Parasite hookworm under the skin of my toe!

Before my trip to Panama one of my friends joked: “Panama? Be careful you don’t get infected by one of these parasites in the sand on the beach!” It won’t happen to me, is what I thought. Let’s make one thing clear first: this is not just something that can happen in Panama. Different types of parasites are common in any tropical country around the world. It is just bad luck if they find you.

Disclaimer: this blog post is meant to share my experience and findings in order to help other travelers. I am by no means a doctor or medical professional and I do suggest to see a doctor (preferably in the country where you experience the symptoms first) in case you have similar symptoms.

Itchy bite trail on my toe

Cutaneous larva migrans toe
The very first trail on my toe in Panama, one day after I discovered it.

Santa Fe was the last destination on my trip through Panama. To my surprise I did not encounter many mosquito or other insect bites during this trip. Well, except for the past few days in Bocas del Toro. I woke up in Santa Fe with a weird trail of itchy bites on one of my toes. As if it was a line of bites. Probably an ant had walked over it and had bitten me a couple of times I thought. “Maybe it’s a parasite!” I joked to my friend.

Next day, after hiking the entire day, I found some rash on several other toes as well on the same foot. Still, as I had hiked the past day with closed shoes I thought it might just be some kind of eczema. For a moment I thought about checking up with a doctor, just in case. Somehow it did seem like trails. But whatever, I was going home in a couple of days and everything would be fine. I did not have any other symptoms like fever, just some itch and a my skin felt a little bit like it was burning if I’d touch it. Insect bites combined with eczema I thought.

One week after getting back to home

I got back home in Holland and expected the symptoms to be gone soon. But one week passed and I felt the itch was getting more serious. I saw clear red trails (red lines) on the other toes that I initially thought were eczema. The trails looked as if there were tiny little worms just below or in the skin. At some places my skin felt as if it was burning while touching it, at other places it was just really itchy. I decided it was time to pay the local doctor a visit. Once I got to the doctor I explained him that I went to Panama, and that I read about common parasites in Central America that are small worms going into (or under) the first layer of the skin. Common remedy according to the internet were Albendazole 400mg pills (probably OTC in every pharmacy in Central America).

The doctor suspected scabies, most likely causes by the bed sheets in hostel beds. He confirmed it with a dermatologist who had said “even though the location of scabies on toes is quite unusual, there is not much else we can think of…” (well, I could think of something. But clearly my input was not appreciated). I got permethrin cream prescribed and after the first time of spreading the cream over my body the scabies were supposed die.

The itch was supposed to stop within more or less three days. One week later I would have to spread permethrin cream over my body again just in case there were eggs that would not have been killed by the first treatment. I did all of this, and washed my bedsheets, socks, etc, all exactly as prescribed.

One week later the symptoms got worse instead of better

Unfortunately after one week I did not see any improvements, in fact the symptoms got worse. My toes were still itchy and the trails were more clear than before. Moreover the trails were shifting (I thought). I decided to go back to the doctor and told him my concerns. The doctor looked at my toes for a few seconds only and conclude this was all normal. “It’s just the skin that’s refreshing after the scabies died. Though it might seems to look worse, it’s very normal..”. I raised my concerns again about the worms that I’d read about, but this was quickly waived away by the doctor. “Even if it were worms, the permethrin would probably have killed those too”. Now I am not a doctor, but I highly doubt this. Permethrin is not listed as a possible remedy against worm or hookworm infections anywhere.

I believe the doctor was just trying to make me stop worrying. Besides, I did not feel taken serious. It was my impression the doctor just found it important to stick to his diagnosis. Understandable, but I can imagine a Dutch doctor is not very familiar with parasites and worms that are common in Central America. Besides I had pointed out my concerns about a potential parasite or worm infection multiple times. I felt that the doctor could at least refer me to someone specialized in this matter, especially after I came back a week after the “scabies treatment” with worse symptoms than before.

Cutaneous larva migrans

Almost another week passed and the itch got worse. For a couple for nights I was waken up and awake for for hours by the itch. I even saw a complete new itchy track. Maybe not completely new, but it just seemed like the worm had moved a few centimeters. I got more worried and started doing more research online. At one point I found an article about cutaneous larva migrans. It sounded and looked exactly the same as what I had.

Cutaneous larva migrans is a parasitic skin infection caused by hookworm larvae that usually infest cats, dogs and other animals. Humans can be infected with the larvae by walking barefoot on sandy beaches or contacting moist soft soil that have been contaminated with animal faeces. It is also known as creeping eruption as once infected, the larvae migrate under the skin’s surface and cause itchy red lines or tracks. […] Sites most commonly affected by cutaneous larva migrans are the feet, spaces between the toes, hands, knees and buttocks. […]

Many types of hookworm can cause cutaneous larva migrans. Common causes are:

  • Ankylostoma braziliense: hookworm of wild and domestic dogs and cats found in central and southern US, Central and South America, and the Caribbean 

Source: http://www.dermnetnz.org/topics/cutaneous-larva-migrans/

Reading further, I was relieved to read that most these little larva in do not like people. In most cases they will die after 4-8 weeks. Unfortunately my symptoms were still getting worse. Also, searching further online I found stories of people who have had these symptoms for over 6 months. Luckily there is medication available to help the worms die faster. Again, I am not a doctor. This is just what I found online. Albandazole 400mg would do the trick, available as anti-parasitic drug OTC in Latin America. Unfortunately not available over the counter in Holland.

Fortunately I was going to Guatemala in one week time. Back in Central America where a doctor would most likely recognize my symptoms and could give me proper diagnosis and treatment. Turned out that I did not even have to see a doctor, I explained my symptoms to the pharmacist in Guatemala, and without any hesitation they told me this would be a parasite, and gave me Albandazole tablets. In two to three days time the itch had faded away, and a week later I took a second dose to make sure the hookworm(s) would be completely exterminated. From now on I’ll always take some Albandazole home after a trip to Central America, as it turns out not all doctors back home will be able to recognise the symptoms or prescribe the right drug.


February 2017

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