What Is The Most Effective Method For Diagnosing And Treating A Suspected Case Of Ancylostoma Caninum-induced Cutaneous Larva Migrans In A Human Patient Who Has Been In Close Contact With A Heavily Infested Dog, Considering The Potential For Co-infection With Other Zoonotic Parasites Such As Hookworms Or Roundworms?

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The most effective approach to diagnosing and treating a suspected case of cutaneous larva migrans (CLM) caused by Ancylostoma caninum in a human patient, while considering potential co-infections with other zoonotic parasites, involves the following steps:

Diagnosis:

  1. Clinical Assessment:

    • Conduct a thorough physical examination to identify characteristic skin lesions, such as serpiginous or linear rashes, typically accompanied by itching.
    • Obtain a detailed history of exposure, particularly contact with infested dogs.

  2. Diagnostic Tests:

    • Skin Biopsy: If the diagnosis is uncertain, a skin biopsy may be performed to look for larvae, though this is not always necessary.
    • Stool Examination: While stool tests may not detect CLM larvae, they are useful to check for co-infections with intestinal parasites like hookworms or roundworms.
    • Blood Tests: Consider testing for antibodies if visceral larva migrans is suspected, especially for co-infections like Toxocara.

Treatment:

  1. Antiparasitic Medication:

    • Albendazole: Typically administered orally for 3-5 days, as it is effective against a broad range of helminths.
    • Ivermectin: May be used as an alternative, sometimes in a single or few doses, depending on the severity.

  2. Topical Therapy:

    • Thiabendazole: Can be applied topically to affected areas, usually for about a week, to complement oral treatment.

  3. Supportive Care:

    • Symptomatic Relief: Use antihistamines or topical corticosteroids to manage itching and inflammation.

Prevention and Public Health Measures:

  • Deworming the Dog: Ensure the infested dog is treated by a veterinarian to prevent re-infection.
  • Sanitation and Hygiene: Advise the patient on improving hygiene practices to avoid further exposure.

Conclusion:

The approach combines clinical diagnosis, appropriate diagnostic tests to rule out co-infections, targeted antiparasitic treatment, supportive care for symptoms, and preventive measures to address the source of infection. This comprehensive strategy ensures effective management of CLM and minimizes the risk of co-infections.