looking Out for Cutaneous Larva Migrans in Military Personnel

Research Paper Title

Unusual presentations of cutaneous larva migrans in British military personnel.

Background

Cutaneous larva migrans (CLM) is one of numerous skin diseases that occur in British military personnel on deployments to the tropics and sub-tropics.

It is typically managed by military primary healthcare services, but diagnostic uncertainty or unavailability of anti-helminthic medication may prompt referral to UK Role 4 healthcare services.

Methods

Cases of CLM seen at the UK Role 4 Military Infectious Diseases & Tropical Medicine Service from 2005 to 2020 were identified and their case notes were reviewed to identify learning and discussion points.

There were 12 cases identified, of which five came from Brunei and three were from Belize.

Causes for referral were due to diagnostic uncertainty (58%) and the unavailability of anti-helminthic medication (42%).

Results

Several cases had CLM in an unusual distribution due to specific military activities performed in endemic areas.

Telemedicine was very useful in making some of the diagnoses in theatre and avoiding the need for medical evacuation.

Conclusions

Military personnel may have unusual presentations of CLM due their unique military activities.

In areas that are endemic for CLM, clinicians should maintain high clinical suspicion for CLM, carry appropriate anti-helminthic medications and consider screening cases of CLM and their colleagues for other infections with similar aetiology (eg, human hookworm infection and strongyloidiasis).

Reference

Inglis, D.M. & Bailey, M.S. (2020) Unusual presentations of cutaneous larva migrans in British military personnel. BMJ Military Health. doi: 10.1136/bmjmilitary-2020-001677. Online ahead of print.

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