text: A husband and wife returned home from a Caribbean cruise with identical souvenirs from their vacation: parasitic infections that caused itchy, red rashes on the couple's backsides, according to a report of their case. 
   
   After sunbathing on a sandy beach in Martinique one afternoon, the wife said she felt a burning sensation on her rear end. By the next day, this irritation had blossomed into an extremely itchy rash with "red pinprick marks," according to the report, which was published Jan. 13 in the journal BMJ Case Reports. 
   
   The woman's husband also developed a rash on his backside after spending time with his wife on the beach. So, the British couple sought help from the medical staff on the cruise ship, who prescribed antibiotics and anti-fungal medications, as well as a steroid cream to relieve the rash and quell the itchiness, the report said. [8 Awful Parasite Infections That Will Make Your Skin Crawl] 
   
   But these treatments didn't help, so when the couple returned home from the cruise, they went to the hospital. By this point, it had been 10 days since they'd sat on the Martinique beach. 
   
   When doctors at Addenbrooke's Hospital in Cambridge, England, examined the 52-year-old woman, they saw a wavy, red rash on her bottom. Her husband had a similar-looking rash on his backside, and doctors diagnosed both of them with "cutaneous larva migrans," according to the case report. 
   
   This is a skin condition caused by a hookworm infection. The most common culprit for the infection in the Caribbean is the hookworm Ancylostoma braziliense, according to the case report. 
   
   People can pick up the parasite after encountering hookworm larvae; these can be excreted in the feces of an infected animal, typically a dog or cat, onto sandy beaches or moist soil, the report said. 
   
   A high percentage of dogs and cats are infected with hookworm, especially strays, said Dr. Peter Hotez, the dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, who was not involved in the couple's case. When these animals defecate on the beach, hookworm larvae can easily migrate through the sand, he said. 
   
   But Caribbean beaches aren't the only places you can find hookworms; some beaches along the Gulf Coast of the U. S. and the Atlantic seaboard may also be teaming with the parasites, Hotez told Live Science. [10 Ways the Beach Can Kill You] 
   
   For a person to become infected with hookworm, there has to be direct contact between the skin and the larvae of the worm, Hotez said. That means that walking barefoot on contaminated beach may cause the infection. Hotez said he speculates that this couple may have sat bare-bottomed on the sand, or the sand may have gotten into their bathing suits. 
   
   Once a hookworm larva penetrates a person's skin, it can burrow around, leaving a trail-like rash of inflamed skin known as a "creeping eruption," Hotez said. Sometimes, the rash can have a winding appearance, as was the case for this couple, or sometimes it can look like lines on the skin, he noted. (The species of hookworm that is thought to have infected the couple can't reproduce in humans; as a result, when the worms infect humans, they typically burrow around in the skin until they die, Live Science previously reported.) 
   
   Doctors prescribed anti-parasitic medication to the husband and wife, according to the report. But five days later, the woman went to the emergency room because she was experiencing shortness of breath, a dry cough and chest pain. Her husband also developed a dry cough. 
   
   A small percentage of people with cutaneous larva migrans may get symptoms in their lungs, Hotez said. When this occurs, it means the larvae got into the bloodstream and were carried to the lungs, he said. 
   
   A chest X-ray can show if the larvae have infiltrated the lungs, Hotez said. And indeed, there was evidence of this in both the man and the woman, according to the case report. 
   
   Lung-related symptoms tend to happen when there is significant exposure to hookworm larvae, Hotez noted; in other words, a person would have to be infected with a large number of larvae. 
   
   The couple was given a second dose of anti-parasitic medication, and the treatment quickly helped clear up their skin as well as their lungs, according to the case report. 
   
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   49/50 9 January 2018 Prime Minister Theresa May leads her first cabinet meeting of the new year at 10 Downing street. PA ||||| Web archive data from a crawl of open access PDF URLs provided by Unpaywall. ||||| An estimated 576-740 million people in the world are infected with hookworm. Hookworm was once widespread in the United States, particularly in the southeastern region, but improvements in living conditions have greatly reduced hookworm infections. Hookworm, Ascaris, and whipworm are known as soil-transmitted helminths (parasitic worms). Together, they account for a major burden of disease worldwide. 
   
   Hookworms live in the small intestine. Hookworm eggs are passed in the feces of an infected person. If the infected person defecates outside (near bushes, in a garden, or field) of if the feces of an infected person are used as fertilizer, eggs are deposited on soil. They can then mature and hatch, releasing larvae (immature worms). The larvae mature into a form that can penetrate the skin of humans. Hookworm infection is mainly acquired by walking barefoot on contaminated soil. One kind of hookworm can also be transmitted through the ingestion of larvae. 
   
   Most people infected with hookworms have no symptoms. Some have gastrointestinal symptoms, especially persons who are infected for the first time. The most serious effects of hookworm infection are blood loss leading to anemia, in addition to protein loss. Hookworm infections are treatable with medication prescribed by your health care provider. 
   
   Image: L: Filariform (L3) hookworm larva in a wet mount. R: Hookworm rhabditiform larva (wet preparation). Credit: DPDx ||||| Medical and scientific journals withdraw or retract articles on a regular basis, usually because of errors discovered or questions raised about the research described. A few days ago, however, a highly unusual “correction” appeared in the prestigious British Medical Journal announcing the withdrawal of a case study titled “Cutaneous larva migrans with pulmonary involvement.” 
   
   The article, which was not retracted, contained no errors. The BMJ simply said in the undated note that “with no admission of liability, BMJ has removed this article voluntarily at the request of the patient concerned.” 
   
   Here’s what happened. 
   
   While sunbathing on a beach in Martinique, a British woman suddenly felt a burning sensation on her backside. The next day, she woke up to find a nasty rash of “red pinprick marks” on her bottom. 
   
   Soon her husband broke out with the same rash in the same unfortunate place. 
   
   While they received treatment in Martinique in the form of steroid cream, antibiotics and antifungal medication, the irritation did not subside. The voyage home, 10 days on a cruise ship, must have been uncomfortable. 
   
   Nor was the rash gone when they got home. 
   
   So they went for treatment at Addenbrooke’s Hospital in Cambridge, England. Doctors there found their backsides “infested by worms,” as the Cambridge News reported. The couple found relief from a combination of medications. 
   
   The doctors thought their case so interesting they wrote it up for the British Medical Journal. The journal did not use the name of the patients. But as journals often do in case studies, it accompanied the text with photos — in this case, of their backsides, from different angles, in full color. 
   
   The couple gave their permission and were warned that journal articles were often read by journalists as well as medical professionals, the BMJ said in an email to The Washington Post. But the couple apparently had not anticipated the potential for tabloid interest. 
   
   By mid-January, their buttocks were spread across Britain and, indeed the world, with headlines such as “Til Rash Do Us Part” in The Sun and “Caribbean getaway leaves a nasty souvenir” in the Daily Mail. 
   
   These were not your typical titillating tabloid photos. They were shots from various distances of behinds bearing inflamed red blotches. 
   
   Many tabloid readers found them gross. 
   
   “A description would have done,” commented one reader of Britain’s Daily Mail, adding that “we didnt need to see the evidence.” 
   
   “Does the DM pixelator have a day off today?!?,” wrote another. 
   
   “Thanks — that’s put me right off my cheese & ham toastie,” wrote a third. 
   
   Like the journal article, the stories did not include the names of the patients or say where they lived or when they visited Martinique. 
   
   But there was enough information — the age of the woman, the island, the cruise, the hospital — that the couple apparently felt that acquaintances conceivably could have made the connection. 
   
   One of the patients — the journal didn’t say which one — got in touch with BMJ and “explained that they were concerned about being identified by close friends and/or colleagues, as a result of the subsequent media coverage,” the publication said in a statement emailed to The Post. 
   
   “Prior to publication of the article, written consent from the patient was obtained,” said the statement. “By signing the consent form, the patient indicated their understanding that complete anonymity could not be guaranteed and it was also made clear in the consent form that BMJ publications are viewed by many non-doctors, including journalists.” 
   
   “The patient’s concerns did not amount to a legal threat,” it added. “… Nevertheless, the journal took the editorial decision to remove the article, because of the distress the patient had suffered. 
   
   ” … To be clear, the removal of the article does not amount to a retraction and the journal stands by its factual content.” 
   
   A spokesman for the hospital, part of Cambridge University Hospitals, also issued a statement: “The case study was shared with the BMJ with the aim of medical advancement, to aid other clinicians, and potentially help the treatment of future patients with similar conditions. Because the article was being picked up in nonmedical publications, a request was made for it to be removed.” 
   
   In fairness to the tabloids, there was some news and public service value to the stories useful to people planning on visits to tropical or subtropical beaches. 
   
   The diagnosis, as described by Livescience, quoting the no-longer-accessible case study, was “cutaneous larva migrans,” otherwise known as a hookworm infection. 
   
   According to the Centers for Disease Control and Prevention, people pick up this nasty parasite from the feces of dogs and cats. If those dogs and cats leave their waste on a beach, sunbathers can contract the infection. 
   
   In the case of the British couple, the infection found its way into their lungs, causing coughing, and in the woman, shortness of breath and pain. 
   
   The advice from the CDC for those visiting such beaches: “wear shoes and use protecting mats or other coverings to prevent direct skin contact with sand or soil.” 
   
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target: – After suffering painful red rashes on their backsides, a husband and wife were left red in the face—so much so that a case study of their ordeal has now been pulled from the prestigious British Medical Journal. As BMJ tells the Washington Post, the British pair whose bottoms became infested with hookworm larvae on a beach in Martinique initially agreed to the Jan. 13 publication of their case, as well as photos of "red pinprick marks" on their backsides. Though their names were never mentioned, the pair "indicated their understanding that complete anonymity could not be guaranteed" and were warned journalists might pick up the story, BMJ says. But when that happened—with headlines like "His and Her Hookworm: Same Rash Strikes Couple on the Rear"—the pair had a change of heart. With the spread of photos and case details—including the woman's age, the couple's Caribbean destination, the cruise line on which they traveled, and the Cambridge hospital they visited—one of the pair asked that the article be withdrawn over concerns "about being identified by close friends and/or colleagues," BMJ says. In what the Post calls a "highly unusual 'correction,'" the journal then announced it was pulling the article despite standing by its content. As the Independent reports, the article was meant to helpful in combating a lack of familiarity in the medical community with hookworm infections. According to the CDC, such infections can be passed through contact with soil or sand contaminated with feces. As the BMJ study explained, the British couple were infected when they sat on a sandy, and apparently unsanitary, beach.