Cutaneous Larva Migrans among Devotees of the Nallur Temple in Jaffna, Sri Lanka

BACKGROUND Many cases of Cutaneous Larva Migrans (CLM) have been observed among devotees, during and immediately after the annual festival at the Nallur Hindu temple in Jaffna. OBJECTIVE To ascertain the risk factors associated with infestation and devotees' knowledge and practices regarding the condition. METHODOLOGY/PRINCIPAL FINDINGS A cross-sectional study using an interviewer-administered questionnaire and observation was conducted in August 2010. Out of 200 selected devotees 194(97%) responded. Soil and dog faecal samples were collected from the temple premises and examined for the presence of nematode larva and egg respectively. Among 194 male respondents, 58.2%(95% CI: 51.2%-65.0%) had lesions of CLM. One hundred and thirty (67%) respondents performed the ritual everyday; whereas 33% did so on special days. One hundred and twelve (57.7%) participants performed the ritual before 5.00am and remaining 42.3% performed after 5.00am. Among the participants, 77(36.7%) had the similar condition in previous years. One hundred and fifty seven (80.9%) were aware about this disease and 52(27%) devotees adopted some kind of precautionary measures. Bivariate analysis showed significant association between occurrence of CLM lesions and frequency of performing the ritual (p<0.001, OR-15.1; 95% CI:7.2-32.0), the timing of ritual performance (p = 0.022, OR-1.96; 95% CI:1.10-3.52), similar condition in previous year (p<0.001, OR-6.83; 95% CI: 3.39-13.76) and previous awareness of the condition (p = 0.005; OR-0.59;95% CI:0.43-0.82). Multivariate analysis showed that the frequency of ritual performance (OR-11.75; 95% CI 5.37-25.74) and similar conditions in previous years (OR-4.71; 95% CI: 2.14-10.39) were the independent risk factors. Two of the 20 soil samples were positive for the nematode larvae and three out of five dog faeces were positive for hookworm eggs. CONCLUSIONS/SIGNIFICANCE Deworming the stray dogs around the temple premises combined with the awareness programs among the public may be the effective and feasible precautionary measures to control similar epidemics in future.