A recent BuzzFeed article reported on 22-year-old Katie Stephens and her boyfriend, Eddie Zytner, a Canadian couple who recently went on a beach vacation in the Dominican Republic. During their vacation, they both developed cutaneous larva migrans, a skin infection caused by hookworms.
According to the Facebook post, Stephens and her boyfriend believe they picked up the parasites while walking on the beaches of Punta Cana, in the Dominican Republic, where they were staying at an oceanside resort. "We did a couple excursions, but other people contracted this parasite and they didn't come on the excursions with us, so it would have had to have been on the resort or beach where we got it," Stephens told BuzzFeed News in a Facebook message.
According to Bobbi Pritt, M.D., Director of the Clinical Parasitology Lab and Co-Director of Vector-Borne Diseases Lab Services in Mayo Clinic’s Department of Lab Medicine and Pathology, "Cutaneous larva migrans basically means there is a larva, or the immature form of a hookworm, migrating around under the skin." The microscopic larvae live in sand or soil that has been contaminated with dog or cat feces, says Dr. Pritt, and enter the foot by directly penetrating the skin. "The hookworm eggs come out of the stool and hatch in the sand or soil, where they live until an unsuspecting human walks on them barefoot," Dr. Pritt says.
This particular skin infection is caused by animal hookworms, as opposed to human hookworms. "Human hookworms are different; they will penetrate the skin but move to the blood and intestinal tract where they cause disease—those don't sit in the skin like the dog and cat ones do," she says.
The worms need a warm, moist environment to survive, so they love tropical areas. "You'll find hookworms in parts of the South in the U.S., but they are endemic to many countries in the Caribbean, as well as Central and South America," Dr. Pritt says. The hookworms are common in beaches or rural areas where stray dogs are defecating, since the eggs come from infected feces. But even a glamorous beach resort can have hookworms, too. "Unless you know a beach doesn't allow dogs, you can't be sure," Dr. Pritt says.
"The foot will become very itchy and inflamed, but you can actually tell where the larva is migrating through the skin because it creates red, squiggly raised lines in the shape of a serpent," Dr. Pritt says.
The good news is that humans are a dead-end host for them. "The hookworms that cause cutaneous larva migrans can't complete their life cycle in humans, so they will eventually die in a few weeks," Dr. Pritt says. But the infection is also very easy to treat, and the right medication will kill the larvae and ease symptoms in a day or two.
According to Dr. Pritt, "The first precaution you can take is to wear closed-toed shoes on the beach, but that’s obviously not appealing, so you can also try contacting the place you are staying to ask if it is a private beach that is fenced off so dogs can't get in. Another great thing people can do is to go to a travel clinic before your trip, and they can tell you specifically what to look out for and whether you need certain medications or vaccines beforehand based on where you are going."