Extensive Cutaneous Larva Migrans with Eczematous Reaction on Atypical Localization
Bibliographic record
Abstract
A 32-year-old man living in midwest Brazil presented with a 15-day history of skin eruption with severe itching after lying on a lawn in an amusement park for a few hours. The patient had no previous history of illness or use of medication. Clinical examination revealed a large (20 × 25 cm) erythematous eczematous plaque on the lower half of his back, with serpiginous tracks in some areas (Figures 1 and and22 ). The clinical characteristics of the lesions and epidemiological history are very suggestive for the diagnosis of cutaneous larva migrans (CLMs) with severe secondary eczematous reaction, on an atypical location. Therefore, considering the diagnosis, a treatment was prescribed with 5% thiabendazole, three times daily for 15 days, and 400 mg of oral albendazole daily for three consecutive days. The response to an antihelminthic drug and rapid resolution of the lesion supported the initial diagnosis of CLM. Figure 1. Large erythematous eczematous plaque on the lower half of patient's back (20 × 25 cm). Figure 2. Serpiginous tracks in some areas of the erythematous eczematous plaque on the lower half of patient's back. CLM is caused by the accidental larval migration of nematodes (most commonly Ancylostoma braziliense) into the epidermis.1–4 This skin infestation, typical of subtropical and tropical regions, is endemic to the Caribbean, Central and South America, and Africa.1–3 With the growing frequency of travel to these areas, the incidence of the disease has also increased elsewhere. Walking barefoot on beach sand is a common feature.2 The larvae penetrate the corneal layer of human epidermis upon contact with soil contaminated with dog or cat feces containing excreted eggs, which in hot, humid environments become filariform larvae.1,4 These larvae migrate within the epidermis, causing an inflammatory reaction with intense itching, eruptions, and a serpiginous aspect that spreads a few centimeters a day.1–4 Lesions are usually few in number, and commonly affected sites include feet, thighs, and buttocks in adults.1,5 Only 7% of lesions occur on the trunk.5 The presence of multiple larvae may produce bizarre patterns.5 Diagnosis is clinical, based on the appearance of the lesions, with an emphasis on patient epidemiology.1,2 Biopsy is not useful.1–3 Differential diagnosis includes scabies, myiasis, tinea corporis, and contact dermatitis.1 Despite the self-limiting nature of the disease, severe itching, risk of secondary infection, and (in some reported cases) progression to Loeffler's syndrome warrant treatment with antihistamines and anthelminthics. First-line treatments are ivermectin and albendazole.1–3 In cases when oral drugs are contraindicated or not sufficient, topical application of 15% thiabendazole solution or ointments should be considered (not available in the United States or Canada).1–3 Treatment is simple, well tolerated, and effective.1–3
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".