Highlights of human toxocariasis

A two-step morphology-PCR strategy for the identification of nematode larvae recovered from muscles after artificial digestion at meat inspection

To ensure that meat from livestock and game is safe for human consumption, European legislation lays down rules for mandatory testing. Helminth larvae are a category of zoonotic foodborne pathogens that can contaminate meat. Among helminths, the only zoonotic nematode regulated in Europe regarding meat inspection is Trichinella spp.. It is precisely during Trichinella testing that other potentially zoonotic larvae can be found. Due to current lack of tools, their identification is often very complicated. Nematode larvae other than Trichinella, recovered from artificial digestions of pig and wild boar muscles from France and Germany, were subjected to a newly developed two-step identification scheme, which includes both morphological examination and molecular assays. The first step is a general orientation towards a broad taxonomic group; the second step consists of targeted identification based on the results of first step. Different parasites were identified, some of which were not zoonotic such as Metastrongylus spp. and Angiostrongylus vasorum, but others are known to be zoonotic such as Toxocara cati, Ascaris suum, and Uncinaria stenocephala. The strategy is efficient for the identification of nematode larvae recovered from muscles but could also be applied for larvae from other sources.

A Systematic Review and Meta-analysis of Toxocariasis in Iran: Is it Time to Take it Seriously?

BACKGROUND

Toxocariasis is one of the neglected zoonosis with considerable public health importance around the world. The current study aimed to elucidate the overall prevalence of Toxocara infection in human and definitive hosts and also the contamination of soil and raw vegetables with the ova of these parasites, in Iran, using systematic review and meta-analysis.

METHODS

Six English and Persian databases were explored from 2000 to 2017 using the terms toxocariasis, Toxocara spp., visceral larva migrans, Iran, epidemiology, and prevalence. This meta-analysis conducted using STATA, and for all statistical tests, a p value less than 0.05 was considered significant. The random-effects model was used to the report of the pooled prevalence with a 95% confidence interval (CI).

RESULTS

The pooled prevalence of toxocariasis in human was calculated as 11% (95% CI 8-13%). In terms of definitive hosts, the pooled prevalence of Toxocara infection in dogs and cats were calculated as 17% (95% CI 14-20%) and 37% (95% CI 26-48%), respectively. Also, the pooled prevalence of Toxocara spp. eggs in the soil and raw vegetable samples were calculated as 18% (95% CI 13-23%) and 2% (95% CI 1-3%), respectively.

CONCLUSIONS

The results of current study demonstrate that toxocariasis should be taken more seriously by health authorities. Implementing an appropriate control program is necessary to reduce the incidence of this disease in Iran.

An Integrated Study of Toxocara Infection in Honduran Children: Human Seroepidemiology and Environmental Contamination in a Coastal Community

(1) Background: Infections caused by Toxocara canis and T. cati are considered zoonoses of global importance. Reports from North and South America indicate that human infections are widespread in both continents, but epidemiological information from Central America is still lacking. (2) Methodology: In the present cross-sectional multi-year study, we aimed to undertake the first seroepidemiological and environmental study on toxocariasis in Honduras. This included the determination of seroprevalence of anti-Toxocara spp. antibodies in children using a Toxocara spp. purified excretory-secretory antigens enzyme-linked immunosorbent assay (TES-ELISA) and a confirmatory Western blot. As well, through statistical analysis including logistic regression we aimed at identifying relevant biological and epidemiological factors associated with seropositivity. The study also entailed detection of parasites' eggs in the soil samples both through Sheather's concentration method and a nested polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. (3) Results: The study was undertaken in a coastal community of Honduras in 2 different years, 2015 and 2017. A total of 88 healthy schoolchildren completed the study, with participation of 79% (73/92) and 65% (46/71) of the student body in 2015 and 2017, respectively. Thirty-one children participated in both years (i.e., dual participants). Through both serological tests, seropositivity was confirmed in 88.6% (78/88) of children. Due to the high number of seropositives, logistic regression analysis was not possible for most socio-economic and epidemiological variables. Eosinophilia, on the other hand, was associated with seropositivity, independently of other intestinal helminthic infections. Continued seropositivity was observed in most of the dual participants, while seroconversion was determined in 8 of these children. Microscopic examination of soil samples did not yield any positive results. Through nested PCR-RFLP, 3 of the 50 samples (6%) were positive for Toxocara spp.; two were identified as T. canis and one as T. cati. (4) Conclusions: This work documents for the first time, high levels of human exposure to Toxocara spp. in Honduras. These findings, along with the country's favorable epidemiological conditions for this zoonosis, emphasize the need for more research to determine whether this infection is underreported in the country.

Prevalence of toxocariasis and its related risk factors in humans, dogs and cats in northeastern Iran: a population-based study

BACKGROUND

Toxocariasis is one of the most common zoonotic infections in dogs and cats. The objectives of this study were to determine the prevalence of anti-Toxocara antibodies and identify the epidemiological and clinical features and related risk factors of toxocariasis in the general population along with the prevalence of this infection in dogs and cats in northeast Iran.

METHODS

In this cross-sectional study, anti-Toxocara antibodies from 1150 urban and rural participants were examined using a commercial enzyme-linked immunosorbent assay. In addition, the stool specimens of 538 dogs and 236 cats were tested using the formalin-ether concentration technique. Sociodemographic data and related risk factors were collected using a structured questionnaire and the data on clinical manifestations were obtained from personal health records.

RESULTS

Anti-Toxocara antibodies were detected in 7.2% (83/1150) of the study population. Risk factors for seropositivity based on multivariable analysis were younger age (p=0.019), living in rural areas (p=0.048), occupations with high exposure risk to toxocariasis (p=0.001), contact with dogs or cats (p=0.003), contact with soil (p=0.001), history of geophagy (p=0.001) and the consumption of raw or undercooked liver (p=0.001). The prevalence of symptoms such as asthma, shortness of breath, blurred vision, abdominal pain and epilepsy were significantly higher in seropositive individuals compared with seronegative ones. Toxocara eggs were found in 15.1% (81/538) of dogs and 34.7% (82/236) of cats. A significant relationship was found between infection in dogs and cats and age, type, place of residence and anthelmintic consumption.

CONCLUSIONS

Identification of anti-Toxocara antibodies in the general population and the presence of confirmed infections in dogs and cats indicates exposure to Toxocara infection as a public health problem in northeast Iran.

Frequency of enteroparasitic infections and serum positivity for Toxocara spp. in children from a public day care center in Southern Brazil

INTRODUCTION

Day care centers play an important social role in children's early education and development. The objective of this study was to investigate the frequency of intestinal parasitic infections and infection with Toxocara spp. in children from a day care center in the city of Rio Grande, Rio Grande do Sul, Brazil. Methods: The study was conducted using fecal samples from 50 children, ages three to six years, using Ritchie, Faust, Rugai, and Kinyoun's techniques. A closed and structured epidemiological questionnaire was used to collect data from the parents/guardians of the children. Serological studies for detection of antibodies to Toxocara spp. by immunoenzymatic assays using Toxocara excretion and secretion antigen (TES) were conducted on sera collected from 41 children. Results: The frequency of enteroparasites was 18%, with 43.9% of the children testing seropositive for Toxocara spp. Low family income and low literacy levels of parents/guardians were common factors between the families of the parasite-positive children. For the children who tested positive for Toxocara spp., most of the parents/guardians reported using only water for sanitizing raw vegetables and fruits. Conclusions: The high seropositivity rates for Toxocara spp. indicate that children were exposed to this parasite, and it is important to reduce the risk of infection. In addition, the seropositivity for enteroparasites and the interviews with the parents/guardians indicate the need to educate the studied population regarding the modes of intestinal parasite transmission and the prophylactic measures needed to prevent their dissemination.

Human toxocariasis and atopy

To assess the possible influence of atopy on the clinical picture of human toxocariasis, a retrospective study was carried out using file records for patients who attended the Outpatient Clinic of Parasitology in Toulouse University Hospitals. A total of 106 file records for patients who had been diagnosed with common/covert toxocariasis were extracted from the database. Forty-nine patients (20 females and 29 males) were considered atopic since they exhibited a long (≥ 1 year) history of various allergic issues along with a titer ≥ 0.7 kIU/L for specific IgE against at least two out of nine mixes of common inhalant allergens. Fifty-seven patients (42 females and 15 males) were designated nonatopic on the basis of a negative result (<0.35 kIU/L) of the test for specific IgE. Demographic (age and sex), clinical (20 signs or symptoms) and laboratory (blood eosinophil count, eosinophil cationic protein, serum total IgE, and specific anti-Toxocara IgE) variables were investigated by bivariate analysis followed by multivariate regression analysis using "atopy" as the outcome variable. On the basis of our results, the clinical or laboratory picture of toxocaral disease was not affected by the presence of an atopic status.

Urticaria and silent parasitism by Ascaridoidea: Component-resolved diagnosis reinforces the significance of this association

Urticaria remains a major problem in terms of aetiology, investigation, and management, and although parasitic diseases are considered potential causes, the absence of a consistent link between parasitic infections and skin allergy symptoms leads to the need for a deeper study of parameters that support this association. The objectives of this study were to analyse a possible relationship between parasitism by Ascarididae (Toxocara canis and Anisakis simplex) and the clinical expression of urticaria and to identify possible parasitic molecular markers for improving the diagnosis of unknown urticaria aetiology. The prevalence of Toxocara and Anisakis infestations was evaluated by measuring the levels of specific IgG (sIgG) and IgE (sIgE) antibodies against crude extracts and isolated components from whole larvae of Anisakis simplex (Ani s 1, Ani s 3 and Ani s 7) and Toxocara canis (TES-120, TES-70, TES-32 and TES-26) using immunologic and molecular diagnostic methods. A cross-sectional study was performed in a group of 400 individuals. The study group consisted of 95 patients diagnosed with urticaria (55 with chronic urticaria and 40 with acute urticaria). A control group consisted of 305 subjects without urticaria (182 diagnosed with respiratory allergy and 123 without allergy). Statistically significant differences were demonstrated in the seroprevalence of specific IgG and IgE antibodies between the urticaria patients and the healthy general population when isolated ascarid antigens were evaluated. The prevalence of IgG antibodies against Ani s 1, IgE antibodies against TES-120 and IgE antibodies against TES-70 were significantly different between the control individuals (healthy general population) and patients with urticaria. Moreover, the urticaria patient group demonstrated a higher seroprevalence of antibodies (sIgE and sIgG) against Anisakis simplex larva whole extract than the control group but just with statistically diferences when sIgE was evaluated. The presence of IgE and/or IgG antibodies against Ani s 3 (tropomyosin) can help to discriminate between patients with and without urticaria. Both ascarids seem to be associated with urticaria, although in our region, Anisakis seems to have greater involvement than Toxocara in this relationship. Molecular diagnostics can be used to associate urticaria with parasite infestations. Tropomyosin and Ani s 1 were the most relevant markers to demonstrate the association between urticaria and the most relevant Ascarididae parasites in our region.

Seroprevalence of Larval Toxocarosis in the Czech Republic

BACKGROUND

Larval toxocarosis (LT), a zoonotic disease transmitted by dogs, cats, and other carnivores, is caused by roundworms of the genus Toxocara. Humans become infected by ingesting embryonated eggs of this parasite. In this study, we present data on the seroprevalence of LT in the Czech Republic collected by the National Reference Laboratory for Tissue Helminthoses in 2012-2016.

METHODS

Using enzyme-linked immunosorbent assay, a total of 4428 adults and children with or without clinical symptoms were examined for the presence of IgG antibodies against Toxocara canis excretory-secretory antigens.

RESULTS

Of all the persons examined, specific Toxocara antibodies were detected in 160 (3.6%) individuals. There were, however, significant differences between various regions, with seropositivity rates ranging from 1.4 to 7.5%.

CONCLUSION

In comparison to studies from 1998 and 2004, our results suggest a decrease in overall Toxocara seroprevalence in the Czech population, whereby the rates are similar to or even lower than rates in some other Central European countries.

Toxocariasis and the clinical spectrum

Toxocara canis and T. cati are among the most widely distributed helminthic species in the world with a high zoonotic impact. Millions of people are infected^a and hundreds of thousands are suffering from toxocarosis, a disease encompassing four different entities: larva migrans visceralis (VLM) syndrome, ocular larva migrans (OLM) syndrome, covert toxocarosis (covT), common toxocarosis (comT) and neurotoxocarosis (NT). Toxocara infections in humans may remain clinically inapparent but may also induce severe diseases. This contribution gives a synoptic overview of the most important historical, clinical, diagnostic and therapeutical aspects of toxocarosis in humans.

Serodiagnostic methods for diagnosing larval toxocariasis

Toxocariasis is a human infection primarily caused by larvae of Toxocara canis from dogs, and also by T. cati from cats. Children have a more significant risk of acquiring the infection due to their closer contact with pets, and greater chances of ingesting soil. Diagnosis of toxocariasis is based on clinical, epidemiological, and serological data. Indirect IgG ELISA is a widely used serodiagnostic method for toxocariasis, with native T. canis TES most commonly used as the antigen. Western blots, using the same antigen, can be used to confirm positive ELISA findings to reduce false-positive results. Improvements in Toxocara serodiagnosis include the use of recombinant TES antigens, simpler and more rapid assay formats, and IgG4 subclass detection. Also, incorporation of recombinant T. cati TES protein increases the diagnostic sensitivity. Development of antigen detection tests using polyclonal and monoclonal antibodies, nanobodies, or aptamers can complement the antibody detection assays, and enhance the effectiveness of the serodiagnosis.

Pathogenesis of cerebral toxocariasis and neurodegenerative diseases

Toxocara canis belongs to one of zoonotic parasites that commonly infects canines worldwide, and its eggs in host faeces may contaminate the food, water, soil and their fur as well as the larvae entrapped in the granuloma can infect paratenic hosts including mice and humans. Survivability of T. canis embryonated eggs under moist, cool conditions may be as long as 2-4 years or more. In paratenic hosts such as mice and humans, T. canis L3 larvae neither moult, grow, nor replicate and will wander through a number of internal organs in humans so as to cause Th2-dominant pathology in various internal organs as leading to neurotoxocariasis (NT), ocular toxocariasis (OT), or visceral larva migrans (VLM). Although the systemic immune response to T. canis has been widely reported, the immune response in the brain has received little attention. Differential cytokine expression and other brain injury-associated biomarkers or neurodegeneration-associated factors have been observed in infected versus uninfected outbred and inbred mice. Preliminary data have also suggested a possible link between significant memory impairment and cytokine production associated with T. canis infection in the hippocampus which has been long recognised as being responsible for learning and memory functions. Notably, it remains an enigma concerning cerebral invasion by T. canis larvae rarely induces a recognisable neurological syndrome or its involvement in neuropathological disorders in humans. Exploration of the relationship between host and parasite in the brain may elucidate the cryptic symptoms of human cerebral toxocariasis, with patients presenting with mental retardation, epilepsy, neurodegeneration and other central nervous system (CNS) disorders.

Clinical pathology of larval toxocariasis

Human toxocariasis is a worldwide helminth zoonosis caused by roundworms of the genus Toxocara. Toxocariasis is the most common helminth infection in many countries. Disease caused by Toxocara can be classified into five clinical forms: generalised, neurological, ocular, covert, and asymptomatic. The clinical pathology of toxocariasis largely depends on the form of infection, the intensity of the infection, the larvae localisation, and the age of the host. Because histological and molecular examination of toxocariasis is limited by difficulties in obtaining material to analyse, clinical diagnosis is often based on nonspecific tests, such as the detection of eosinophilia and hyperimmunoglobulinemia E (Hyper-IgE). Specific analysis uses an initial ELISA test to detect anti-Toxocara IgG and requires confirmation for all positive results via Western blot. This strategy does not distinguish between actual and recent infections, making the monitoring of disease a challenge for clinicians. Additional research will be required to distinguish active disease from the presence of recent infection.

Current epidemic situation of human toxocariasis in China

Toxocariasis is a worldwide-distributed helminthic zoonosis, which mainly results from ascarid nematodes Toxocara canis and Toxocara cati. Humans become infected by accidental ingestion of infective eggs, raw or undercooked meat containing larvae. Keeping and contacting cats and dogs, and bad hygiene situations or habits are the main risk factors for Toxocara infection in China. The seroprevalence of Toxocara spp. is reported from 12.14% to 44.83%, and the overall seroprevalence in children was 12.14% in 1993 and elevated to 19.3% in 2015. Among the 103 cases reported in China during 1983-2019, ocular larva migrans (OLM), visceral larva migrans (VLM), and neural larva migrans (NLM) occupied 92.23%, 6.80%, and 0.97% of cases, respectively. The diagnosis of toxocariasis is mainly based on the history of exposure to infective eggs or larvae, clinical manifestations, laboratory examinations, and imaging studies. As most individuals who are infected with larval Toxocara, are unaware of their infections, patients with mild signs as described under covert toxocariasis (CT) can recover spontaneously, and treatment may not be necessary. Albendazole is the preferred treatment for patients with VLM; steroids, such as prednisolone combined with albendazole, are frequently used in treating patients with OLM, and surgery serves as an alternative treatment; thiabendazole is effective in treating patients with NLM. The true number of cases and prevalence of toxocariasis in China seems to be underestimated and neglected because of the lack of population-based epidemiological studies and insufficient clinical awareness of this disease, which are aspects that need to be improved by the Chinese government.

Seroprevalence estimates for toxocariasis in people worldwide: A systematic review and meta-analysis

Background

Human toxocariasis is an important neglected disease. We performed a systematic review and meta-analysis study to estimate the global and regional prevalence of anti-Toxocara serum antibodies (referred to as ‘T-seroprevalence’) in human populations around the world.

Methods

We searched five international databases (PubMed, EMBASE, Web of Science, SciELO and Scopus) for seroprevalence studies published from 1 January 1980 to 15 March 2019. We used random effect models to calculate the overall T-seroprevalence (with 95% CIs) in all six WHO regions and worldwide. We also conducted subgroup and linear meta-regression analyses to evaluate the impact of socio-demographic, geographical and climatic parameters on seroprevalence.

Results

We identified 250 eligible studies (253 datasets) comprising 265,327 participants in 71 countries for inclusion in the present meta-analysis. The estimated global T-seroprevalence rate was 19.0% (95%CI, 16.6–21.4%; 62,927/265,327); seroprevalence was highest in the African region (37.7%; 25.7–50.6%) and lowest in the Eastern Mediterranean region (8.2%; 5.1–12.0%). The pooled seroprevalence for other WHO regions was 34.1% (20.2–49.4%) in the South-East Asia; 24.2% (16.0–33.5%) in the Western Pacific; 22.8% (19.7–26.0%) in the American; and 10.5% (8.5–12.8%) in the European regions. A significantly higher T-seroprevalence was associated with a lower income level; lower human development index (HDI); lower latitude; higher humidity; higher temperature; and higher precipitation (P-value < 0.001). Potential risk factors associated with seropositivity to Toxocara included male gender; living in a rural area; young age; close contact with dogs, cats or soil; consumption of raw meat; and the drinking of untreated water.

Conclusions

The present findings indicate high levels of infection with, or exposure to Toxocara spp. in many countries, which calls for increased attention to human toxocariasis and improved measures to prevent adverse health risks of this disease.

There have been many epidemiological studies on the seroprevalence of Toxocara infection or toxocariasis in humans in individual countries, but there has been no systematic review/meta-analysis to estimate the extent of Toxocara infection or exposure in human populations worldwide. By reviewing 250 studies of 265,327 people from 71 countries, we provide the first comprehensive global estimates of T-seroprevalence in humans to date. The findings indicate that almost one fifth (19%) of the world’s human population is seropositive to Toxocara. The highest seroprevalence rates were found in Africa (37.7%) and the lowest in the Eastern Mediterranean region (8.2%). Individual countries with high HDIs and high income levels usually had low T-seroprevalence rates. Our findings also showed that T-seroprevalence varies markedly among countries, according to geographical location (coordinates) and climatic features. Evidence from this study indicates that human toxocariasis is a prevalent, neglected tropical disease and potentially one of major importance to global public health. Our study emphasizes the need for governmental authorities to pay increased attention to the risks and socioeconomic impact of HT in many countries around the world, and for them to design and implement HT prevention or control programs, considering risk predictors identified here.

Associations of mental disorders and neurotropic parasitic diseases: a meta-analysis in developing and emerging countries

BACKGROUND

Although they are declining worldwide, neurotropic parasitic diseases are still common in developing and emerging countries. The aim of this study was to estimate the pooled prevalence and pooled association measures of comorbidities between mental disorders (anxiety, depression, bipolar disorder, and schizophrenia) and neurotropic parasitic diseases (malaria, cysticercosis, toxoplasmosis, human African trypanosomiasis, Chagas disease, and human toxocariasis) in developing and emerging countries.

METHODS

As the first meta-analysis on this topic, this study was performed in accordance with PRISMA guidelines. The protocol was registered in PROSPERO (N°CRD42017056521). The Medline, Embase, Lilacs, and Institute of Epidemiology and Tropical Neurology databases were used to search for articles without any restriction in language or date. We evaluated the quality of studies independently by two investigators using the Downs and Black assessment grid and pooled estimates using the random-effects method from CMA (Comprehensive Meta Analysis) Version 3.0.

RESULTS

In total, 18 studies published between 1997 and 2016 met our inclusion criteria. We found that the prevalence of anxiety and depression in people suffering from Chagas disease and/or neurocysticercosis was 44.9% (95% CI, 34.4-55.9). In 16 pooled studies that included 1782 people with mental disorders and 1776 controls, toxoplasmosis and/or toxocariasis were associated with increased risk of schizophrenia and/or bipolar disorders (odds ratio = 2.3; 95% CI, 1.7-3.2). Finally, toxocariasis and/or toxoplasmosis were associated with an increased risk of the onset of schizophrenia (odds ratio = 2.4; 95% CI, 1.7-3.4).

CONCLUSION

Our pooled estimates show that the associations between diseases studied are relatively high in developing and emerging countries. This meta-analysis supports the hypothesis that toxoplasmosis could be the cause of schizophrenia. These findings could prove useful to researchers who want to further explore and understand the associations studied.

Larval distribution, migratory pattern and histological effects of Toxocara canis in Rattus norvegicus

The common dog roundworm Toxocara canis can infect other animals and humans which may act as their paratenic and accidental hosts, respectively. Larvae do not further develop to adult worms in these hosts. Instead, they undergo migration to various body organs, causing the neglected parasitic disease known as toxocariasis. Although rats are considered as potential paratenic hosts of the parasite, there are only few studies which utilized Rattus norvegicus (Sprague-Dawley strain) for experimental infections involving toxocariasis. This study aimed to determine whether T. canis could establish in Sprague-Dawley rats artificially infected with 500 T. canis embryonated eggs and if the animals can be used as animal models for toxocariasis. Following squash method and tissue digestion, larvae were recovered from the lungs, liver and brain of the infected rats. Furthermore, gross examination of organs revealed macroscopic lesions and hemorrhages in the lungs and brain. Microscopically, accumulation of inflammatory cells, thickening of alveoli lining and destruction of bronchial walls and hepatic necrosis were observed. This study showed that T. canis has established in Sprague-Dawley rats and could serve as a model for Toxocara infection studies.

Multiplex profiling of inflammation-related bioactive lipid mediators in Toxocara canis- and Toxocara cati-induced neurotoxocarosis

Background

Somatic migration of Toxocara canis- and T. cati-larvae in humans may cause neurotoxocarosis (NT) when larvae accumulate and persist in the central nervous system (CNS). Host- or parasite-induced immunoregulatory processes contribute to the pathogenesis; however, detailed data on involvement of bioactive lipid mediators, e.g. oxylipins or eico-/docosanoids, which are involved in the complex molecular signalling network during infection and inflammation, are lacking.

Methodology/Principal findings

To elucidate if T. canis- and T. cati-induced NT affects the homeostasis of oxylipins during the course of infection, a comprehensive lipidomic profiling in brains (cerebra and cerebella) of experimentally infected C57BL/6J mice was conducted at six different time points post infection (pi) by liquid-chromatography coupled to electrospray tandem mass spectrometry (LC-ESI-MS/MS). Only minor changes were detected regarding pro-inflammatory prostaglandins (cyclooxygenase pathway). In contrast, a significant increase of metabolites resulting from lipoxygenase pathways was observed for both infection groups and brain regions, implicating a predominantly anti-inflammatory driven immune response. This observation was supported by a significantly increased 13-hydroxyoctadecadienoic acid (HODE)/9-HODE ratio during the subacute phase of infection, indicating an anti-inflammatory response to neuroinfection. Except for the specialised pro-resolving mediator (SPM) neuroprotectin D1 (NPD1), which was detected in mice infected with both pathogens during the subacute phase of infection, no other SPMs were detected.

Conclusions/Significance

The obtained results demonstrate the influence of Toxocara spp. on oxylipins as part of the immune response of the paratenic hosts. Furthermore, this study shows differences in the alteration of the oxylipin composition between T. canis- and T. cati-brain infection. Results contribute to a further understanding of the largely unknown pathogenesis and mechanisms of host-parasite interactions during NT.

Neurotoxocarosis (NT) is induced by larvae of the zoonotic roundworms Toxocara canis and T. cati migrating and persisting in the central nervous system of paratenic hosts, and may be accompanied by severe neurological symptoms. Toxocara spp. are known to modulate the hosts’ immune response, but data concerning involvement of signalling molecules are lacking. An important class of mediators participating in the complex molecular signalling network during infection and inflammation are bioactive regulatory lipids, derived from arachidonic acid and other polyunsaturated fatty acids. For a better understanding of inflammatory processes in the brain during an infection with Toxocara spp., a comprehensive analysis of regulatory lipids was conducted. The infection was predominantly characterised by only minor changes in the pattern of pro-inflammatory oxylipins, while anti-inflammatory metabolites, derived from lipoxygenase pathways, were significantly elevated in the subacute phase as well as in the beginning of the chronic phase of infection. This trend was also reflected in the 13-HODE/9-HODE ratio, a biomarker for the immunological status of an active infection. Obtained data provide a valuable insight in the host’s immune reaction as response against neuroinvasive Toxocara spp.-larvae, contributing to the characterisation of the mostly unknown pathogenesis of NT.

Cytokine production and signalling in human THP-1 macrophages is dependent on Toxocara canis glycans

The effect of Toxocara canis antigens on cytokine production by human THP-1 macrophages was studied in vitro. Toxocara Excretory–Secretory products (TES) and recombinant mucins (Tc-MUC-2, Tc-MUC-3, Tc-MUC-4, and Tc-MUC-5) as well as deglycosylated forms of these antigens were used in the study. TES products stimulated macrophages to produce the innate proinflammatory IL-1β, IL-6, and TNF-α cytokines regardless of the presence of glycans. Recombinant mucins induced glycan-dependent cytokine production. Sugar moieties led to at least 3-fold higher production of regulatory IL-10 as well as proinflammatory cytokines. The presence of glycans on mucins also affected the downstream signalling pathways in stimulated cells. The most prominent difference was noted in AKT and AMPK kinase activation. AKT phosphorylation was observed in cells stimulated with glycosylated mucins, whereas treatment with deglycosylated antigens led to AMPK phosphorylation. MAP kinase family members such as JNK and p38 and c-Jun transcription factor were phosphorylated in both cases what suggests that toll-like receptor signalling may be involved in mucin-treated macrophages. This pathway is however modified by other signalling molecules as only mucins containing intact sugars significantly induced the production of cytokines.

Histopathological Lesions Caused by Experimental Toxocara Canis and Toxascaris Leonina Infections in Farm Mink (Neovison Vison)

INTRODUCTION

Canine roundworm T. canis and T. leonina infections were investigated in experimentally infected farm mink (Neovison vison) to describe the pattern of pathological lesions in this paratenic host.

MATERIAL AND METHODS

Material and MethodsInfections in mink developed following ingestion of embryonated eggs of either parasite or mice tissue infected with both parasite species.

RESULTS

Comparative analysis of haematoxylin- and eosin-stained slides showed essential differences among the experimental groups. The lesions observed included eosinophil and mononuclear inflammatory infiltrates of the intestinal wall and local lymph nodes, inflammation and haemorrhages in liver tissues, and interstitial inflammation and mineralisation of the kidneys and lungs. Larvae migrating through the minks' bodies also caused particularly salient enlargement of lymphoid follicles in the spleen and inflammatory infiltrates of mononuclear cells in skeletal and heart muscles.

CONCLUSIONS

It is assumed that histopathological lesions appeared as a local and general host response to invasive L3 T. canis and T. leonina larvae migrating through the tissues of infected farm mink. Interestingly, mink infected with embryonated eggs had more pronounced lesions than animals infected with tissue larvae. Detailed histopathological examinations of parenchymal organs and striated muscles revealed lesions resembling those observed in other paratenic host species due to toxocarosis.

Diagnosis of ocular toxocariasis by detecting antibodies in the vitreous humor

OBJECTIVES

To demonstrate the production of the local toxocara antibodies in the vitreous of patients with negative serology.

MATERIAL AND METHODS

Retrospective review of the medical records of patients seen in a Tertiary Referral Hospital, and at an Eye Institute, with an ocular diagnosis of toxocariasis who had a negative serology and positive titres in the vitreous.

RESULTS

After reviewing the medical records of 40 patients with a diagnosis of ocular toxocariasis, a total of six cases (15%) were found with a negative serology and a positive vitreous titre for toxocara antibody, both of them performed using an ELISA procedure. The mean age was 18 years, there were no differences observed between males and females. A peripheral granuloma was the most common clinic finding, and all patients underwent vitrectomy either to remove epiretinal membranes or to repair retinal detachments.

CONCLUSION

A negative serology does not rule out a diagnosis of ocular toxocariasis. Vitreous samples may be necessary to confirm a clinical diagnosis.

The Prevalence of Intestinal Helminths in Free-Ranging Canids of Mazandaran, Northern Iran

BACKGROUND

The purpose of this study was to investigate the current knowledge on the epidemiology of importance zoonotic parasitic diseases in free-ranging canids of Mazandaran, north of Iran.

METHODS

Overall, 63 small intestinal samples of animals (20 stray dogs and 43 golden jackals) were collected from April 2017 to May 2018. The intestine contents were studied to detect and identify helminth infections. Additionally, 274 fecal samples (130 dogs, 35 fox, 90 golden jackal and 19 wolf) were examined by Sheather's flotation method for detection of Taenia eggs.

RESULTS

Sixty (95.2%) animals were infected with at least one species of intestinal helminth. the intestinal helminths were found in dogs and golden jackals included: Dipylidium caninum (25.3%), Uncinaria stenocephala (52.3%), Ancylostoma caninum (41.2%), Mesocestoides spp. (33.3%) and Toxocara canis (14.2%). In fecal examination, 2.5% of samples contained Taenia eggs, and through a species-specific PCR, 1.09% of these samples were confirmed positive for Echinococcus granulosus.

CONCLUSION

There is a high prevalence and clear risks of zoonotic helminths in free-ranging carnivores in Mazandaran province, north of Iran. Therefore, understanding the epidemiology of zoonotic parasite infection is useful for health care access both domestic animals and humans health.

Anti-Toxocara Seropositivity in the Patients with Eye Diseases in Ophthalmology Clinics in Tehran, Iran

BACKGROUND

Eye diseases, including, Uveitis, inflammation of the retina, and choroid are caused by different agents in humans and has a variety of anterior medial and posterior types. The agent of eye diseases is very different from simple bacterial to acute viral, fungal and parasitic infection. There is limited information regarding the type of eye diseases and Toxocara canis.

METHODS

Blood samples of 359 individuals (339 patients including endophthalmitis, uveitis, DCR, glaucoma, and cataract 20 individuals as control group) together with their information were collected from ophthalmology hospitals in Tehran, Iran from Feb 2013 to Jan 2015. The patient's serum was evaluated for the presence of anti-Toxocara antibodies by ELISA kits and blood smears for high eosinophilia. The positive samples were confirmed by Western blot analysis for T. canis infection.

RESULTS

Overall, 339 patients sera with eye diseases and control group were tested for anti-T. canis antibodies. Nineteen (5.6%) patients had anti-T. canis IgG that 14 (6.1%) were male and 5 (4.5%) were female, and all the patients had negative eosinophilia as well. The results of Western blot analysis for 19 positive patients indicated that 15 were infected by T. canis and 4 were infected by other parasitic infection. The results for control group were negative.

CONCLUSION

All the patients with inflammatory eye diseases such as endophthalmitis, uveitis DCR, glaucoma and cataract were studied for Toxocara infection in this research work were at risk. Therefore, in contrast to the previous idea, all eye inflammatory diseases in ocular patients should be considered for Toxocara antibodies in addition to Uveitis.

New insight into the diagnostic cut-off value of serum anti-Toxocara IgG for ocular toxocariasis in uveitis patients

Uveitis is one of the commonest causes of vision loss worldwide and its exact etiology is still not clarified in most patients. The current study is a trial to assess the efficacy of serum anti-Toxocara immunoglobulin G (IgG) by enzyme-linked immunosorbent assay (ELISA) as a diagnostic tool for ocular toxocariasis (OT) and to detect OT prevalence and the associated ocular manifestations in sera of patients with uveitis. One hundred and twelve patients (62 females and 50 males) with uveitis were diagnosed by ophthalmologists, radiologists and rheumatologists according to ocular manifestations, laboratory and radiological investigations. Serum anti-Toxocara IgG titers were determined by ELISA in sera of all patients. Our results revealed that OT is highly associated with intermediate and posterior uveitis. Children and young adult females, especially those residing in rural areas, complained mainly of diminution of vision in the left eye, with strabismus and leukocoria. At a cut-off value of 0.258, the sensitivity and specificity of IgG ELISA were 93.3% and 100%, respectively. In conclusion, at a novel cut-off value of 0.258 the serum anti-Toxocara IgG ELISA is predicted to be a diagnostic tool for OT regarding sensitivity and specificity. Also, it has potential importance in the interpretation and differential diagnosis of OT. Thus, serum anti-Toxocara IgG ELISA should be a routine test for screening of suspected cases.

Clinical course and treatment outcomes of toxocariasis-related eosinophilic disorder

Blood eosinophilia is a common clinical finding. Helminthic infections, including toxocariasis, are a common cause of eosinophilia; however, the clinical course of toxocariasis associated with eosinophilia is not fully understood. Thus, controversies exist regarding treatment indications.To evaluate the clinical features and natural course of various types of eosinophilia, with a particular focus on toxocariasis, we retrospectively reviewed the medical records of 1000 patients with peripheral blood eosinophilia who were referred to the allergy clinic at Asan Medical Center between 2007 and 2012. Clinical parameters and imaging study findings were evaluated. The treatment response to albendazole and resulting changes in eosinophilia and imaging studies were analyzed in patients diagnosed with toxocariasis.Among the 1000 subjects, toxocariasis was the most common cause of eosinophilia (n = 534; 53.4%), followed by allergic disease and adverse drug reactions. The majority of patients with toxocariasis were men, and they were mostly asymptomatic. More than one-third of patients (n = 215; 40.3%) with toxocariasis exhibited organ involvement, particularly hepatic involvement. In most cases of eosinophilia and organ involvement due to toxocariasis, the symptoms normalized regardless of treatment.Most cases of eosinophilia related to toxocariasis displayed a self-remitting course regardless of treatment. With the exception of several clinical situations, including ocular involvement, the clinical need for anti-helminthic therapy in toxocariasis is not that significant.

Gastrointestinal Parasites in Shelter Dogs: Occurrence, Pathology, Treatment and Risk to Shelter Workers

Dogs entering shelters can carry gastrointestinal parasites that may pose serious risks to other animals, shelter staff and visitors. Shelters provide an environment that could facilitate the spread of parasitic infections between animals. Nematodes and protozoa that transmit through ingestion or skin penetration are major enteric parasites of concern in shelter settings. Ancylostoma spp., Uncinaria stenocephala, Toxocara canis, Toxascaris leonina, Trichuris vulpis and Dipylidium caninum are the major helminths while Giardia, Cryptosporidium, Isospora spp. and Sarcocystis spp. are the most prevalent protozoan parasites in shelter dogs. The prevalence of gastrointestinal parasites in shelter dogs is typically higher than in owned dogs. A range of cost-effective drugs is available for prevention and control of helminths in shelters, notably fenbendazole, pyrantel, oxantel, and praziquantel. Parasiticide options for protozoan parasites are often cost-prohibitive or limited by a lack of veterinary registration for use in dogs. Environmental control measures reliant upon hygiene and facility management are therefore a mainstay for control and prevention of protozoan parasites in shelters. This philosophy should also extend to helminth control, as integrated parasite control strategies can allow anthelmintics to be used more sparingly and judiciously. The purpose of this article is to comprehensively review the current knowledge on the prevalence of gastrointestinal parasites most commonly found in dogs in shelters, canvass recommended treatment programs in shelter dogs, and to explore the likelihood that parasiticide resistance might emerge in a shelter environment.

Water related ocular diseases

A number of ocular diseases can be attributed to contaminated water and we have coined a term "Water-related ocular diseases (WRODs)" to denote this wide-spectrum of conditions. WRODs are directly related to human contact with water and can occur through toxic, allergic, inflammatory or infective mechanisms. The non-infective causes can include chemicals used to clean swimming pools, oil spills and water-sport related injuries. Similarly, a number of infective organisms causing ocular diseases are transmitted through water. Since, these conditions can occasionally prove devastating, a review was done with the following aims: (i) To study the epidemiology of WRODs (ii) To assess the clinical presentation and current management of WRODs (iii) To highlight the future challenges and possible solutions to these problems. The online search was conducted utilizing search engines such as PubMed, Google Scholar, ClinicalKey and the Virtual Library of the Ministry of Health, Malaysia for relevant terms such as water-borne, swimming pool and eye infections.

Seroprevalence of Toxocara in Children from Urban and Rural Areas of Ilam Province, West Iran

Objectives

The present study was performed to determine the seroprevalence of Toxocara in children ≤ 10 years old, from rural and urban areas of Ilam.

Methods

Serum samples from 383 children ≤ 10 years old, were selected randomly from rural and urban areas of Ilam province and surveyed using enzyme-linked immunosorbent assays.

Results

The total rate of infection with Toxocara was 22% (31% with a history of contact with dogs and cats, and 14% without a history of contact). Of those infected, 23% were male and 18% were female, 36% lived a rural life and 20% had an urban life. A significant correlation was found between the incidence of disease, and urban and rural life, as well as exposure to dogs and cats. There was no correlation between prevalence and gender or age.

Conclusion

Given the high prevalence of infection with Toxocara amongst children in Ilam province, preventive work in the community such as education in risk management and periodic treatment with anti-parasitic drugs and elimination of stray dogs and cats is an appropriate measure.

Toxocariasis: a silent threat with a progressive public health impact

Background

Toxocariasis is a neglected parasitic zoonosis that afflicts millions of the pediatric and adolescent populations worldwide, especially in impoverished communities. This disease is caused by infection with the larvae of Toxocara canis and T. cati, the most ubiquitous intestinal nematode parasite in dogs and cats, respectively. In this article, recent advances in the epidemiology, clinical presentation, diagnosis and pharmacotherapies that have been used in the treatment of toxocariasis are reviewed.

Main text

Over the past two decades, we have come far in our understanding of the biology and epidemiology of toxocariasis. However, lack of laboratory infrastructure in some countries, lack of uniform case definitions and limited surveillance infrastructure are some of the challenges that hindered the estimation of global disease burden. Toxocariasis encompasses four clinical forms: visceral, ocular, covert and neural. Incorrect or misdiagnosis of any of these disabling conditions can result in severe health consequences and considerable medical care spending. Fortunately, multiple diagnostic modalities are available, which if effectively used together with the administration of appropriate pharmacologic therapies, can minimize any unnecessary patient morbidity.

Conclusions

Although progress has been made in the management of toxocariasis patients, there remains much work to be done. Implementation of new technologies and better understanding of the pathogenesis of toxocariasis can identify new diagnostic biomarkers, which may help in increasing diagnostic accuracy. Also, further clinical research breakthroughs are needed to develop better ways to effectively control and prevent this serious disease.

Electronic supplementary material

The online version of this article (10.1186/s40249-018-0437-0) contains supplementary material, which is available to authorized users.

Seroprevalence of ToxocaraCanis in Asthmatic Children and its Relation to the Severity of Diseases - a Case-Control Study

Background

Toxocariasis is a common parasitic infectionworldwide even in developed countries. Through this health problem, the immune system is triggered and the antibody is produced, leading to some hypersensitive situations like asthma. In the present study, we tried to show a correlation between Toxocara Canis (T. canis) seropositivityand asthma in Isfahan city.

Methods

This research is a cross-sectional study involving 40 asthmatics and 46 non-asthmatic cases aged 2-18 years. In all cases, T. canis IgG level was measured using enzyme-linked immunosorbent assay (ELISA) and compared between two groups.

Results

The seroprevalence of IgG anti-T. canis antibodies were 45%in the asthmatic patients and 21.7% in thecontrols (P= 0.022). The more severe asthmatic patients had significantly more risk for T. canis seropositivity (P= 0.019). In the asthmatic patients, there was a significant correlation between Toxocara seropositivity and goingto park or playground (P= 0.001).

Conclusion

In this study, we found a significantly positive serology of T. canis in asthmatic children especially in more severe disease. To verify the etiologic role of Toxocara in asthma, more advanced studies are needed.

[Zoonotic intestinal nematodes in dogs from public parks in Yucatán, México]

INTRODUCTION

Dogs represent a potential public health risk because of the natural transmission of zoonotic parasitic infections.

OBJECTIVE

To estimate the frequency and to determine factors associated with the presence of intestinal nematode eggs in dog feces collected in public parks of Mérida,Yucatán, México.

MATERIALS AND METHODS

A total of 100 dog fecal samples collected from 20 public parks in two areas of Mérida were analyzed. Samples were processed by the centrifugation-flotation and the McMaster techniques to confirm the presence and to quantify the excretion of intestinal nematode eggs per gram of feces. The factors associated with the presence of nematode eggs were identified using the chi square univariate analysis.

RESULTS

We found an 11% frequency of fecal samples positive for intestinal nematode eggs. Eggs of three species of parasites were identified: Ancylostoma caninum was the most common (10%), followed by Toxocara canis (10%), and Trichuris vulpis (1%). Most positive samples were infected with only one intestinal nematode (10%), and only 1 % was positive for a mixed infection by A. caninum and T. vulpis. The presence of stray dogs in public parks was an associated factor (p=0.046) with a higher number of fecal samples positive for intestinal nematode eggs.

CONCLUSIONS

The frequency of intestinal nematodes in dog feces with zoonotic potential was high in parks of Mérida, Yucatán, México; samples from parks where there were stray dogs had a higher possibility of being positive.

Tissue expression pattern of ABCG transporter indicates functional roles in reproduction of Toxocara canis

Toxocara canis is a zoonotic parasite with worldwide distribution. ATP-binding cassette (ABC) transporters are integral membrane proteins which involve in a range of biological processes in various organisms. In present study, the full-length coding sequence of abcg-5 gene of T. canis (Tc-abcg-5) was cloned and characterized. A 633 aa polypeptide containing two conserved Walker A and Walker B motifs was predicted from a continuous 1902 nt open reading frame. Quantitative real-time PCR was employed to determine the transcriptional levels of Tc-abcg-5 gene in adult male and female worms, which indicated high mRNA level of Tc-abcg-5 in the reproductive tract of adult female T. canis. Tc-abcg-5 was expressed to produce rabbit polyclonal antiserum against recombinant TcABCG5. Indirect-fluorescence immunohistochemical assays were carried out to detect the tissue distribution of TcABCG5, which showed predominant distribution of TcABCG5 in the uterus (especially in the germ cells) of adult female T. canis. Tissue transcription and expression pattern of Tc-abcg-5 indicated that Tc-abcg-5 might play essential roles in the reproduction of this parasitic nematode.

A Lateral Flow Rapid Test for Human Toxocariasis Developed Using Three Toxocara canis Recombinant Antigens

Laboratory diagnosis of toxocariasis is still a challenge especially in developing endemic countries with polyparasitism. In this study, three Toxocara canis recombinant antigens, rTES-26, rTES-30, and rTES-120, were expressed and used to prepare lateral flow immunoglobulin G4 (IgG4) dipsticks. The concordance of the results of the rapid test (comprising three dipsticks) with a commercial IgG-enzyme-linked immunosorbent assay (ELISA) (Cypress Diagnostics, Belgium) was compared against the concordance of two other commercial IgG-ELISA kits (Bordier, Switzerland and NovaTec, Germany) with the Cypress kit. Using Toxocara-positive samples, the concordance of the dipstick dotted with rTES-26, rTES-30, and rTES-120 was 41.4% (12/29), 51.7% (15/29), and 72.4% (21/29), respectively. When positivity with any dipstick was considered as an overall positive rapid test result, the concordance with the Cypress kit was 93% (27/29). Meanwhile, when compared with the results of the Cypress kit, the concordance of IgG-ELISA from NovaTec and Bordier was 100% (29/29) and 89.7% (26/29), respectively. Specific IgG4 has been recognized as a marker of active infection for several helminthic diseases; therefore, the two non-concordant results of the rapid test when compared with the NovaTec IgG-ELISA kit may be from samples of people with non-active infection. All the three dipsticks showed 100% (50/50) concordance with the Cypress kit when tested with serum from individuals who were healthy and with other infections. In conclusion, the lateral flow rapid test is potentially a good, fast, and easy test for toxocariasis. Next, further validation studies and development of a test with the three antigens in one dipstick will be performed.

Identifying anti-Toxocara IgG antibodies in horses of Mexico

ABSTRACT Both the presence of owned dogs and stray dogs allows the spread of Toxocara, a parasite whose eggs can be found in soil, water and food. Animals, including horses, serve as definitive and paratenic hosts. In México, where consumption of horse meat is common, Toxocara is a zoonotic parasite. The aim of this study was to identify the presence of anti-Toxocara antibodies in work horses and horses intended for human consumption by ELISA. ELISA was chosen for analysis as paratenic hosts do not shed Toxocara eggs in their feces. Blood samples were collected from a total of 188 horses, 94 of which were work horses and 94 horses from the slaughter house. Samples were analyzed by ELISA, and the general equine seroprevalence was found to be 44.6% (n = 188). Adult horses for slaughter had a 61.7% greater presence of anti-Toxocara antibodies (p = 0.006). Toxocara IgG antibodies were found in horses, confirming that horses are paratenic hosts and possible sources of infection for other animals and people.

Lactobacillus rhamnosus reduces parasite load on Toxocara canis experimental infection in mice, but has no effect on the parasite in vitro

Human toxocariasis is a neglected global parasitic zoonosis. The efficacy of drug treatment for this disease has been hindered by the biological complexity of the main etiological agent, the nematode Toxocara canis. Experimental studies have shown the potential of probiotics to promote a reduction in the parasite load of T. canis larvae. This study aimed to evaluate the effect of probiotic Lactobacillus rhamnosus ATCC 7469 on the parasite load of BALB/c mice with acute toxocariasis and evaluate the direct effect of this probiotic on T. canis larvae in vitro. In vivo administration of probiotics reduced the parasite load of T. canis larvae by 53.3% (p = 0.0018) during the early stage of infection in mice. However, when analyzed in vitro, it was observed that the probiotic did not present a deleterious effect on the larvae, as approximately 90% of these remained viable. These results demonstrate the potential of the probiotic L. rhamnosus in the reduction of T. canis larvae in BALB/c mice and suggest it could be used as an alternative means for the controlling of visceral toxocariasis. However, further studies are required to elucidate the mechanisms of action promoted by this probiotic.

In vitro effect of Chrysosporium indicum and Chrysosporium keratinophylum on Toxocara canis eggs

The degree of antagonism exercised by fungi on geohelminth development varies according to the morphological alterations caused by different fungal species. Saprophytic fungi may exert ovicidal or ovistatic effects. The aim of this study was to apply scanning electron microscopy (SEM) to observe the action of two soil saprophytic species of Chrysosporium (C. indicum and C. keratinophylum) on Toxocara canis eggs. The fungal strains to be tested were incubated for 28 days at 28°C in 2% water agar with a suspension of unembryonated T. canis eggs. A suspension of T. canis eggs in 2% water agar was used as control group. The assay was done in triplicate for each fungus and the control group. SEM observations were performed on the 4th, 7th, 14th, 21st, and 28th day after inoculation. The effect of the fungi on eggs was evaluated in accordance with the alterations observed on the surface and the changes in the normal characteristics of the eggs. Hyphae around the eggs, appresoria penetrating the shell and changes in the typical egg membrane were observed in this assay. Type 3 effect (alterations that occur both in the embryo and the shell, and hyphal penetration of the eggs) was the prevalent effect. SEM allowed us to observe clearly the morphological alterations in T. canis eggs due to the effect of C. indicum and C. keratinophylum. Both saprophytic species of Chrysosporium alter the egg structure and alterations increase as exposure increases.

Assessment of the diagnostic value of specific anti-Toxocara IgA in Slovakian patients suspected to have toxocarosis

Human toxocarosis is one of the most widespread and prevalent helminthic zoonosis in many countries, including Slovakia. The aim was to evaluate the usefulness of IgA anti-Toxocara antibody detection in the serodiagnosis of toxocarosis. The levels of specific IgA antibodies were determined by excretory-secretory (ES)-enzyme-linked immunosorbent assay (ELISA). The IgA seropositivity in IgG anti-Toxocara seropositive patients (n = 52) was 32.7% and found to be highest in the oldest age groups (P = 0.026). The presence of IgA in suspected patients for toxocarosis were evaluated in respect to some characteristics of examined persons. Substantially higher IgA seropositivity was detected in patients with increased total IgE (44.8%) than in subjects with a normal level of IgE (17.4%; P = 0.036). No associations (P > 0.05) were found between IgA seropositivity and sex, level of specific IgG antibodies, avidity of IgG, eosinophilia, domicile, geophagia, traveling abroad, dog/cat ownership, or clinical symptoms. The IgA-ELISA showed sensitivity of 57.1% and specificity of 100%. Mild correlations (r = 0.302, r = 0.305, r = - 0.409) were observed between the levels of anti-Toxocara IgA antibodies and age, the amounts of eosinophils and IgA antibody levels, the amounts of eosinophils, and the values of IgG avidity, respectively. The presence of anti-Toxocara IgA may facilitate the diagnosis of toxocarosis and may well be useful for the determination of acute Toxocara infection. Moreover, this test should be accompanied by other immunological markers of examined patients (e.g., increased total IgE, eosinophilia, and low-avidity IgG antibodies).

Toxocariasis: critical analysis of serology in patients attending a public referral center for ophthalmology in Brazil

PURPOSE

To analyze the contribution of IgG anti-Toxocara antibodies in the diagnosis of ocular toxocariasis (OT) in serum samples of patients attending a public referral center for ophthalmology in Brazil and to determine the most frequent ocular signs and symptoms.

STUDY DESIGN

This was a retrospective descriptive study of a cohort of outpatients followed from December 1989 to May 2006.

METHODS

IgG anti-Toxocara antibody titers were determined by enzyme-linked immunosorbent assay. The results were correlated with the clinical and funduscopic findings.

RESULTS

Of the diagnoses for the 126 patients, 42 were considered as probable OT, 48 as negative, and 36 as inconclusive. The median IgG anti-Toxocara antibody titers of the patients with probable OT were significantly higher than those of the patients in the negative or inconclusive groups (P = 0.0001). Higher titers were observed more frequently in patients in the probable OT group (P = 0.01) than in the negative group, in which titers were absent or lower in most patients (P < 0.0001). The right eye was affected more in the OT group than in the negative group (P = 0.01), and inflammation was located mostly in the intermediate and posterior poles. The mean age of the patients diagnosed with probable OT was significantly lower (mean, 8 years) than that of the negative patients (mean, 14.5 years) (P = 0.006).

CONCLUSIONS

Higher levels of antibodies could help with the diagnosis of OT in patients with symptoms and clinical signs; however, negative results cannot exclude possible OT. Conversely, patients with negative serology or low titers make the diagnosis of OT less likely.

Soil-Transmitted Helminths in Tropical Australia and Asia

Soil-transmitted helminths (STH) infect 2 billion people worldwide including significant numbers in South-East Asia (SEA). In Australia, STH are of less concern; however, indigenous communities are endemic for STH, including Strongyloides stercoralis, as well as for serious clinical infections due to other helminths such as Toxocara spp. The zoonotic hookworm Ancylostoma ceylanicum is also present in Australia and SEA, and may contribute to human infections particularly among pet owners. High human immigration rates to Australia from SEA, which is highly endemic for STH Strongyloides and Toxocara, has resulted in a high prevalence of these helminthic infections in immigrant communities, particularly since such individuals are not screened for worm infections upon entry. In this review, we consider the current state of STH infections in Australia and SEA.

Clinical usefulness of Western blotting and ELISA avidity for the diagnosis of human toxocariasis

The serodiagnosis of human toxocariasis is difficult. Specific IgGs detected routinely with ELISA based on Toxocara excretory-secretory (TES) antigens often persist for years at an elevated level, which does not allow either the differentiation between an active and persistent infection or monitoring of the effect of treatment. Additionally, false-positive results may occur in co-infections with other helminths due to cross-reactions. We evaluated the usefulness of an IgG avidity index (AI) and a Western blotting (WB) IgG in the diagnosis of patients suspected of Toxocara infection. We studied 138 subjects who were submitted to serological testing two or more times. Confirmation of an infection by WB was achieved in 73.2% of patients. A high AI was obtained in 89.1% of patients, and low AI and borderline AI were found in only 10.9%. Low and borderline values of AI remained at similar levels in subsequent studies over 2-3 years. The results showed the necessity of obligatory verification of all ELISA IgG positive and questionable results by WB. The index of IgG avidity may be helpful in excluding recent infection, but its usefulness in detecting an active phase of invasion requires further research.

Toxocara eggs in an 18th century Franciscan from Portugal. The challenge of differentiating between parasitism and chance in Paleoparasitology

In 2005, an adult male was excavated in the cloister of the former Convent of the Holy Spirit, in the Franciscan Province of Holy Mary of Arrábida, Lisbon district. From the anterior part of the sacrum, a darker organic agglomeration was collected and studied for intestinal parasites. Samples were rehydrated with Lycopodium tablets in a Na3PO4 5% solution for 72h, followed by the swirl technique. Organic material was concentrated at 2500rpm. At least 20 slides of each sample were examined using a light/polarized microscope. A control sample from outside the pelvis revealed no biological remains. A sample collected inside the pelvic girdle was positive for pollen grains, other plant remains and Toxocara eggs, perhaps T. cati (2766 eggs/gram sediment). This finding, although exciting, cannot be explained in a simple way because humans are not definitive hosts for Toxocara species. Ingestion of feces-contaminated food or water, geophagy, or true infection are hypotheses considered in this study, which demonstrates the difficulty of interpreting the presence of animal parasites in human remains. This is the first time Toxocara eggs are found associated with human remains.

Variations in the Rate of Infestations of Dogs with Zoonotic Nematodes and the Contamination of Soil in Different Environments

Companion animals are an important aspect in human life. However, they may also be considered a source of pathogens. An example of zoonotic parasitoses is toxocarosis or cutaneous larva migrans (CLM). The aim of the study was to detect zoonotic nematodes of dogs living in different areas and the intensity of contamination in parasite polluted environments that are hazardous to human health. The fecal samples were examined using standard flotation and decantation methods as well as McMaster's quantitative technique. The soil samples in urban and rural areas were examined using a modified flotation method as described by Quinn et al. Statistical analyses were performed by IBM SPSS Statistics Version 23. The overall prevalence of parasites in dogs was 38%, 17.02% and 56.60% from urban and rural areas, respectively. The percentage values of nematodes important for human health (Toxocaracanis, Ancylostomatidae, Trichurisvulpis) remained at the same level (16%). The infected dogs were dominated by a single parasite species, the main was T.canis (28.95%). In total, 54.30% of the soil samples were contaminated with parasite eggs. The contamination of urban and rural sandpits was 40% and 60%, respectively. The molecular examinations of soil samples using LAMP (loop-mediated isothermal amplification) confirmed the presence of nematode eggs of the species T.canis in all samples previously classified as positive.

Protective and risk factors associated with the presence of Toxocara spp. eggs in dog hair

Toxocariasis is one of the most prevalent parasitic zoonoses in the world. The disease is principally caused by the nematode Toxocara canis, whose definitive host is the dog. The transmission of toxocariasis to humans is mainly caused by accidental ingestion of embryonated eggs of the parasite, present in the soil. Studies have shown that dog hair has the capacity to harbor eggs of the parasite and represents a risk for transmission of the zoonosis. The objective of the present study was to evaluate the frequency and factors associated with the contamination of dog hair by Toxocara spp. of animals attended and/or abandoned at a Veterinary-Teaching Hospital in Southeast Brazil. The hair samples were collected from the perineal region, and upper and lower tail regions. For analysis of the samples and recovery of Toxocara spp., the material was washed in Tween 20 and then filtered through sieves of 300μm, 212μm, and 38μm. Hair samples from 165 dogs were analyzed. Of the analyzed samples, 59 (35.8%) were from puppies and 106 (64.2%) from adult animals. In the sample evaluation, 6.7% of the dogs (11/165) were contaminated, with a mean of 12.2 eggs per animal (1-70 eggs/animal) and 57.5 eggs/gram of hair. All the recovered eggs were not embryonated. There was an influence of age (puppies), breed (without defined breed), and origin (stray) of the dogs. On the other hand, deworming was a protective factor. Our results show that the risk of transmission of toxocariasis by direct contact, mainly in well-cared dogs, is low. Thus, prophylactic anthelmintic treatment and correct care regarding the hygiene of animals, especially puppies, should be recommended to reduce any risk of transmission of toxocariasis.

Treatment of larva migrans syndrome with long-term administration of albendazole

BACKGROUND

Larva migrans syndrome is a food-borne parasitic disease in humans, caused by accidental ingestion of eggs or larvae of ascarid nematodes, namely, Toxocara canis, Toxocara cati, or Ascaris suum, the roundworms commonly found in the intestines of dogs, cats and pigs respectively. When a patient is diagnosed as having larva migrans syndrome, oral-administration of albendazole is recommended, however, the regimen remains controversial worldwide. In Japan, the duration of albendazole administration is longer than those of European and North American countries. The purpose of this study was to assess the efficacy and safety of long-term administration treatment of albendazole for larva migrans syndrome.

METHODS

From 2004 to 2014, our laboratory was involved in the diagnosis of 758 larva migrans syndrome cases, of which 299 cases could be followed up after the treatment. We analyzed these 299 follow-up cases on the ELISA results before and after the treatment as well as on anthelmintic used, dose and duration of medication, clinical findings, and side effects, recorded on a consultation sheet provided by the attending physicians. We have 288 cases as the subjects of this study.

RESULTS

Albendazole represented a 78.0% efficacy rate. The side effects represented 15.0% in using albendazole alone cases; however, the side effects were mild to moderate and there were no severe cases reported.

CONCLUSIONS

The long-term administration treatment of albendazole is safe and effective for larva migrans syndrome.

Immunoglobulin M antibodies are not specific for serodiagnosis of human toxocariasis

Serodiagnosis of human toxocariasis is established by detecting serum anti-Toxocara IgG antibodies, but there is little knowledge regarding the reactivity of human IgM antibodies against the Toxocara antigens. In this study, we have evaluated the reactivity of IgM antibodies in sera from patients with toxocariasis, patients with other helminth infections, and healthy individuals, against Toxocara larval excretory-secretory (TES) antigens by enzyme-linked immunosorbent assay (ELISA) and Western blot (WB). Anti-Toxocara IgM were detected in 91.4% of sera from patients with toxocariasis, 76% of sera from patients with other helminth infections, and 45.3% of sera from healthy individuals when ELISA was used. Likewise, IgM antibodies were detected in 94.8% of sera from patients with toxocariasis, 65.3% of sera from patients with other helminth infections, and 41% of sera from healthy individuals when WB was used. This reactivity exhibited only a slight decrease when the TES antigens were deglycosylated, showing that not only glycosidic epitopes, but also peptide epitopes are involved in the recognition and binding of IgM antibodies during the immune response against the parasite. The results shown that IgM antibodies are not specific for serodiagnosis of human toxocariasis.

Enteroparasitoses and Toxocarosis Affecting Children from Mar del Plata City, Argentina

This study evaluated the existence of enteroparasitoses and toxocarosis in children of peripheral (PC) and urban communities (UC) from Mar del Plata city (Argentina) and their associations with socio-environmental conditions. A Parasite Vulnerability Index (PVI) was elaborated using variables such as overcrowding, floor type, drinking water source, wastewater disposal, solid waste disposal, presence of animals and schooling level. The PC evidenced statistically significant higher frequencies of families with high (38.9%) and medium (55.5%) PVI, while in the UC low PVI (93%) was the most frequent. A statistically significant higher frequency of PC children was parasitized (30.2 vs. 14.5%; χ ² Pearson = 5.21; P < 0.05), presented higher parasite frequencies, specific richness, parasitic loads, and they also evidenced polyparasitism. The Multiple Correspondence Analysis (MCA) showed associations between PC-parasitized children, overcrowding and contact with pets and farm animals. The ELISA test to the specified determination of Toxocara canis IgG was reactive in a statistically significant higher proportion of PC children than the UC (55 vs. 8.5%; χ ² = 30.5; P < 0.01). The MCA associated PC reactive children, not adequate hand washing, moderate and hypereosinophilia and contact with pets and farm animals. Deficient socio-environmental conditions became children more vulnerable to get enteroparasitoses and toxocarosis in the PC than in the UC.

A diagnostic protocol designed for determining allergic causes in patients with blood eosinophilia

BACKGROUND

Blood eosinophilia is a common laboratory abnormality, and its characterization frequently represents a quandary for primary care physicians. Consequently, in France, specialists and particularly hematologists, often must investigate patients who present with blood eosinophilia that often, but not always, occurs because of allergic causes. Both the Departments of Hematology and Parasitology at Toulouse University Hospitals established a collaboration to rule out allergic causes of eosinophilia, particularly helminthiases, prior to initiating more sophisticated investigations.

METHODS

Since 2004, the authors employed the same protocol to investigate eosinophilic outpatients who attended the clinic of Parasitology at Toulouse University Hospitals, and they reported the performance of this diagnostic procedure that was designed to be rapid (no hospitalization required) and only moderately expensive.

RESULTS

A total of 406 patients who presented with blood eosinophilia greater than 0.5 (×109, giga cells per litter, G/L) had an allergic etiology in 350 (86.2%) cases. Among the remaining 56 subjects, 17 did not undergo a follow-up and 39 were referred to another specialized department, mostly Hematology. However, only 21 patients attended then were subsequently investigated. Non-allergic causes of eosinophilia, including 3 cases of the lymphoid variant of hypereosinophilic syndrome and 2 cases of myeloproliferative disorder, were identified in 14 patients, whereas 7 remained diagnosed as having idiopathic eosinophilia.

CONCLUSION

This study underlines the need to investigate patients presenting with even moderate blood eosinophilia. The work-up that was employed appears to be efficient and versatile and may be used by any medical specialist, such as in hematology, infectious disease, or internal medicine departments, who needs to investigate eosinophilic patients and should initially rule out any etiology of allergic eosinophilia.

Efficacy of Zingiber officinale ethanol extract on the viability, embryogenesis and infectivity of Toxocara canis eggs

This study evaluated the effect of Zingiber officinale (Z. officinale) ethanol extract on the viability, embryogenesis and infectivity Toxocara canis (T. canis) eggs. It was carried out both in vitro and in vivo. In the in vitro experiment, unembryonated T. canis eggs were incubated with 25, 50 and 100 mg/mL Z. officinale extract at 25 °C for 6, 12, and 24 h to assess the effect of Z. officinale on their viability and for two weeks to assess the effect of Z. officinale on their embryogenesis. In vivo experiment was performed to assess the effect of Z. officinale on infectivity of T. canis eggs. Treated embryonated eggs by Z. officinale extract at concentrations of 25, 50 and 100 mg/mL for 24 h were inoculated into mice and their livers were examined for the presence of T. canis larvae on the 7th day after infection and for histopathological evaluation at 14th day post-infection. Z. officinale showed a significant ovicidal activity on T. canis eggs. The best effect was observed with 100 mg/mL concentration after 24 h with an efficacy of 98.2%. However, the treated eggs by 25, 50 mg/mL of Z. officinale extract after 24 h showed ovicidal activity by 59.22 and 82.5% respectively. Moreover, this extract effectively inhibited T. canis eggs embryogenesis by 99.64% and caused their degeneration at the concentration of 100 mg/mL after 2 weeks of treatment. However, the lower concentrations, 25 and 50 mg/mL inhibited embryogenesis by 51.19 and 78.57% respectively. The effect of Z. officinale on the infectivity T. canis eggs was proven by the reduction of larvae recovery in the livers by 35.9, 62.8 and 89.5% in mice groups inoculated by Z. officinale treated eggs at concentrations of 25, 50 and 100 mg/mL respectively. Histopathologically, the liver tissues of mice infected with Z. officinale treated eggs at the concentration of 100 mg/mL appeared healthy with slight degenerative changes of hepatocytes, opposite to that recorded in the infected mice with treated eggs by the lower concentrations. In conclusion; Z. officinale extract possessed dose-dependent anti-T. canis activity on the viability, embryogenesis and infectivity of T. canis eggs.