Acylostoma brazliense ( Creeping eruptions larvae). Have you seen one before?
The mother came in with this very irritable child who was apprehensive of the white coats. He initially preferred to wait outside the consulting room while the mom handle "his" business with us.
The complain was that of a young child, 5 years old , who was always itching his butt, feet and perineum. He would, on some occasion, literally spring up from his sitting position screaming something was walking inside of his bum. It was on one of this occasion that the mother took a closer look to find some movement just under the skin of his gluteus. She was aghast with fear that she sort for help at some chemist where some medications were given to her for him. They didn't work ofcourse.
After so many tries she got tired and decided it was time to look for real help. She came to the facility where she met with a real doctor for the first time and was happy when we prescribed some medication after examination.
The child has creeping eruptions caused by acylostoma brazliense. One of those neglected diseases. It is a species of hook worm whose larva find a way of penetrating an intact skin and lying subcutaneously. More often than not, they die off after about 2-8weeks or even a year! They are, however, limited from breaking into the blood stream as humans are dead ends. They larva lacks the collagenase enzyme to digest the collagen to lead them into the blood stream therefore limiting them to just underneath the skin.
Once a child walks barefooted in sand where the larva of hookworm has been deposited by defecation or other means, they are likely to get bitten and the worm finding its way into the skin. This is one classical case you would hardly see in hospitals in the cities, you would find this more in the rural areas. Classical case as seen in texts.
This is said to have come from Niger republic in the days of old. Mother attempting a lavage for her baby probably suffering from some form of constipation.
I just hope the baby isn't suffering from hirschsprung's disease because she would be getting a shit load of bowel contents in her mouth following a fountain's sign.
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