Cutaneous Larva Migrans and Tungiasis in International Travelers Exiting Brazil: An Airport Survey
Article first published online: 7 NOV 2007
Journal of Travel Medicine
Volume 14, Issue 6, pages 374–380, November/December 2007
How to Cite
Heukelbach, J., Gomide, M., Araújo, F., Pinto, N. S.R., Santana, R. D., Brito, J. R.M. and Feldmeier, H. (2007), Cutaneous Larva Migrans and Tungiasis in International Travelers Exiting Brazil: An Airport Survey. Journal of Travel Medicine, 14: 374–380. doi: 10.1111/j.1708-8305.2007.00156.x
- Issue published online: 7 NOV 2007
- Article first published online: 7 NOV 2007
Background Hookworm-related cutaneous larva migrans (CLM) and tungiasis are commonly diagnosed in travelers returning from endemic areas, but reliable data on disease occurrence do not exist. To describe the occurrence of CLM and tungiasis in international travelers, a cross-sectional study was done.
Method We conducted an airport survey in European travelers exiting northeast Brazil. Questionnaires were distributed at the departure gate of the international airport of Fortaleza (Ceará State) while passengers were waiting to board their plane. The questionnaire included questions on personal characteristics, pretravel health advice, acquired parasitic skin diseases during their stay in Brazil, and clinical characteristics of the infestation. To help identify CLM and tungiasis, photographs of the typical appearances of the infestations were presented.
Results Data from 372 tourists (aged 16–76 y, median = 40 y) were available for analysis; 45% had obtained pretravel health advice, usually from travel clinics (46.2%) and Internet sites (39.6%). Only 14% of those who obtained advice had been informed about CLM as a travel health risk and 22% about tungiasis. During their stay in Brazil, 12 (3.2%) tourists had experienced tungiasis and 3 (0.8%) CLM. In all cases, lesions were confined to the feet. The three travelers with CLM complained of irritability; itching was present in two cases. Pain (58.3%) and itching (50%) were the most common symptoms in travelers with tungiasis. The length of stay was a clear predictor for tungiasis, with a 20 times higher occurrence in travelers who had stayed for more than 4 weeks in Brazil.
Conclusions Tungiasis and CLM are not rare in international tourists departing from Brazil, and pretravel counseling is insufficient. Pretravel health advice should include information on the risk of acquiring tungiasis and CLM and how to prevent an infestation. Airport surveys using questionnaires can be used to obtain incidence data on both parasitic infestations.