You might want to consider a pair of sandals the next time you take a long stroll on the beach.
After playing barefoot on the sand with his friends, this seven-year-old boy developed itchy raised lines on his left heel.
While they may look like simple scratches, doctors discovered they were actually the outlines of parasitic worms that had burrowed under his skin.
The boy, from Namibia, had gotten the parasites from stepping on feces from an infected dog or cat that were contaminated with larva.
When doctors realized the boy lived in an area where there were dogs and cats and regularly played barefoot, it was a clue that he could’ve come into contact with the hookworm larvae
Adult hook worms outside the body. The disease the boy contracted is caused by the larvae, which are even smaller than this
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When the boy came into the doctors office, he reported that the lines on his foot got more pronounced as he itched, the case study published in the journal Scientific Research, said.
Doctors ruled out other culprits, finding the boy hadn’t been bitten by any bugs or been otherwise injured. He was growing normally and had all of his vaccinations.
But when Doctors asked the boy about his home, they found some clues.
He was from a densely populated area of Rundu, a region in Northeast Namibia, with a population of over 118,000.
Here, doctors discovered the boy had been playing barefoot in the sand with his friends in areas where dogs and cats also relieved themselves.
They therefore diagnosed him with cutaneous larva migrans.
Adult hookworms live in the intestines of infected dogs and cats. When those animals go to their bathroom, sometimes, their feces contains hookworm eggs.
When a human steps on, sits on or touches that soil, the larva can burrow into the skin. They are not mature enough to penetrate into other regions of the body, and stay in the skin, moving as much as a centimeter per day.
It’s especially common in the feet, buttocks, thighs and hands, but the worms can enter through any part of the skin. It cannot spread between humans.
When the larvae moves under the skin, the body’s immune system reacts, causing the inflamed, bumpy red lines that are characteristic of the disease.
This infection is especially common in tropical regions of the world with poor sanitation and infrastructure – including the Caribbean, Southeast Asia, Africa and parts of the Southeastern United States.
Doctors don’t know how common it is, and the study authors said it’s a ‘neglected non-communicable zoonotic disease’, largely because it affects people in poor countries, though some tourists are also infected with it each year.
Hookworms have sharp heads that they can use to burrow into the skin. The worm pictured is an adult, and is much larger than the kind that lives under the skin.
A separate case of subcutaneous substantia nigra. The lines form when the body’s immune system reacts to the worms inside it, causing inflammation and itchiness, that appear as these raised lines on the surface of the skin
Doctors have been reporting on this condition for over 100 years, and have come up with multiple treatments. The Namibian boy was given tablets of Albendazole, an FDA approved treatment for any patristic worms, and an anti-itching medication.
After one week, his itchiness had disappeared. By six weeks, the marks of the worms had disappeared.
Sometimes, the condition resolves itself without treatment, as the larvae die off under the skin on their own.
But when the worms make the patient itchy, like in the case of the 7 year old, it can lead to sores on the skin that become infected, so doctors opt to treat it with medication.
In rare cases where doctors don’t treat it and the patient itches themselves into a wound, there have been reports of more serious infection, according to researchers from Sampson Regional Medical Center.
These infections can lead to kidney damage, other rashes, joint pain, fever and a weakened immune system, more susceptible to other diseases.
There is no vaccination against the worm, but people can help prevent the spread of the disease by deworming their pets and wearing shoes when walking on sand or soil.
Human hookworm was previously thought to be eradicated in the US between the 1950’s and 1980s, thanks to better sanitation practices. But a study in 2017 found it still persists in certain highly rural areas in the south, largely because of poor sewage systems.
