Ahn SJ, Woo SJ, Jin Y, Chang YS, Kim TW, Ahn J, Heo JW, Yu HG, Chung H, Park KH, Hong ST. Clinical features and course of ocular toxocariasis in adults.
PLoS Negl Trop Dis 2014;
8:e2938. [PMID:
24922534 PMCID:
PMC4055477 DOI:
10.1371/journal.pntd.0002938]
[Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 04/29/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose
To investigate the clinical features, clinical course of granuloma, serologic findings, treatment outcome, and probable infection sources in adult patients with ocular toxocariasis (OT).
Methods
In this retrospective cohort study, we examined 101 adult patients diagnosed clinically and serologically with OT. Serial fundus photographs and spectral domain optical coherence tomography images of all the patients were reviewed. A clinic-based case-control study on pet ownership, occupation, and raw meat ingestion history was performed to investigate the possible infection sources.
Results
Among the patients diagnosed clinically and serologically with OT, 69.6% showed elevated immunoglobulin E (IgE) levels. Granuloma in OT involved all retinal layers and several vitreoretinal comorbidities were noted depending on the location of granuloma: posterior pole granuloma was associated with epiretinal membrane and retinal nerve fiber layer defects, whereas peripheral granuloma was associated with vitreous opacity. Intraocular migration of granuloma was observed in 15 of 93 patients (16.1%). Treatment with albendazole (400 mg twice a day for 2 weeks) and corticosteroids (oral prednisolone; 0.5–1 mg/kg/day) resulted in comparable outcomes to patients on corticosteroid monotherapy; however, the 6-month recurrence rate in patients treated with combined therapy (17.4%) was significantly lower than that in patients treated with corticosteroid monotherapy (54.5%, P = 0.045). Ingestion of raw cow liver (80.8%) or meat (71.2%) was significantly more common in OT patients than healthy controls.
Conclusions
Our study discusses the diagnosis, treatment, and prevention strategies for OT. Evaluation of total IgE, in addition to anti-toxocara antibody, can assist in the serologic diagnosis of OT. Combined albendazole and corticosteroid therapy may reduce intraocular inflammation and recurrence. Migrating feature of granuloma is clinically important and may further suggest the diagnosis of OT. Clinicians need to carefully examine comorbid conditions for OT. OT may be associated with ingestion of uncooked meat, especially raw cow liver, in adult patients.
Toxocariasis is one of America's most common neglected infections of poverty and a helminthiasis of global importance. Little is known about the epidemiologic, demographic, and clinical features of ocular toxocariasis (OT) in adult patients, and the treatment regimen for OT has not been standardized. We conducted a retrospective cohort study examining the clinical features, serologic markers, clinical course of granuloma, probable infection sources, and treatment outcome in 101 adult patients diagnosed clinically and serologically with OT. All the patients had unilateral involvement. Ninety-three (92.1%) and 78 (77.2%) of 101 adult patients had retinal granuloma and intraocular inflammation, respectively. In addition to retinal granuloma, retinal nerve fiber layer defect, epiretinal membrane, vitreous opacity, retinal detachment, macular edema, and macular hole were observed in the eyes with OT. Granuloma in OT can involve all retinal layers, and its intraocular migration was observed in 15 patients (16.1%). Among the 101 patients, 69.6% and 11.6% showed elevated immunoglobulin E levels and eosinophilia, respectively. We believe that OT may be associated with ingestion of uncooked meat, especially cow liver, in adult patients. Furthermore, we suggest that combined albendazole and corticosteroid therapy may reduce intraocular inflammation and recurrence.
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