[Systemic toxocariasis in the adult patient]

We report a retrospective review of eight patients (one male), aged 19 to 31 years old, with systemic toxocariasis (visceral larva migrans), seen at the Salvador Hospital of Santiago. Four cases had heart involvement, three had lung involvement and in two, several organs were affected. Seven cases had leukocytosis (range 14, 5 to 160 x 10(9)/l) and all had eosinophilia (35 to 90%). Serum ELISA titers for Toxocara sp were positive in all cases, ranging from 64 to 1000. Six patients were treated with thiabendazole and one with albendazole. Steroids or hydroxiurea were administered to patients with heart failure or hyperleukocytosis. Subjects with lung involvement recovered quickly but those with cardiac compromise had a partial recovery with frequent decompensations of their cardiac failure and one death. Eosinophilia lasted up to 20 years, in spite of specific treatment. We emphasize the importance of infection prevention, accuracy of diagnosis and the severity of cardiac damage in the adult patient.

Hepatic granulomas due to visceral larva migrans in adults: appearance on US and MRI

Visceral larva migrans is a syndrome characteristically involving children with a history of pica, and usually presents with fever, abdominal pain, tender hepatomegaly, and hypereosinophilia. Hepatic granulomas of visceral larva migrans are rare in adults. We describe three adult patients with hepatic lesions which on histopathology demonstrated characteristic granulomas of visceral larva migrans. All patients had abdominal sonograms and two had additional MR scans of the liver. Both ultrasound and magnetic resonance imaging demonstrated characteristic appearances which have not been described previously (viz., ill-defined central necrotic areas surrounded by concentric thick walls and perifocal edema in the liver parenchyma).

Clinical and laboratorial features of visceral toxocariasis in infancy

Forty children with a diagnosis of Visceral Toxocariasis were evaluated prospectively from February 1982 to June 1989. Diagnosis was established by clinical, laboratory and serological (ELISA - ES Toxocara canis antigen) evaluations. A great clinical polymorphism was found in our patients, ranging from unspecific or absent manifestations to an exuberant symptomatology. The laboratory findings were: leukocytosis, eosinophilia and elevation of serum gammaglobulin and isohemagglutinin levels. No significant relationship between clinical findings and laboratory parameters was found. Serology (ELISA) was a method of great diagnostic support but did not show a correlation with clinical and laboratory findings in this study. There was a significant relationship between pulmonary manifestations and the presence of signs and/or symptoms, when the patients were sent to us. Our findings, especially the high incidence of pulmonary manifestations, suggest that Visceral Toxocariasis has to be included in the differential diagnostic of children with pulmonary manifestations, characteristic epidemiological data and associated eosinophilia.

[Rheumatologic aspects of toxocariasis (visceral Larva migrans). Apropos of 2 cases]

Visceral Larva migrans is a human infection by the larvae of dog ascarids or, more rarely, ascarids of other animal species. It is endemic in France. Two cases which respectively manifested as acute oligoarthritis and inflammatory myalgia with increased muscle enzyme levels are reported. Manifestations of the minor forms of this infestation are reviewed.

A case of ileus caused by a spiruroid nematode

A 34-year-old male living in Aichi Prefecture, Japan, complained of lower abdominal pain. Ileus was suspected based on his clinical history and symptoms, and a laparotomy was performed. Four sections of a nematode were found in a large eosinophilic granuloma in the intestinal wall, and were identified as the larva of a spiruroid nematode. This is the third reported case of a spiruroid nematode infection found in the ileum.

Acute eosinophilic pneumonia due to toxocariasis with bronchoalveolar lavage findings

A previously healthy young man presented with breathlessness, diffuse pulmonary infiltrates on the chest x-ray film, and a high degree of peripheral blood eosinophilia. Analysis of bronchoalveolar lavage (BAL) fluid showed 64 percent eosinophils. A diagnosis of toxocariasis was eventually reached on the basis of a positive enzyme-linked immunosorbent assay (ELISA) for Toxocara canis. The routine performance of the ELISA test for Toxocara in the diagnostic approach to pulmonary infiltration with eosinophilia could reveal an undetermined, sometimes unsuspected, number of cases of adult toxocariasis with pulmonary involvement. A high degree of eosinophilia in the differential cell count of BAL fluid may eventually prove to be a useful clue in favor of such a diagnosis.

Visceral larva migrans in seven members of one family in Trinidad

The occurrence of the first seven cases of visceral larva migrans in Trinidad and Tobago is described. All cases occurred in children of the same family. The ELISA test was used to confirm the clinical diagnosis.

[Inflammatory joint disease as a manifestation of Toxocara canis larva migrans]

We report a case of migrating joint involvement occurring as the first manifestation of Toxocara canis larva migrans. We also reviewed the literature on joint disease caused by parasitic infections. Diagnostic criteria are described. We suggest that an immunoallergic mechanism is involved. Furthermore, the therapeutic trial with thiabendazole contributed usefully to the diagnosis in our patient.

[Visceral larva migrans. Report of 3 cases]

We report three cases of children with visceral larva migrans confirmed by enzyme-linked immunosorbent assay (ELISA), in Goiânia. Pulmonary interstitial infiltrates with dry cough and peripheral eosinophilia characterised the first case. Clinical and laboratorial finding in the second case included dry cough, pulmonary infiltrates, peripheral eosinophilia and hypergammaglobulinaemia. A persistent eosinophilia, between 1987-1989, without apparent cause led to the confirmation of parasite infection in the third case.

[Ocular toxocariasis. Apropos of a case]

We report a case of ocular toxocariasis characterized by the global involvement of both eyes. Ophthalmologic evaluation demonstrated involvement of the cornea, iris and lens, an inflammatory granuloma, and hyalitis. Immunologic tests were negative in the serum and positive in the aqueous humor. IgE levels were higher in the aqueous humor than in the serum, suggesting local antibody production. The patient also had iron deficiency anemia and atrophy of the intestinal mucosa that resolved after treatment of the iron deficiency.

Acute transient myositis due to Toxocara

Two children presented with spontaneous, isolated swelling of the lower half of the left leg; this was diagnosed as acute myositis of unknown aetiology. Further investigations showed antibodies to Toxocara. The symptoms resolved within 72 hours and the children were discharged on no treatment.

Presumed Toxocara canis with peripheral retinal granuloma and secondary macular hole

Ocular manifestations of a presumed parasitic infection Toxocaris canis were discovered in the eye of a 53-year-old male presenting for a routine examination. Current serologic and skin tests were of little value in establishing the diagnosis, although the ELISA immunosorbent agglutination serologic test was helpful but not definitive. The clinician therefore was forced to diagnose this disease based on the characteristic clinical findings.

Clinical features of covert toxocariasis

The clinical features found in 14 children with toxocara ELISA titres of greater than or equal to 0.7 were compared with those found in 34 toxocara negative children. Blood eosinophils were elevated in 7 of the 14 patients and the highest eosinophilia was 14%. There was a highly significant association between hepatomegaly, cough, sleep disturbance and a raised titre (p less than 0.01). Behaviour disturbance, abdominal pain and headache were also significantly associated with a raised titre (p less than 0.05). The combination of abdominal pain, headache and cough was even more significantly associated with a high titre (p less than 0.0005) than were individual clinical features. It is suggested that in addition to the two well recognised clinical conditions of visceral larva migrans and ocular toxocariasis the clinical entity of covert toxocariasis should receive recognition. Eosinophilia may or may not be present in this condition.

Neuroretinitis in presumed visceral larva migrans

Neuroretinitis is a rate manifestation of toxocariasis that can occur as a late sequelae to the active disseminated phase of the disease visceral larval migrans (VLM). This case report describes a 14-year-old boy who developed VLM and concurrent neuroretinitis. During the acute illness, the patient's serum ELISA titer to Toxocara canis rose to greater than 256 and a lymph node biopsy revealed necrotizing lymphadenitis with eosinophilia. The constitutional symptoms of VLM may be mild and easily overlooked in children. Toxocariasis is an important diagnostic consideration in persons with acute neuroretinitis, since medical treatment may alter its course.

Toxocara canis infection: clinical and epidemiological associations with seropositivity in kindergarten children

To determine epidemiological and clinical associations with Toxocara canis seropositivity, we studied 333 (87%) children of a cohort of 383 five- to seven-year-olds. The prevalence of seropositivity (antibody titer to T canis, greater than or equal to 1:32) was 23.1%. Black children were more frequently seropositive than were white children, as were children of parents who did not graduate from high school. In a sample of seropositive and seronegative children, seropositivity was associated with both a history of pica and puppy ownership, but not with a greater frequency of symptoms and signs that occur in visceral larva migrans or with poor growth. No child had evidence of ocular toxocariasis on retinal examination. For the whole sample, poor reading achievement, marked distractibility, and lower intelligence were associated with seropositivity, but by using multiple regression analysis, we found that these associations may be attributable to confounding variables.