ED for 14 days. |
abdominal pain, headache, drowsiness, urticaria |
|
Fish tapeworm (Diphyllobothrium latum). |
Niclosamide 1 time 2 g, children: see above. |
Possibly Vit. B12, no purging, removal of worm head necessary |
|
Hymenolepsis nana (dwarf tapeworm) |
Praziquantel (e.g. Cesol) once 25 mg/kg bw |
abdominal pain and headache, dizziness, urticaria |
Niclosamide |
Echinococcus (dog tapeworm) |
Mebendazole day 13: 2 times/day 500 mg p.o., day 46: 3 times/day 500 mg p.o., then 3 times/day 10001500 mg p.o. for 46 weeks for cystic E., for alveolar E. up to 2 years. Combination with praziquantel if necessary. |
Parasitolysis with cyst rupture possible, often no complete elimination. |
Surgery, albendazole |
Bilharzia (Schistosoma mansoni). |
Praziquantel once 40 mg/kg bw |
abdominal pain and headache, dizziness, urticaria |
Oxamniquine (e.g. Mansil) |
Paragonimus (lung fluke) |
Praziquantel 3 times/day 25 mg/kg bw for 2 days |
abdominal pain and headache, dizziness, urticaria |
Bithionol (e.g. Actamer) |
Clonorchis (Chinese liver fluke) |
Praziquantel 3 times/day 25 mg/kg bw, single dose |
abdominal pain and headache, dizziness, urticaria |
|
Fasciola hepatica |
Bithionol (e.g. Bitin) 40 mg/kg bw every 2nd day, total 1015 doses |
Nausea, vomiting, diarrhea, photosensitization, cardiotoxicity. |
Spectrum of action of different chemotherapeutic agents (modified according to Forth)
Parasites |
Tiabendazole (e.g. mintezole) |
Pyrantel (e.g. Helmex) |
Mebendazole (e.g. Vermox) |
Ivermectin (e.g. Mectizan) |
Pyrivinium (e.g. Molevac) |
Bephenium (e.g. Alcopar) |
Ascaris |
++ |
+++ |
+++ |
+++ |
++ |
++ |
Enterobius |
++ |
+++ |
+++ |
+++ |
+++ |
0 |
Trichuris |
++ |
++ |
+++ |
+++ |
0 |
0 |
Hookworm |
+++ |
+++ |
+++ |
+++ |
0 |
++ |
Strongyloides |
+++ |
+ |
++ |
+++ |
0 |
+ |
Trichinella |
0 |
0 |
++ |
+++ |
0 |
0 |
Larva migrans |
+++ |
? |
? |
+++ |
0 |
0 |
LiteratureThis section has been translated automatically.
- Enk CD et al (2003) Onchocerciasis. dermatologist 54: 513-517
- Garcia HH et al (2004) A trial of antiparasitic treatment to reduce the rate of seizures due to cerebral cysticercosis. N Engl J Med 350: 249-258
- Ito A et al (2003) Human Taeniasis and cysticercosis in Asia. Lancet 362: 1918-1920
- Kern (1991) Extraintestinal helminthiases. Therapy week 41: 1074-1080
- Ponnighaus JM et al (2001) Cutaneous manifestation of cysticercosis. dermatologist 52: 1098-1100
- Simon C et al (1989) Antibiotic therapy. Schattauer Publishing House