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Henke K, Ntovas S, Xourgia E, Exadaktylos AK, Klukowska-Rötzler J, Ziaka M. Who Let the Dogs Out? Unmasking the Neglected: A Semi-Systematic Review on the Enduring Impact of Toxocariasis, a Prevalent Zoonotic Infection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6972. [PMID: 37947530 PMCID: PMC10649795 DOI: 10.3390/ijerph20216972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/28/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
Toxocariasis remains an important neglected parasitic infection representing one of the most common zoonotic infections caused by the parasite Toxocara canis or, less frequently, by Toxocara cati. The epidemiology of the disease is complex due to its transmission route by accidental ingestion of embryonated Toxocara eggs or larvae from tissues from domestic or wild paratenic hosts. Even though the World Health Organization and Centers for Disease Control classified toxocariasis amongst the top six parasitic infections of priority to public health, global epidemiological data regarding the relationship between seropositivity and toxocariasis is limited. Although the vast majority of the infected individuals remain asymptomatic or experience a mild disease, the infection is associated with important health and socioeconomic consequences, particularly in underprivileged, tropical, and subtropical areas. Toxocariasis is a disease with multiple clinical presentations, which are classified into five distinct forms: the classical visceral larva migrans, ocular toxocariasis, common toxocariasis, covert toxocariasis, and cerebral toxocariasis or neurotoxocariasis. Anthelmintic agents, for example, albendazole or mebendazole, are the recommended treatment, whereas a combination with topical or systemic corticosteroids for specific forms is suggested. Prevention strategies include educational programs, behavioral and hygienic changes, enhancement of the role of veterinarians, and anthelmintic regimens to control active infections.
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Affiliation(s)
- Katrin Henke
- Department of Internal Medicine, Thun Hospital, Krankenhausstrasse 12, 3600 Thun, Switzerland;
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3008 Bern, Switzerland; (S.N.); (A.K.E.); (J.K.-R.)
| | - Sotirios Ntovas
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3008 Bern, Switzerland; (S.N.); (A.K.E.); (J.K.-R.)
- Department of Visceral Surgery and Medicine, lnselspital, University Hospital, University of Bern, 3008 Bern, Switzerland
| | - Eleni Xourgia
- Department of Heart Surgery, lnselspital, University Hospital, University of Bern, 3008 Bern, Switzerland;
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3008 Bern, Switzerland; (S.N.); (A.K.E.); (J.K.-R.)
| | - Jolanta Klukowska-Rötzler
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3008 Bern, Switzerland; (S.N.); (A.K.E.); (J.K.-R.)
| | - Mairi Ziaka
- Department of Internal Medicine, Thun Hospital, Krankenhausstrasse 12, 3600 Thun, Switzerland;
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3008 Bern, Switzerland; (S.N.); (A.K.E.); (J.K.-R.)
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Köchle BR, Garijo-Toledo MM, Llobat L, Sansano-Maestre J. Prevalence of Toxocara Eggs in Public Parks in the City of Valencia (Eastern Spain). Vet Sci 2022; 9:vetsci9050232. [PMID: 35622760 PMCID: PMC9145089 DOI: 10.3390/vetsci9050232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 12/10/2022] Open
Abstract
Toxocara spp. is one of the most common zoonotic geohelminths in the world. Its infections are associated with the accidental ingestion of contaminated soil and affecting, especially children. In this study, feces, and soil samples from 14 public parks in the city of Valencia were analyzed. The Telemann method and a modified version of a sieving technique were used to process feces and soil, respectively. None of the fecal samples and 10.9% of soil samples from five parks (35.7%) tested positive for the presence of Toxocara eggs. The most contaminated areas were the canine sanitary parks (30.8% of the samples), followed by socialization areas for dogs (9.7%); no positive samples were found at children’s playgrounds. Our results suggest that most pets in Valencia are periodically dewormed, although additional preventive measures should be applied, since the risk of infection exists probably due to the presence of stray dogs and feral cats.
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Affiliation(s)
- Belinda Rose Köchle
- Department of Animal Production and Public Health, Faculty of Veterinary Medicine and Experimental Sciences, Universidad Católica de Valencia San Vicente Mártir, Calle Guillem de Castro, 94, 46003 Valencia, Spain;
| | - María Magdalena Garijo-Toledo
- Department of Animal Production and Health, Public Veterinary Health and Food Science and Technology, Faculty of Veterinary Medicine, Universidad Cardenal Herrera-CEU, CEU Universities, Calle Tirant Lo Blanc, 7, 46115 Valencia, Spain;
- Correspondence: (M.M.G.-T.); (J.S.-M.); Tel.: +34-961369000 (M.M.G.-T.); Fax: +34-961395272 (M.M.G.-T.)
| | - Lola Llobat
- Department of Animal Production and Health, Public Veterinary Health and Food Science and Technology, Faculty of Veterinary Medicine, Universidad Cardenal Herrera-CEU, CEU Universities, Calle Tirant Lo Blanc, 7, 46115 Valencia, Spain;
| | - José Sansano-Maestre
- Department of Animal Production and Public Health, Faculty of Veterinary Medicine and Experimental Sciences, Universidad Católica de Valencia San Vicente Mártir, Calle Guillem de Castro, 94, 46003 Valencia, Spain;
- Correspondence: (M.M.G.-T.); (J.S.-M.); Tel.: +34-961369000 (M.M.G.-T.); Fax: +34-961395272 (M.M.G.-T.)
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Docu Axelerad A, Stroe AZ, Gogu AE, Pusztai A, Jianu DC, Daniel D, Docu Axelerad D. Clinical spectrum of symptoms in cerebral Toxocariasis (Review). Exp Ther Med 2021; 21:521. [PMID: 33815594 PMCID: PMC8014984 DOI: 10.3892/etm.2021.9953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/09/2021] [Indexed: 11/06/2022] Open
Abstract
Human helminth zoonosis is one of the most encountered helminthiases worldwide. Representative diseases include Toxocara canis and Toxocara cati, which are common nematodes prevalent in dogs and cats. The infiltration of these roundworms in the human body through contaminated food or nematode eggs could lead to central nervous system injury as the roundworms can cross the blood-brain barrier leading to neurotoxocariasis. Among the neurological and neuropsychological disturbances produced by Toxocara infection, in humans, the most representative are meningitis, encephalitis, myelitis and cerebral vasculitis, but asymptomatic central nervous system infection is probably the most prevalent. The present review examines the clinical symptomatology of neurotoxocariasis in case reports in the literature in the last 7 decades (1950-2020). The available evidence was retrieved from PubMed and Medline electronic databases. The present review reports the most prevalent clinical symptomatology in the cases of detected and diagnosed Toxocara infection with neuroinvasion. Thus, the present review aims to raise the awareness of neurological cases of Toxocara infection with the potential to at least establish differential diagnosis of neurotoxocariasis.
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Affiliation(s)
- Any Docu Axelerad
- Department of Neurology, Faculty of General Medicine, ‘Ovidius’ University of Constanta, 900470 Constanta, Romania
| | - Alina Zorina Stroe
- Department of Neurology, Faculty of General Medicine, ‘Ovidius’ University of Constanta, 900470 Constanta, Romania
| | - Anca Elena Gogu
- Department of Neurology, Faculty of General Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, 300041 Timisoara, Romania
| | - Agneta Pusztai
- Department of Anatomy, Faculty of General Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, 300041 Timisoara, Romania
| | - Dragos Catalin Jianu
- Department of Neurology, Faculty of General Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, 300041 Timisoara, Romania
| | - Duta Daniel
- Department of Sports, Faculty of Physical Education and Sports, ‘Ovidius’ University of Constanta, 900470 Constanta, Romania
| | - Daniel Docu Axelerad
- Department of Sports, Faculty of Physical Education and Sports, ‘Ovidius’ University of Constanta, 900470 Constanta, Romania
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Bossi G, Bruno R, Novati S, Maserati R, Mussati G, Gorone MP, Nepita EV, Regalbuto C, Gola G, Simoncelli AM, Bruno A, Musso P, Clerici E, Marseglia GL. Cerebral Toxocariasis as a Cause of Epilepsy: A Pediatric Case. Neuropediatrics 2021; 52:142-145. [PMID: 33472248 DOI: 10.1055/s-0040-1721701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Toxocarosis is the consequence of human infection by Toxocara spp. larvae and is one of the most common ascarioses, not only in developing countries, but also in the European region, where its prevalence reaches 14%. Due to their particular behavior, children are at higher risk of this parasitic infection, whose clinical features depend on the localization of the Toxocara larvae. Neurotoxocariasis is very uncommon in children and may take different forms depending on the underlying physiopathologic process: immune reaction against the parasite antigens, vasculitis, treatment complications, or, very rarely, brain localization of Toxocara spp. larvae. The association between neurotoxocariasis and the onset of childhood epilepsy has been postulated but is still debated. Moreover, a Toxocara spp. abscess causing epileptic seizures in children has been rarely described, especially in western countries. Hereby we present a 9-year-old patient with a new diagnosis of epilepsy definitely secondary to brain abscess due to the localization of Toxocara canis larvae. Diagnosis was confirmed by neuroimaging and serological test. The successful treatment with albendazole and steroids was documented with a close and long-term clinical and neuroradiological follow-up. Our experience confirms that every case of cryptogenetic epilepsy in children deserves a neuroimaging study and, in case of cystic images, Toxocara serology is mandatory to avoid further unnecessary invasive diagnostic investigations and to set the specific drug therapy.
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Affiliation(s)
- Grazia Bossi
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raffaele Bruno
- Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Stefano Novati
- Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Maserati
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Georgia Mussati
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Corrado Regalbuto
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gioia Gola
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna Maria Simoncelli
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonella Bruno
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paola Musso
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Edoardo Clerici
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Omer FM, Awadalla NJ, Alsaleem SA, Alsaleem MA, Moosa RA, Alqahtani MA, Asiri AA, Alahmari EM, Alqahtani AN, Mahfouz AA. Toxocara Awareness Among Medical Practitioners in Saudi Arabia. ECOHEALTH 2021; 18:107-112. [PMID: 34014415 DOI: 10.1007/s10393-021-01529-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 04/17/2021] [Accepted: 04/30/2021] [Indexed: 06/12/2023]
Abstract
Human toxocariasis is a zoonotic infection with global and regional impacts. Worldwide it is underestimated and clinically overlooked. Medical practitioners are generally unaware of the extent of the resulting disease spectrum. The objective of the study was to assess knowledge and disease awareness among medical practitioners in Aseer, south-western Saudi Arabia. A questionnaire addressing knowledge about the parasite, its visceral larva migrans and the disease spectrum generated was used to interview participants. The study included 285 participants. In answer to the question what is toxocara, only 27%, answered correctly that it is a nematode, paediatricians being the majority. With regard to years of experience among participants, 56.8% of those who answered correctly had less than 5-year experience, as opposed to 35.4% for those with more than 10-year experience. The cumulative awareness about the disease manifestations and spectrum, i.e. those who knew, was less than 30% across specialties and years of experiences. Lack of awareness regarding Toxocara infection and the disease spectrum it can generate is evident. The consequence for such lack of knowledge within our practising medical community is simply unacceptable as it might translate into misdiagnosis and consequently misguided treatment.
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Affiliation(s)
- Fakhreldin M Omer
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Nabil J Awadalla
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
- Department of Community Medicine, Mansoura University, Mansoura, Egypt
| | - Safar Abadi Alsaleem
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mohammed Abadi Alsaleem
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Riyad A Moosa
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mohamed A Alqahtani
- Medical Student, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Abdulmageed A Asiri
- Medical Student, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Ebtesam M Alahmari
- Medical Student, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Amal N Alqahtani
- Medical Student, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Ahmed A Mahfouz
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia.
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
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6
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Abstract
PURPOSE Toxocariasis is a helminthozoonosis caused by the infection of a human host by the larva of Toxocara spp., predominately involving Toxocara canis and Toxocara cati, which are common nematodes in dogs and cats, respectively. Human transmission occurs through contact with animals or by consumption of food contaminated with parasite's eggs. The purpose of this article is to review the current knowledge regarding human neurotoxocariasis. METHODS We conducted a systematic review of the existing literature concerning toxocariasis of the nervous system. RESULTS Clinical spectrum of human toxocariasis varies widely from a subclinical course to significant organ morbidity. Clinical course depends on parasitic load, the migration route of the larvae and host response. Human neurotoxocariasis is a relatively rare entity yet associated with severe sequelae. Manifestations include meningitis (usually eosinophilic), encephalitis, myelitis, cerebellar vasculitis, space-occupying lesion, behavioral abnormalities, and optic neuritis. Even though valid diagnostic criteria are lacking, neurotoxocariasis should be suspected in patients with neurologic symptoms and cerebrospinal fluid (CSF) pleocytosis with eosinophilia, positive serology for anti-Toxocara antibodies, in serum and/or CSF, sterile CSF and clinical improvement after antihelminthic treatment. Neurotoxocariasis is treated by benzimidazole components, most frequently albendazole, corticosteroids, or diethylcarbamazine. CONCLUSION Parasite larvae migrate through tissues and are able to reach the nervous system causing neurotoxocariasis. Its clinical spectrum varies and includes myelitis, meningoencephalitis, brain abscess, and vasculitis. Neurotoxocariasis should always be suspected in patients with neurologic symptoms accompanied by eosinophilia in blood and/or CSF. Early diagnosis and treatment could prevent long-term neurologic impairment.
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Abstract
Several imaging modalities have now been employed to visualize the manifestations of larval Toxocara infection in hepatic, neurologic, ocular, renal, and other anatomical sites. This report reviews the usefulness and value of these individual imaging methods in diagnosis and follow-up of the different cases causing eosinophilic (granulomatous) infiltrations the liver, lungs, brain, heart, and eyes. Imaging provides a means of assisting in diagnosis and management in this infection where diagnosis by biopsy is often unlikely to capture an actual larva for the purpose of making a definitive diagnosis on the basis of larval morphology or DNA detection.
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Affiliation(s)
- Christoph F Dietrich
- Department of Internal Medicine (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.
| | - Carmen Cretu
- Department of Parasitology, Carol Davila University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Baalbaki M, El Najjar M, Atweh S, El Ayoubi NK. Toxocara infection in the differential diagnosis of multiple sclerosis in the Middle East. Mult Scler J Exp Transl Clin 2020; 6:2055217319855757. [PMID: 35145728 PMCID: PMC8822452 DOI: 10.1177/2055217319855757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/18/2019] [Indexed: 01/03/2023] Open
Abstract
A critical step in the diagnosis of multiple sclerosis is to rule out a heterogeneous variety of multiple sclerosis mimickers, which is crucial in the era of powerful immune-modulator treatments. In this review, we discuss the background of toxocariasis in general, present central nervous system Toxocara infection as one of the multiple sclerosis mimickers in the Middle East, and share our experience about the diagnosis and management of this condition. This entity seems very relevant in a region such as the Middle East, where displacement of populations and conflict can result in non-hygienic food and water management bundles. The diagnosis should be entertained, especially when assessing patients with myelopathy. The presence of a single lesion in the spinal cord with inflammatory features should prompt serological testing for Toxocara IgG and IgM in serum and the cerebrospinal fluid. This infection is treatable, with the regimen of high-dose albendazole being one of the most accepted treatments. Although most cases exhibit a good prognosis, some have residual deficits localized to the affected spinal cord level.
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Affiliation(s)
| | - Mayssam El Najjar
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Lebanon
| | - Samir Atweh
- Department of Neurology, American University of Beirut Medical Center, Lebanon
| | - Nabil K El Ayoubi
- American University of Beirut, Cairo street, Beirut, 1107 2020, Lebanon
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Toxocariasis: a silent threat with a progressive public health impact. Infect Dis Poverty 2018; 7:59. [PMID: 29895324 PMCID: PMC5998503 DOI: 10.1186/s40249-018-0437-0] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/09/2018] [Indexed: 11/10/2022] Open
Abstract
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.
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Sánchez SS, García HH, Nicoletti A. Clinical and Magnetic Resonance Imaging Findings of Neurotoxocariasis. Front Neurol 2018; 9:53. [PMID: 29472889 PMCID: PMC5809457 DOI: 10.3389/fneur.2018.00053] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/19/2018] [Indexed: 01/08/2023] Open
Abstract
Human toxocariasis is one of the most prevalent helminthiases worldwide. Toxocara canis larvae can cross the blood-brain barrier leading to the neurotoxocariasis. The clinical presentation consists of a wide spectrum of neurological manifestations, but asymptomatic infection is probably common. Neurotoxocariasis is not a frequent diagnosis probably due to the non-specific nature of its symptoms as well as the lack of confirmatory diagnostic tests. Diagnosis of neurotoxocariasis is based on the presence of a high titer of anti-Toxocara antibody in the cerebrospinal fluid or in the serum, presence of eosinophilia in the serum or cerebrospinal fluid, and clinical and radiological improvement after anthelmintic therapy; however, universally accepted diagnostic criteria are lacking. Magnetic resonance imaging (MRI) findings include single or multiple, subcortical, cortical or white matter hyperintense lesions, best visualized on FLAIR and T2-weighted imaging, and usually isointense or hypointense on T1. These imaging findings are suggestive but not specific to neurotoxocariasis. Definitive diagnosis is made by histological confirmation, but it is rarely followed. This review provides an overview of the clinical manifestations, management options, and MRI findings of neurotoxocariasis.
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Affiliation(s)
- Sofia S Sánchez
- Department of Microbiology, School of Public Health (SSS), Center for Global Health - Tumbes (HHG), Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Sciences (HHG), Center for Global Health - Tumbes (HHG), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hector H García
- Department of Microbiology, School of Public Health (SSS), Center for Global Health - Tumbes (HHG), Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Sciences (HHG), Center for Global Health - Tumbes (HHG), Universidad Peruana Cayetano Heredia, Lima, Peru.,Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Alessandra Nicoletti
- Department G. F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
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Role of Macrophages in the Repair Process during the Tissue Migrating and Resident Helminth Infections. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8634603. [PMID: 27648452 PMCID: PMC5014929 DOI: 10.1155/2016/8634603] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/13/2016] [Accepted: 07/19/2016] [Indexed: 12/30/2022]
Abstract
The Th1/Th2/Th17 balance is a fundamental feature in the regulation of the inflammatory microenvironment during helminth infections, and an imbalance in this paradigm greatly contributes to inflammatory disorders. In some cases of helminthiasis, an initial Th1 response could occur during the early phases of infection (acute), followed by a Th2 response that prevails in chronic infections. During the late phase of infection, alternatively activated macrophages (AAMs) are important to counteract the inflammation caused by the Th1/Th17 response and larval migration, limiting damage and repairing the tissue affected. Macrophages are the archetype of phagocytic cells, with the primary role of pathogen destruction and antigen presentation. Nevertheless, other subtypes of macrophages have been described with important roles in tissue repair and immune regulation. These types of macrophages challenge the classical view of macrophages activated by an inflammatory response. The role of these subtypes of macrophages during helminthiasis is a controversial topic in immunoparasitology. Here, we analyze some of the studies regarding the role of AAMs in tissue repair during the tissue migration of helminths.
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Abstract
PURPOSE Toxocariasis is a widespread zoonosis, which may result in central nervous system injury. METHODS We conducted a systematic literature review in MEDLINE, SciELO, ScienceDirect and Google Scholar up to April 2015 using a combination of the following search terms: "neurotoxocariasis" or "neurotoxocarosis", "toxocariasis" or "toxocarosis" and "cerebral" or "neurologic". RESULTS One hundred cases of neurotoxocariasis were identified in literature. The majority of patients were male (58 %), with a median age of 42 years. The predominant clinical pictures were myelitis (60 %), encephalitis (47 %) and/or meningitis (29 %). Fever was inconstant (23 %). The suspected mode of transmission, mentioned in only 49 % of cases, was mainly contact with dogs and/or cats (67 %) and ingestion of contaminated food (31 %). Diagnostic imaging examinations found hypodense lesions in cerebral scanner sequences and hyperintense lesions in cerebral MRI T2-weighted sequences in 65 and 57 % of encephalitis cases respectively, and in 92 % of myelitis cases in medullary MRI T2-weighted sequences. The detection of antibodies against Toxocara spp. was almost constant in blood and cerebrospinal fluid (CSF), 99 and 93 %, respectively. The two most commonly used drugs were corticosteroids (72 %) and/or albendazole (68 %) for a period of at least 3 weeks, which often needed to be repeated. Despite a low mortality rate (6 %), complete remission was observed in only 40 % of cases. CONCLUSIONS Neurotoxocariasis, a completely preventable zoonosis, could lead to severe sequelae failing prompt diagnosis. A compatible clinical picture, presence of risk factors, blood eosinophilia and high titers of antibodies against Toxocara spp. in CSF should alert physicians.
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Abstract
Toxocara canis and T. cati are highly prevalent nematode infections of the intestines of dogs and cats. In paratenic hosts, larvae do not mature in the intestine but instead migrate through the somatic tissues and organs of the body. The presence of these migrating larvae can contribute to pathology. Toxocara larvae can invade the brains of humans, and while case descriptions of cerebral toxocariasis are historically rare, improved diagnosis and greater awareness have contributed to increased detection. Despite this, cerebral or neurological toxocariasis (NT) remains a poorly understood phenomenon. Furthermore, our understanding of cognitive deficits due to toxocariasis in human populations remains particularly deficient. Recent data describe an enhanced expression of biomarkers associated with brain injury, such as GFAP, AβPP, transforming growth factor β1 (TGF-β1), NF-L, S100B, tTG, and p-tau, in mice receiving even low doses of Toxocara ova. Finally, this review outlines a hypothesis to explore the relationship between the presence of T. canis larvae in the brain and the progression of Alzheimer's disease (AD) due to enhanced AD-associated neurodegenerative biomarker expression.
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14
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Artinyan E, Uysal HK, Akgul O, Altiparmak S, Oner YA. Research on Toxocara canis antibodies obtained from patients with eosinophilia. Indian J Med Microbiol 2015; 32:383-6. [PMID: 25297021 DOI: 10.4103/0255-0857.142239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Eosinophils may suggest the presence of a great variety of anomalies whereupon allergies, malignancies, certain tissue disorders, idiopathic hypereosynophilic syndrome and parasitic infections (with the exception of protozoons) can be cited as a few. Although the clinical manifestations may differ, the eosinophils level is quite an important data in cases related to the helminth infections. Similarly, in parasitic infections related to larva migrans (visceral, cutaneous, ocular), the eosinophils level is again a primary indicator and its evident cause is the roundworm Toxocara spp. AIM The aim of this study was to evaluate the significance characteristics of Toxocara spp. in patients with eosonophilia. MATERIALS AND METHODS In our study, serums were collected from 93 patients of various age groups with eosonophilia (10% and above) while visiting Istanbul University Medical Faculty due to various complaints. RESULTS Serum samples were treated with Toxocara IgG ready ELISA kit and Toxocara western blot IgG ready kit. Based on the ELISA method; out of 93 patients, 30 patients (32.3%) were positive. Western blot technique; 45 (48.4%) were positive with anti-toxocara IgG antibodies. CONCLUSION Results point out to western blot technique being more sensitive and superior on a scale of (P < 0.0001) when compared with the ELISA method.
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Affiliation(s)
| | - H Kirkoyun Uysal
- Department of Parasitology, Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University Istanbul, Turkey
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Gyang PV, Akinwale OP, Lee YL, Chuang TW, Orok AB, Ajibaye O, Liao CW, Chen PC, Chou CM, Huang YC, Barghouth U, Fan CK. Seroprevalence, disease awareness, and risk factors for Toxocara canis infection among primary schoolchildren in Makoko, an urban slum community in Nigeria. Acta Trop 2015; 146:135-40. [PMID: 25812836 DOI: 10.1016/j.actatropica.2015.03.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/14/2015] [Accepted: 03/16/2015] [Indexed: 01/03/2023]
Abstract
In this study, we investigated the seroprevalence of Toxocara canis infection in southern Nigeria, which previously was unknown, in addition to evaluating disease awareness and potential risk factors for schoolchildren in an urban slum community. In total, 366 primary schoolchildren were investigated for the presence of anti-Toxocara IgG antibodies. Blood was collected and screened by a Western blot analysis based on the excretory-secretory antigens of larval T. canis (TcES), targeting low molecular weight bands of 24-35kDa specific for T. canis. Children were considered seropositive if their serum reacted with TcES when diluted to a titer of 1:32. Questionnaires concerning possible risk factors were given to the schoolchildren to acquire data on this infection. The overall seroprevalence of Toxocara infection was 86.1% (315/366). The logistic regression analysis of risk factors showed that children's age (odds ratio (OR)=2.88, 95% confidence interval (CI)=1.08-7.66, p=0.03), contact with dogs (OR=0.51, 95% CI=0.28-0.94, p=0.03), the age of the dog (OR=0.34, 95% CI=0.18-0.68, p=0.002), the feeding location of the dog (OR=0.31, 95% CI=0.12-0.79, p=0.01), the consumption of raw vegetables (OR=0.89, 95% CI=0.54-1.48, p=0.004), and the drinking of unboiled water (OR=0.48, 95% CI=0.26-0.90, p=0.02) were risk factors associated with Toxocara infection. Although there was a high awareness of dogs being hosts of some parasites in this study, not much was known about T. canis. This is the first serological investigation of T. canis infection among primary schoolchildren in southern Nigeria. The high seroprevalence recorded is an indication of high transmission with the consequent risk of visceral or ocular larval migrans and neurologic toxocariasis in these children. Our findings suggest the need for prompt interventional measures, particularly health education on personal hygiene.
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Fu CJ, Chuang TW, Lin HS, Wu CH, Liu YC, Langinlur MK, Lu MY, Hsiao WWW, Fan CK. Seroepidemiology of Toxocara canis infection among primary schoolchildren in the capital area of the Republic of the Marshall Islands. BMC Infect Dis 2014; 14:261. [PMID: 24886153 PMCID: PMC4024650 DOI: 10.1186/1471-2334-14-261] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 05/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Toxocariasis, which is predominantly caused by Toxocara canis (T. canis) infection, is a common zoonotic parasitosis worldwide; however, the status of toxocariasis endemicity in the Republic of the Marshall Islands (RMI) remains unknown. METHODS A seroepidemiological investigation was conducted among 166 primary school children (PSC) aged 7-12 years from the capital area of the RMI. Western blots based the excretory-secretory antigens of larval T. canis (TcES) was employed, and children were considered seropositive if their serum reacted with TcES when diluted at a titer of 1:64. Information regarding demographic characteristics of and environmental risk factors affecting these children was collected using a structured questionnaire. A logistic regression model was applied to conduct a multivariate analysis. RESULTS The overall seropositive rate of T. canis infection was 86.75% (144/166). In the univariate analysis, PSC who exhibited a history of feeding dogs at home (OR = 5.52, 95% CI = 1.15-26.61, p = 0.02) and whose parents were employed as nonskilled workers (OR = 2.86, 95% CI = 1.08-7.60, p = 0.03) demonstrated a statistically elevated risk of contracting T. canis infections. Cleaning dog huts with gloves might prevent infection, but yielded nonsignificant effects. The multivariate analysis indicated that parental occupation was the critical risk factor in this study because its effect remained significant after adjusting for other variables; by contrast, the effect of dog feeding became nonsignificant because of other potential confounding factors. No associations were observed among gender, age, consuming raw meat or vegetables, drinking unboiled water, cleaning dog huts with gloves, or touching soil. CONCLUSIONS This is the first serological investigation of T. canis infection among PSC in the RMI. The high seroprevalence indicates the commonness of T. canis transmission and possible human risk. The fundamental information that the present study provides regarding T. canis epidemiology can facilitate developing strategies for disease prevention and control.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Chia-Kwung Fan
- Department of Parasitology, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Bhalla D, Godet B, Druet-Cabanac M, Preux PM. Etiologies of epilepsy: a comprehensive review. Expert Rev Neurother 2014; 11:861-76. [DOI: 10.1586/ern.11.51] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Bhalla D, Dumas M, Preux PM. Neurological manifestations of filarial infections. HANDBOOK OF CLINICAL NEUROLOGY 2013; 114:235-42. [PMID: 23829914 DOI: 10.1016/b978-0-444-53490-3.00018-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Filarial infections cause a huge public health burden wherever they are endemic. These filaria may locate anywhere in the human body. Their manifestations and pathogenic mechanisms, except the most common ones, are rarely investigated systematically. Their neurological manifestations, however, are being increasingly recognized particularly with onchocerciasis or Loa loa infections, Wuchereria bancrofti, or Mansonella perstans. The risk of developing these manifestations may also increase in cases that harbor multiple filariasis or coinfections, for instance as with Plasmodium. The microfilaria of Onchocerca and Loa loa are seen in cerebrospinal fluid. The pathogenesis of neurological manifestations of these infections is complex; however, pathogenic reactions may be caused by mechanical disruption, e.g., degeneration often followed by granulomas, causing fibrosis or mass effects on other tissues, vascular lesions, e.g., vascular block of cerebral vessels, or disordered inflammatory responses resulting in meningitis, encephalitis or localized inflammatory responses. The chances of having neurological manifestations may also depend upon the frequency and"heaviness"of infection over a lifetime. Hence, this type of infection should no longer be considered a disease of the commonly affected areas but one that may produce systemic effects or other manifestations, and these should be considered in populations where they are endemic.
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Affiliation(s)
- Devender Bhalla
- INSERM UMR 1094, Tropical Neuroepidemiology, Limoges, France; University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France; Centre Hospitalier Universitaire, Limoges, France
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Fan CK, Liao CW, Cheng YC. Factors affecting disease manifestation of toxocarosis in humans: Genetics and environment. Vet Parasitol 2013; 193:342-52. [DOI: 10.1016/j.vetpar.2012.12.030] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
Parasitic infections of the central nervous system (CNS) include two broad categories of infectious organisms: single-celled protozoa and multicellular metazoa. The protozoal infections include malaria, American trypanosomiasis, human African trypanosomiasis, toxoplasmosis, amebiasis, microsporidiasis, and leishmaniasis. The metazoal infections are grouped into flatworms, which include trematoda and cestoda, and roundworms or nematoda. Trematoda infections include schistosomiasis and paragonimiasis. Cestoda infections include cysticercosis, coenurosis, hydatidosis, and sparganosis. Nematoda infections include gnathostomiasis, angiostrongyliasis, toxocariasis, strongyloidiasis, filariasis, baylisascariasis, dracunculiasis, micronemiasis, and lagochilascariasis. The most common route of CNS invasion is through the blood. In some cases, the parasite invades the olfactory neuroepithelium in the nasal mucosa and penetrates the brain via the subarachnoid space or reaches the CNS through neural foramina of the skull base around the cranial nerves or vessels. The neuropathological changes vary greatly, depending on the type and size of the parasite, geographical strain variations in parasitic virulence, immune evasion by the parasite, and differences in host immune response. Congestion of the leptomeninges, cerebral edema, hemorrhage, thrombosis, vasculitis, necrosis, calcification, abscesses, meningeal and perivascular polymorphonuclear and mononuclear inflammatory infiltrate, microglial nodules, gliosis, granulomas, and fibrosis can be found affecting isolated or multiple regions of the CNS, or even diffusely spread. Some infections may be present as an expanding mass lesion. The parasites can be identified by conventional histology, immunohistochemistry, in situ hybridization, and PCR.
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Affiliation(s)
- José Eymard Homem Pittella
- Pathology Service, Hospital das Clínicas, Medical Faculty of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Quattrocchi G, Nicoletti A, Marin B, Bruno E, Druet-Cabanac M, Preux PM. Toxocariasis and epilepsy: systematic review and meta-analysis. PLoS Negl Trop Dis 2012; 6:e1775. [PMID: 22905274 PMCID: PMC3419195 DOI: 10.1371/journal.pntd.0001775] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 06/29/2012] [Indexed: 11/18/2022] Open
Abstract
Objective Human toxocariasis is a zoonotic infection caused by the larval stages of Toxocara canis (T. canis) and less frequently Toxocara cati (T. cati). A relationship between toxocariasis and epilepsy has been hypothesized. We conducted a systematic review and a meta-analysis of available data to evaluate the strength of association between epilepsy and Toxocara spp. seropositivity and to propose some guidelines for future surveys. Data Sources Electronic databases, the database from the Institute of Neuroepidemiology and Tropical Neurology of the University of Limoges (http://www-ient.unilim.fr/) and the reference lists of all relevant papers and books were screened up to October 2011. Methods We performed a systematic review of literature on toxocariasis (the exposure) and epilepsy (the outcome). Two authors independently assessed eligibility and study quality and extracted data. A common odds ratio (OR) was estimated using a random-effects meta-analysis model of aggregated published data. Results Seven case-control studies met the inclusion criteria, for a total of 1867 participants (850 cases and 1017 controls). The percentage of seropositivity (presence of anti-Toxocara spp. antibodies) was higher among people with epilepsy (PWE) in all the included studies even if the association between epilepsy and Toxocara spp. seropositivity was statistically significant in only 4 studies, with crude ORs ranging 2.04–2.85. Another study bordered statistical significance, while in 2 of the included studies no significant association was found. A significant (p<0.001) common OR of 1.92 [95% confidence interval (CI) 1.50–2.44] was estimated. Similar results were found when meta-analysis was restricted to the studies considering an exclusively juvenile population and to surveys using Western Blot as confirmatory or diagnostic serological assay. Conclusion Our results support the existence of a positive association between Toxocara spp. seropositivity and epilepsy. Further studies, possibly including incident cases, should be performed to better investigate the relationship between toxocariasis and epilepsy. Human toxocariasis is an infection caused by the larval stage of the worms Toxocara canis and less frequently Toxocara cati, common parasites of domestic and peridomestic dogs and cats. It is a cosmopolitan infection, occurring whenever the man-soil-dog relationship is particularly close, especially in tropical countries, where the humid climate favours the survival of parasite eggs in the soil, and in rural settings, where the poor hygiene increases the probability of human infection. Epilepsy affects nowadays at least 65 million of people worldwide and is particularly common in tropical areas, probably because of the presence of cases caused by infectious diseases largely absent in industrialized countries. For several decades, researchers have investigated the possible association between toxocariasis and epilepsy. In this study we conducted a statistical analysis of all the data available on the relationship between these two conditions. The combined results of the 7 studies included indicate an association between the two diseases. Further studies are necessary to demonstrate a causal relationship (i.e. toxocariasis causes epilepsy). Considering that toxocariasis is a preventable and common disease, a better understanding of the relationship between toxocariasis and epilepsy may contribute to improving prevention of epilepsy worldwide.
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Affiliation(s)
- Graziella Quattrocchi
- Department GF Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Alessandra Nicoletti
- Department GF Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Benoit Marin
- INSERM U1094, Tropical Neuroepidemiology, Limoges, France
- University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Limoges, France
- CNRS FR 3503 GEIST, Limoges, France
- CHU Limoges, France
| | - Elisa Bruno
- Department GF Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Michel Druet-Cabanac
- INSERM U1094, Tropical Neuroepidemiology, Limoges, France
- University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Limoges, France
- CNRS FR 3503 GEIST, Limoges, France
- CHU Limoges, France
| | - Pierre-Marie Preux
- INSERM U1094, Tropical Neuroepidemiology, Limoges, France
- University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Limoges, France
- CNRS FR 3503 GEIST, Limoges, France
- CHU Limoges, France
- * E-mail:
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Martins CM, Barros CDCD, Bier D, Marinho AP, Figueiredo JMG, Hoffmann JL, Molento MB, Biondo AW. Dog parasite incidence and risk factors, from sampling after one-year interval, in Pinhais, Brazil. REVISTA BRASILEIRA DE PARASITOLOGIA VETERINARIA 2012; 21:101-6. [DOI: 10.1590/s1984-29612012000200006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 02/14/2012] [Indexed: 11/21/2022]
Abstract
Domestic animals in urban areas may serve as reservoirs for parasitic zoonoses. The aim of this study was to monitor the parasitic status of household dogs in an urban area of Pinhais, in the metropolitan region of Curitiba, Paraná State, Brazil, after a one-year period. In May 2009, fecal samples, skin scrapings and ticks were collected from 171 dogs. Questionnaires were applied to the owners (sex, age, environment and anthelmintic use). In May 2010, 26.3% (45/171) of the dogs were fecal samples reanalysed. From the fecal samples, 33.3% (57/171) in 2009 and 64.4% (29/45) in 2010 were positive. The parasite species most observed were, respectively in 2009 and 2010, Ancylostoma sp., 66.7 and 44.8%, and Strongyloidesstercoralis, 26.3 and 3.4%. All the skin scrapings were negative, and no ticks or protozoa were found. There was no statistical association (p > 0.05) between positive fecal tests and age, sex or environment. In 2009 alone, dogs with a history of antiparasitic drug administration were 2.3 times more likely to be negative. A great number of replacement dogs was noticed one year later. Therefore, isolated antiparasitic treatment strategies may have no impact on parasite control, given the risk of introduction of new agents, thereby limiting the prevention strategies.
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Peters JM, Madhavan VL, Kazacos KR, Husson RN, Dangoudoubiyam S, Soul JS. Good outcome with early empiric treatment of neural larva migrans due to Baylisascaris procyonis. Pediatrics 2012; 129:e806-11. [PMID: 22311989 DOI: 10.1542/peds.2011-2078] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report a remarkably good outcome in a 14-month-old boy with early clinical diagnosis and aggressive empirical treatment of neural larva migrans caused by the raccoon roundworm Baylisascaris procyonis. He presented with fever, meningismus, lethargy, irritability and asymmetric spastic extremity weakness. Early findings of marked blood and cerebrospinal fluid eosinophilia and of diffuse white matter signal abnormality in the brain and spinal cord on MRI suggested a parasitic encephalomyelitis. Rapid presumptive treatment with albendazole and high-dose steroids halted progression of clinical signs. The diagnosis was confirmed by 2 sequential enzyme-linked immunosorbent assay studies positive for B procyonis serum immunoglobulin G and by Western blot. Field examination with soil sampling yielded infective Baylisascaris eggs. Repeat MRI 3 months later showed atrophy and diffuse, chronic white matter abnormalities, discordant with the marked clinical improvement in this interval. At 10 months, residual neurologic deficits included subtle paraparesis and moderate language delay. This case is the first in which spinal involvement in human Baylisascaris infection was clinically suspected and confirmed by neuroimaging. Importantly, early diagnosis and aggressive treatment of Baylisascaris meningo-encephalitis and myelitis with albendazole and high-dose steroids likely contributed to the good outcome in this patient, in contrast with previous reports.
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Affiliation(s)
- Jurriaan M Peters
- Department of Neurology, Children's Hospital Boston, Boston, MA 02115, USA
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Yemadje LP, Houinato D, Quet F, Druet-Cabanac M, Preux PM. Understanding the differences in prevalence of epilepsy in tropical regions. Epilepsia 2011; 52:1376-81. [PMID: 21627649 DOI: 10.1111/j.1528-1167.2011.03099.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Epilepsy is a frequent chronic neurologic disorder that affects nearly 70 million people worldwide. The majority of people with epilepsy live in developing countries, where epilepsy remains a major public health problem. Wide prevalence differences exist among various populations across sub-Saharan Africa, Latin America, and Asia. In particular, prevalence is lower in Southeast Asia than in sub-Saharan Africa and Latin America. Methodologic problems alone do not seem to explain these differences shown in recent review papers. The distribution of numerous risk or etiologic factors such as infectious diseases with neurologic sequel, head injuries, or genetic factors could explain these differences. Stigmatization of people with epilepsy could lead to underestimating the prevalence of epilepsy, even in well-conducted studies. It is important to standardize the process of epidemiologic monitoring of epilepsy in order to improve the reliability in data comparison. Understanding the reasons for these differences is a crucial issue for eventually raising new hypotheses or prevention strategies.
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Affiliation(s)
- Luce-Perrine Yemadje
- University of Limoges, IFR 145 GEIST, Institute of Tropical Neurology, EA 3174 Comparative and Tropical Neuroepidemiology, Limoges, France
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Toxocara canis larvae reinfecting BALB/c mice exhibit accelerated speed of migration to the host CNS. Parasitol Res 2011; 109:1267-78. [DOI: 10.1007/s00436-011-2371-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 03/25/2011] [Indexed: 10/18/2022]
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Nkouawa A, Sako Y, Itoh S, Kouojip-Mabou A, Nganou CN, Saijo Y, Knapp J, Yamasaki H, Nakao M, Nakaya K, Moyou-Somo R, Ito A. Serological studies of neurologic helminthic infections in rural areas of southwest cameroon: toxocariasis, cysticercosis and paragonimiasis. PLoS Negl Trop Dis 2010; 4:e732. [PMID: 20625553 PMCID: PMC2897840 DOI: 10.1371/journal.pntd.0000732] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 05/12/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Both epilepsy and paragonimiasis had been known to be endemic in Southwest Cameroon. A total of 188 people (168 and 20 with and without symptoms confirmed by clinicians, respectively, 84.6% under 20 years old) were selected on a voluntary basis. Among 14 people (8.3%) with history of epilepsy, only one suffered from paragonimiasis. Therefore, we challenged to check antibody responses to highly specific diagnostic recombinant antigens for two other helminthic diseases, cysticercosis and toxocariasis, expected to be involved in neurological diseases. Soil-transmitted helminthic infections were also examined. METHODOLOGY/PRINCIPAL FINDINGS Fecal samples were collected exclusively from the 168 people. Eggs of Ascaris lumbricoides, Trichuris trichiura and hookworms were found from 56 (33.3%), 72 (42.8%), and 19 (11.3%) persons, respectively. Serology revealed that 61 (36.3%), 25 (14.9%) and 2 (1.2%) of 168 persons showed specific antibody responses to toxocariasis, paragonimiasis and cysticercosis, respectively. By contrast, 20 people without any symptoms as well as additional 20 people from Japan showed no antibody responses. Among the 14 persons with epilepsy, 5 persons were seropositive to the antigen specific to Toxocara, and one of them was simultaneously positive to the antigens of Paragonimus. The fact that 2 children with no history of epilepsy were serologically confirmed to have cysticercosis strongly suggests that serological survey for cysticercosis in children is expected to be useful for early detection of asymptomatic cysticercosis in endemic areas. CONCLUSIONS/SIGNIFICANCE Among persons surveyed, toxocariasis was more common than paragonimiasis, but cysticercosis was very rare. However, the fact that 2 children were serologically confirmed to have cysticercosis was very important, since it strongly suggests that serology for cysticercosis is useful and feasible for detection of asymptomatic cysticercotic children in endemic areas for the early treatment.
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Affiliation(s)
- Agathe Nkouawa
- Department of Parasitology, Asahikawa Medical College, Asahikawa, Hokkaido, Japan
- Medical Research Center, Institute of Medical Research and Medicinal Plants Studies (IMPM), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Yasuhito Sako
- Department of Parasitology, Asahikawa Medical College, Asahikawa, Hokkaido, Japan
| | - Sonoyo Itoh
- Department of Parasitology, Asahikawa Medical College, Asahikawa, Hokkaido, Japan
| | | | - Christ Nadège Nganou
- Department of Parasitology and Infectious Diseases, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon
| | - Yasuaki Saijo
- Division of Community Medicine and Epidemiology, Department of Health Science, Asahikawa Medical College, Asahikawa, Hokkaido, Japan
| | - Jenny Knapp
- Department of Parasitology, Asahikawa Medical College, Asahikawa, Hokkaido, Japan
| | - Hiroshi Yamasaki
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Minoru Nakao
- Department of Parasitology, Asahikawa Medical College, Asahikawa, Hokkaido, Japan
| | - Kazuhiro Nakaya
- Animal Laboratory for Medical Research, Asahikawa Medical College, Asahikawa, Hokkaido, Japan
| | - Roger Moyou-Somo
- Medical Research Center, Institute of Medical Research and Medicinal Plants Studies (IMPM), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
- Department of Parasitology and Infectious Diseases, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon
| | - Akira Ito
- Department of Parasitology, Asahikawa Medical College, Asahikawa, Hokkaido, Japan
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Biochemical and immunopathological changes in experimental neurotoxocariasis. Mol Biochem Parasitol 2010; 172:1-8. [PMID: 20302888 DOI: 10.1016/j.molbiopara.2010.03.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 03/09/2010] [Accepted: 03/09/2010] [Indexed: 11/28/2022]
Abstract
Toxocariasis is a widespread soil-transmitted parasitic disease. Toxocara canis larvae migrate through the tissues with a special predilection for the central nervous system. Recently, neurotoxocariasis is being diagnosed in humans with increasing frequency due to improved diagnostic tools. The present study aimed at exploring the biochemical and immunopathological alterations in the brain in experimental T. canis infection. For this purpose, 75 Toxocara-infected mice were sacrificed at 2, 5, and 16 weeks post-infection. The brains were removed and assayed for total larval count, pro-inflammatory cytokines (TNF-alpha, IL-6), and central neurotransmitters (gamma-aminobutyric acid, glutamate, dopamine, norepinephrine, and serotonin). Brain sections were also stained for histopathological study, and for assessment of the expression of inducible nitric oxide synthase (iNOS), and glial fibrillary acidic protein (GFAP) by immunohistochemical methods. We found that larval recovery showed progressive increase over the course of infection. Furthermore, the infected mice displayed increased expression of pro-inflammatory cytokines and iNOS, as well as significant disturbances in neurotransmitter profile. Astrocytic activation, evidenced by enhanced expression of GFAP, was also manifest in infected animals. These changes were maximal in the chronic stage of infection or intensified over time. In conclusion, experimental neurotoxocariasis is associated with significant biochemical, immunological, and pathological changes.
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Abstract
A boy with bilateral retinoblastoma underwent metastatic surveillance for increased risk of systemic and central nervous system metastasis because of the extensive choroid and optic nerve invasion in his enucleated eye. Two years after finishing chemotherapy, surveillance MRI showed multiple new liver, lung and spinal cord lesions. High Toxocara antibody titers, eosinophilia, and elevated IgE levels supported a diagnosis of toxocariasis, rather than retinoblastoma metastasis. This is the first report of early, asymptomatic spinal cord toxocariasis diagnosed incidentally through metastatic surveillance.
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Jagannath PM, Venkataramana NK, Rao SAV, Naik AL, Shivakumar SK, Saktepar A, Gopalakrishnan R, Shankar SK. Recurrent cerebral larva migrans: A case report and review of literature. J Pediatr Neurosci 2009; 4:36-40. [PMID: 21887174 PMCID: PMC3162836 DOI: 10.4103/1817-1745.49107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Cerebral larva migrans (CLM) is an uncommon and rarely diagnosed entity. We report here a histopathologically proven case of CLM in a 13 year-old girl, who presented with bilateral focal seizures, right hemiparesis, and lapsed into altered sensorium prior to admission. Her CT scan was suggestive of a granulomatous lesion which eventually turned out to be CLM (toxocariasis). Interestingly, the lesion recurred after excision, with a confusing clinical picture. Following the second surgery, the pathology was reconfirmed and cure was provided for the disease. There has been no further intracranial recurrence during the past ten years although she developed cutaneous lesions.
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Affiliation(s)
- P. M. Jagannath
- Department of Neurosurgery, BGS Global Neuroscience Institute, BGS Global Hospital, Bangalore – 560 060, India
| | - N. K. Venkataramana
- Department of Neurosurgery, BGS Global Neuroscience Institute, BGS Global Hospital, Bangalore – 560 060, India
| | - Shailesh A. V. Rao
- Department of Neurosurgery, BGS Global Neuroscience Institute, BGS Global Hospital, Bangalore – 560 060, India
| | - Arun L. Naik
- Department of Neurosurgery, BGS Global Neuroscience Institute, BGS Global Hospital, Bangalore – 560 060, India
| | - S. K. Shivakumar
- Department of Neurosurgery, BGS Global Neuroscience Institute, BGS Global Hospital, Bangalore – 560 060, India
| | - Anvesh Saktepar
- Department of Neurosurgery, BGS Global Neuroscience Institute, BGS Global Hospital, Bangalore – 560 060, India
| | - Raghuram Gopalakrishnan
- Department of Neurosurgery, BGS Global Neuroscience Institute, BGS Global Hospital, Bangalore – 560 060, India
| | - S. K. Shankar
- Department of Neuropathology, NIMHANS, Bangalore-560 029, India
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LIAO CW, CHO WL, KAO TC, SU KE, LIN YH, FAN CK. Blood-brain barrier impairment with enhanced SP, NK-1R, GFAP and Claudin-5 expressions in experimental cerebral toxocariasis. Parasite Immunol 2008; 30:525-34. [DOI: 10.1111/j.1365-3024.2008.01048.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Winkler AS, Blocher J, Auer H, Gotwald T, Matuja W, Schmutzhard E. Anticysticercal and antitoxocaral antibodies in people with epilepsy in rural Tanzania. Trans R Soc Trop Med Hyg 2008; 102:1032-8. [DOI: 10.1016/j.trstmh.2008.05.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Revised: 05/06/2008] [Accepted: 05/06/2008] [Indexed: 11/29/2022] Open
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Liao CW, Fan CK, Kao TC, Ji DD, Su KE, Lin YH, Cho WL. Brain injury-associated biomarkers of TGF-beta1, S100B, GFAP, NF-L, tTG, AbetaPP, and tau were concomitantly enhanced and the UPS was impaired during acute brain injury caused by Toxocara canis in mice. BMC Infect Dis 2008; 8:84. [PMID: 18573219 PMCID: PMC2442079 DOI: 10.1186/1471-2334-8-84] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Accepted: 06/24/2008] [Indexed: 11/25/2022] Open
Abstract
Background Because the outcomes and sequelae after different types of brain injury (BI) are variable and difficult to predict, investigations on whether enhanced expressions of BI-associated biomarkers (BIABs), including transforming growth factor β1 (TGF-β1), S100B, glial fibrillary acidic protein (GFAP), neurofilament light chain (NF-L), tissue transglutaminases (tTGs), β-amyloid precursor proteins (AβPP), and tau are present as well as whether impairment of the ubiquitin-proteasome system (UPS) is present have been widely used to help delineate pathophysiological mechanisms in various BIs. Larvae of Toxocara canis can invade the brain and cause BI in humans and mice, leading to cerebral toxocariasis (CT). Because the parasitic burden is light in CT, it may be too cryptic to be detected in humans, making it difficult to clearly understand the pathogenesis of subtle BI in CT. Since the pathogenesis of murine toxocariasis is very similar to that in humans, it appears appropriate to use a murine model to investigate the pathogenesis of CT. Methods BIAB expressions and UPS function in the brains of mice inoculated with a single dose of 250 T. canis embryonated eggs was investigated from 3 days (dpi) to 8 weeks post-infection (wpi) by Western blotting and RT-PCR. Results Results revealed that at 4 and 8 wpi, T. canis larvae were found to have invaded areas around the choroid plexus but without eliciting leukocyte infiltration in brains of infected mice; nevertheless, astrogliosis, an indicator of BI, with 78.9~142.0-fold increases in GFAP expression was present. Meanwhile, markedly increased levels of other BIAB proteins including TGF-β1, S100B, NF-L, tTG, AβPP, and tau, with increases ranging 2.0~12.0-fold were found, although their corresponding mRNA expressions were not found to be present at 8 wpi. Concomitantly, UPS impairment was evidenced by the overexpression of conjugated ubiquitin and ubiquitin in the brain. Conclusion Further studies are needed to determine whether there is an increased risk of CT progression into neurodegenerative disease because neurodegeneration-associated AβPP and phosphorylated tau emerged in the brain.
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Affiliation(s)
- Chien-Wei Liao
- Institute of Tropical Medicine, National Yang-Ming University School of Medicine, 155 Li-Nong St,, Sec, 2, Taipei 112, Taiwan.
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Finsterer J, Auer H. Neurotoxocarosis. Rev Inst Med Trop Sao Paulo 2008; 49:279-87. [PMID: 18026633 DOI: 10.1590/s0036-46652007000500002] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 04/16/2006] [Indexed: 11/22/2022] Open
Abstract
Infection of humans with embryonated eggs of Toxocara canis (larva migrans) remains asymptomatic, or results in covert or common toxocarosis, visceral larva migrans syndrome, or ophthalmologic and neurologic impairment. Though neurological manifestations of Toxocara canis larvae are rare, toxocarosis remains an important differential diagnosis of various neurological disorders. Manifestations of the central nervous system are dementia, meningo-encephalitis, myelitis, cerebral vasculitis, epilepsy, or optic neuritis. Manifestations of the peripheral nervous system comprise radiculitis, affection of cranial nerves, or musculo-skeletal involvement. If toxocarosis is neglected, ignored, or refused as a differential of these abnormalities, it may be easily overlooked for years. Early recognition and treatment of the infection is, however, of paramount importance since it reduces morbidity and mortality and the risk of secondary superinfection. Like the visceral manifestations, neurological manifestations of toxocarosis are treated by benzimidazole components, most frequently albendazole, corticosteroids, or diethylcarbamazine. If detected and treated early, the prognosis of neurological manifestations of toxocarosis is favourable.
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HAMILTON CM, BRANDES S, HOLLAND CV, PINELLI E. Cytokine expression in the brains of Toxocara canis-infected mice. Parasite Immunol 2008; 30:181-5. [DOI: 10.1111/j.1365-3024.2007.01002.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Moiyadi A, Mahadevan A, Anandh B, Shivashankar RS, Chickabasavaiah YT, Shankar SK. Visceral larva migrans presenting as multiple intracranial and intraspinal abscesses. Neuropathology 2007; 27:371-4. [PMID: 17899691 DOI: 10.1111/j.1440-1789.2007.00775.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Involvement of nervous system by toxocariasis is rare and can produce a spectrum of pathology that includes eosinophillic meningoencephalitis, meningomyelitis, space occupying lesions, vasculitis causing seizures or behavioral abnormalities posing diagnostic dilemmas. We describe a 38-year-old man who presented with multiple intracranial and intramedullary abscesses caused by visceral larva migrans. Neurohelminthiasis as a cause of multiple abscesses, though rare, should be entertained as a differential diagnosis particularly in tropical South-east Asian countries where helminthiasis is still an epidemiological concern prevalent in the pediatric age group.
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Affiliation(s)
- Alefia Moiyadi
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Ho SY, Watanabe Y, Lee YC, Shih TH, Tu WJ, Ooi HK. Survey of gastrointestinal parasitic infections in quarantined dogs in Taiwan. J Vet Med Sci 2006; 68:69-70. [PMID: 16462120 DOI: 10.1292/jvms.68.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Intestinal helminth and protozoan infection in the quarantined dogs in Taiwan were examined using fecal examination between January to December, 2004. Of the 376 dogs imported from 11 countries, 63 (16.8%) were found to be infected with at least one species of intestinal parasite. The parasites detected were oocysts of Isospora canis and eggs of Toxocara canis, Trichuris vulpis and hookworms. Of the 63 infected dogs, 11 were found to have a mixed infection of two different species of parasites. This paper illustrates that parasites are transmitted from one country to another through the transport of animals. Moreover, there is also a possibility of parasitic infection among quarantined dogs as well as the zoonotic potential for quarantine officers during the quarantine period.
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Affiliation(s)
- Shi-Yen Ho
- Graduate Institute of Veterinary Microbiology, National Chung Hsing University, Taichung 40227, Taiwan
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Cianferoni A, Schneider L, Schantz PM, Brown D, Fox LM. Visceral larva migrans associated with earthworm ingestion: clinical evolution in an adolescent patient. Pediatrics 2006; 117:e336-9. [PMID: 16452340 DOI: 10.1542/peds.2005-1596] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 16-year-old girl developed a cough, hypereosinophilia (absolute eosinophil count: 32000/mm3), hypergammaglobulinemia, and multiple noncavitary pulmonary nodules 1 month after having ingested an earthworm on a dare. Spirometry revealed moderate restriction and reduced gas diffusion. Parabronchial biopsy demonstrated eosinophilic organizing pneumonitis with multiple eosinophilic microabscesses, and Toxocara titers were elevated (>1:4096). Ophthalmologic examination ruled out ocular larva migrans. The patient received a 10-day course of albendazole (400 mg orally twice daily) and demonstrated significant clinical improvement with resolution of cough and pulmonary function abnormalities. Her white blood cell count and hypergammaglobulinemia normalized within 20 days, yet eosinophils (absolute eosinophil count: 1780/mm3) and Toxocara serologies (>1:4096) remained elevated 3 months after completing antihelminthic therapy. In this instance, the ingested earthworm served as the paratenic carrier of Toxocara larvae from the soil to the patient. This case highlights the clinical evolution of pulmonary visceral larva migrans infection caused by Toxocara spp. associated with a discrete ingestion in an adolescent patient. In addition, it provides a rare opportunity to define the incubation period of visceral larva migrans and emphasizes the importance of education regarding sources of Toxocara infection.
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Gorgulu A, Albayrak BS, Gorgulu E, Tural O. Postoperative cerebral abscess formation caused by Toxocara canis in a meningioma cavity. J Neurooncol 2005; 77:325-6. [PMID: 16314947 DOI: 10.1007/s11060-005-9040-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Accepted: 09/02/2005] [Indexed: 11/26/2022]
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