You might want to consider a pair of sandals the next time you take a long walk on the beach.
After playing barefoot in the sand with his friends, this seven-year-old boy developed itchy lines on his left heel.
Although they may look like simple scratches, doctors discovered that they were actually the outlines of parasitic worms that had burrowed beneath her skin.
The boy, from Namibia, had contracted the parasites by stepping in the feces of an infected dog or cat that was contaminated with larvae.
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 might have come into contact with hookworm larvae.
Adult hookworms outside the body. The disease that the child contracted is caused by the larvae, which are even smaller than this one.
When the boy arrived at the doctor’s office, he reported that the lines on his foot became more pronounced as he itched, according to the case study published in the journal Scientific researchsaying.
Doctors ruled out other culprits and found that the boy had not been stung by any insects or suffered any injuries. He was growing normally and was up to date with all his vaccinations.
But when doctors asked the boy about his home, they found some clues.
He came from a densely populated area of Rundu, a region in northeastern Namibia with a population of over 118,000.
There, doctors discovered that the boy had been playing barefoot in the sand with his friends in areas where dogs and cats also relieved themselves.
Therefore, he was diagnosed with cutaneous larva migrans.
Adult hookworms live in the intestines of infected dogs and cats. When these animals defecate, hookworm eggs may be present in their feces.
When a human steps on, sits on or touches the soil, the larvae can burrow into the skin. They are not mature enough to penetrate other regions of the body and remain in the skin, moving up to one centimetre per day.
It is especially common on the feet, buttocks, thighs and hands, but the worms can enter through any part of the skin and are not transmitted between humans.
When the larvae move under the skin, the body’s immune system reacts, causing the swollen, 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’s authors said it is a “neglected noncommunicable zoonotic disease,” largely because it affects people in poor countries, although some tourists also become infected 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 one living under the skin.
A separate case of the subcutaneous black substance. The lines form when the body’s immune system reacts to the worms inside, causing inflammation and itching, which appear as these raised lines on the surface of the skin.
Doctors have been reporting on this condition for over 100 years and have devised multiple treatments. The Namibian boy was given albendazole tablets, an FDA-approved treatment for any patristic worm, and an anti-itch medication.
After a week, the itching was gone. After six weeks, the maggot marks were gone.
Sometimes the condition resolves without treatment as the larvae die on their own under the skin.
But when the worms make the patient itch, as in the case of the 7-year-old boy, they can cause skin sores that become infected, so doctors choose to treat them with medication.
In rare cases where doctors don’t treat it and the patient scratches the wound, there have been reports of more serious infections, according to researchers at Sampson Regional Medical Center.
These infections can cause kidney damage, other rashes, joint pain, fever, and a weakened immune system that is more susceptible to other illnesses.
There is no vaccine 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 dirt.
Human hookworm infection was thought to have been eradicated in the United States between 1950 and 1980 thanks to better sanitation practices. However, a 2017 study found that it still persists in certain rural areas of the South, largely due to poor sewage systems.