A seroepidemiological survey of toxocariasis among eosinophilia patients in Chungcheongnam-do

Toxocariasis and Strongyloidiasis as Triggering Factors for Wells' Syndrome

Wells' syndrome is a rare inflammatory skin disease characterized by pruritic erythematous lesions and cutaneous edema, often accompanied by eosinophilia. Parasitic infestations, such as toxocariasis and strongyloidiasis, can serve as triggers. However, Wells' syndrome associated with toxocariasis and strongyloidiasis has not been reported previously in Indonesia. Herein, we present a case of a 27-year-old male with a chief complaint of recurrent, pruritic, and painful erythematous rash on the right lower leg for 6 months, accompanied by fever and diarrhea. Physical examination showed cutaneous edema with erythematous macules and bullae on the affected leg. Peripheral blood eosinophilia was noted, and the histopathological analysis demonstrated flame figures, confirming the diagnosis of Wells' syndrome. A stool culture identified Strongyloides stercoralis, confirming strongyloidiasis, and serological testing was positive for toxocariasis immunoglobulin G antibodies. The patient was treated with albendazole 400 mg twice daily for 3 weeks resulted in clinical improvement observed by the 14th day. The diverse clinical features of Wells' syndrome present a challenge to clinicians in making an accurate diagnosis, which typically hinges on histopathological assessment and identifying flame figures. Therefore, clinicopathological correlation is important to establish an accurate diagnosis.

Seroprevalence of Toxocariasis Among Hypereosinophilic Children: A Single Center Study, Tehran, Iran

Background: Toxocariasis is a parasitic disease causing hypereosinophilia. This study aimed to investigate the serological prevalence of toxocariasis among hypereosinophilic children in Children’s Medical Center, Tehran, Iran, as well as to explore its relationship with epidemiological variables and some blood indices. Methods: This descriptive cross-sectional study was performed in 2020 on children referred to referral children hospital for routine tests. A total of 282 children diagnosed with hypereosinophilia were selected and included in the study, and then, their serum was collected. After obtaining informed consent from their parents, the parents were asked to fill out a questionnaire. The serological ELISA test was used to assess the anti-Toxocara IgG antibody. Data were analyzed using SPSS software 18. Results: Out of 282 hypereosinophilic children, 17 (6%) had serological results positive for anti-Toxocara antibody. The mean age of children with toxocariasis was higher than that of children without toxocariasis (P = 0.312). Furthermore, ESR and CRP variables were significantly higher in infected children than those in non-infected children (P < 0.05). Conclusions: The results of the present study confirmed the relationship between toxocariasis and hypereosinophilia. Since the symptoms of toxocariasis are non-specific and may go undiagnosed, it was found necessary to examine toxocariasis in cases of hypereosinophilic individuals.

Dog and Cat Contact as Risk Factor for Human Toxocariasis: Systematic Review and Meta-Analysis

Toxocariasis, a neglected parasitic zoonosis with worldwide distribution, has been reportedly associated to different risk factors in several epidemiological and meta-analysis studies. However, dog and cat contact (environmental and animal exposure) as isolated associated risk factor for children and adults remains to be fully established. Accordingly, the present meta-analysis has aimed to directly assess dog and cat contact for toxocariasis seropositivity in under-18 and adult persons, using a survey strategy of PubMed/Medline, Embase, Scopus and Scielo Databases, from January 2009 to December 2021. A meta-analysis model of random effects was applied to estimate odds ratio (OR) with 95% Confidence Interval (CI). The statistical heterogeneity was evaluated by the Cochran Q-Test and I² values. A total of 41 transversal studies (n = 20.515 individuals) from different geographic regions (classified by the World Health Organization) were included herein. In overall, 1,882/13,496 (13.95%; 95% IC = 13.4–14.5) youngers and 513/7.019 (7.3%; 95% CI = 6.7–7.9) adults in contact with dogs or cats were serologically reagent for anti-Toxocara antibodies. Association of dog and cat contact was observed only in youngers, with both dogs (OR = 1.53; p < 0.0001) and cats (OR = 1.64; p = 0.0001). In addition, association of dog and contact and serology was statistically significant in populations of Americas (OR = 1.37; 95% CI = 1.1–1.7), Middle East (OR = 2.9; 95% CI = 1.6–5.1) and West Pacific (OR = 1.6; 95% IC = 1.3–1.9). In conclusion, contact with dogs and cats, particularly by younger individuals and in regions such as Americas, Middle East, and West Pacific, should be always a public health concern for toxocariasis. Moreover, dogs and cats should be periodically dewormed, washed and hair cleaned prior to contact with youngers. Finally, robust statistical results herein may serve as basis for future strategies and preventive measures for safer dog and cat contact.

Toxocariasis-Associated Acute Perimyocarditis with Cardiogenic Shock: A Case Report

Patient: Female, 21-year-old

Final Diagnosis: Toxocariasis-associated acute perimyocarditis with cardiogenic shock

Symptoms: Dizziness • epigastric pain • headache • vomiting

Medication: —

Clinical Procedure: —

Specialty: Cardiology

Keys to Unlock the Enigma of Ocular Toxocariasis: A Systematic Review and Meta-analysis

Purpose: Ocular toxocariasis (OT) is a zoonotic infection caused by larval stages of Toxocara canis and T. cati. The current review and meta-analysis aimed to evaluate the global prevalence of OT.Methods: Five English (PubMed, Scopus, Science Direct, Web of Science, and Google Scholar) databases were explored and 101 articles met the inclusion criteria.Results: The pooled prevalence (95% confidence interval) of OT was higher in immunological studies (9%. 6-12%) than in studies that applied ophthalmic examination (1%. 1-2%). The lower middle-income level countries had the highest prevalence (6%. 2-12%) as well as the African region (10%. 7-13%). The highest infection rate (4%. 2-7%) was detected in the 1-25 mean age group.Conclusion: Regular anthelminthic treatment of cats and dogs, and removal of animal feces from public places must be considered.

Seroepidemiological Study of Toxocariasis in Children Aged 6-14 Year Old in Sanandaj, Western Iran

Background:

Toxocariasis is a disease caused by Toxocara nematodes and occurs from consuming their eggs. The main hosts of these worms are dogs and cats. The disease in humans becomes a visceral larva migrans (VLM). This descriptive cross-sectional study was conducted to determine the prevalence of toxocariasis in children aged 6–14 years.

Methods:

This cross-sectional descriptive study was conducted from Jun 1 2016 to Dec 1 2017 in Sanandaj, west of Iran. A total of 182 serum samples were collected from children age 6 to14 yr referred to medical diagnostic laboratories. Demographic data (age, sex, and parents’ literacy status), clinical signs (cough, headache, fever, abdominal pain), and the history of contact with dogs and cats was collected by a questionnaire. The presence of anti-Toxocara IgG antibody was detected by T. canis IgG ELISA (IBL, Germany) kit.

Results:

Of 182 subjects, 97 (53.3%) were male and 85 (46.7%) female. The average age was 9.2 years. Antibodies against T. canis were positive in three cases (1.65%) of all the studied subjects.

Conclusions:

The results showed a low prevalence of toxocariasis in children studied.

Prevalence of Toxocariasis and Its Risk Factors in Patients with Eosinophilia in Korea

Eosinophilia occurs commonly in many diseases including allergic diseases and helminthic infections. Toxocariasis has been suggested as one cause of eosinophilia. The present study was undertaken to examine the prevalence of toxocariasis in patients with eosinophilia and to identify the risk factors for toxocariasis. This prospective cohort study recruited a total of 81 patients with eosinophilia (34 males and 47 females) who visited the outpatient clinic at Seoul National University Hospital from January 2017 to February 2018 and agreed to participate in this study. The prevalence of toxocariasis was examined by T. canis-specific ELISA, and the various risk factors for toxocariasis were evaluated by a questionnaire survey. Among 81 patients with eosinophilia, 18 were positive for anti-T. canis antibodies (22.2%); 88.9% were male (16/18) and 11.1% were female (2/18). Multivariate statistical analysis revealed that males (OR 21.876, 95% CI: 1.667–287.144) with a history of consuming the raw meat or livers of animals (OR 5.899, 95% CI: 1.004–34.669) and a heavy alcohol-drinking habit (OR 8.767, 95% CI: 1.018–75.497) were at higher risk of toxocariasis in patients with eosinophilia. Toxocariasis should be considered a potential cause of eosinophilia when the patient has a history of eating the raw meat or livers of animals in Korea. A single course of albendazole is recommended to reduce the migration of Toxocara larvae in serologically positive cases with eosinophilia.

Ocular Toxocariasis: Beyond Typical Patterns through the New Imaging Technologies

PURPOSE

To report five cases of ocular Toxocariasis (OT) in which ultrawide-field (UWF) imaging was helpful in diagnosis and assessment. OT is an underdiagnosed condition triggered by the ocular invasion of Toxocara larvae. Typical features are peripheral granuloma or endophthalmitis.Methods: A retrospective case series of 10 outpatients were studied by complete ophthalmologic examination and complementary tests. UWF retinal imaging, fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SDOCT) were retrospectively analyzed. Five patients with suspected OT were included.Results: UWF imaging and FAF was able to detect all retinal lesions in a single rapid capture. Two patients showed positive serology for Toxocara. An image suggesting the larva in the vitreous cavity was shown in one patient. Antihelmintic 15 treatment along with steroids was prescribed in two patients.Conclusion: UWF imaging and SDOCT provide a more efficient approach and follow-up in OT, raising final standards of care.

Clinical characteristics and progression of liver abscess caused by toxocara

AIM: To evaluate the clinical characteristics and progression of liver abscess caused by toxocara.

METHODS: We retrospectively reviewed the medical records of patients with serum IgG antibody to Toxocara canis and liver abscess diagnosed using abdominal computed tomography between February 2010 and February 2015. Among 84 patients exhibiting serum IgG antibody to Toxocara canis, 34 patients were diagnosed with liver asbscess and treated with albendazole. A follow-up period of 1 year was conducted.

RESULTS: Mean patient age was 53 (34-79) years, with 26 (76.5%) patients being male. Twenty-one (61.7%) patients were moderate or heavy drinkers, 23 (67.6%) patients had a history of eating raw meat or liver and 6 (17.6%) patients owned pet dogs or cats. Main patient symptoms consisted of right upper quadrant pain, fever, and fatigue; 18 (52.9%) patients, however, presented with no symptoms. Lung involvement was detected in 444 (11.7%) patients. The eosinophil count increased in 29 (85.3%) patients at initial diagnosis, and decreased in most patients after albendazole treatment. The initial serum IgE level increased in 25 (73.5%) patients, but exhibited various response levels after albendazole treatment. Liver abscess formation improved in all patients.

CONCLUSION: The liver abscess was improved with albendazole treatment.

Latent and Asymptomatic Toxocara Infection among Young Population in Northwest Iran: The Necessity of Informing People as a Potential Health Risk

Objectives. This study was designed to determine the frequency of anti-Toxocara antibodies in youngsters aging from 2 to 20 years in northwest Iran. Materials and Methods. 397 samples were taken randomly almost equally from four locations in Urmia, west Azerbaijan, during August 2014 to September 2015. Anti-Toxocara IgG antibody assays were done on sera by using ELISA kit (IBL, Germany). In order to prevent cross-reaction, the samples of the patients who are infected with other parasites in stool exam, especially Ascarididae family, were also excluded. SPSS 16.0 software was used for statistical analysis. Results. 12 (3%) of the serum samples were positive for anti-Toxocara IgG. According to the Chi-square analysis, risk factors such as mother's educational level, keeping dogs or cats as pets, and history of coughing were related to Toxocara infection (P < 0.05). There was no relationship between toxocariasis and gender, history of onychophagy, pica, fever, abdominal pain, and anorexia; however, we found a significant relationship between Toxocara infection and chronic coughing (P = 0.045). Conclusion. Toxocariasis in northwest Iran can be considered as a public health problem. This study may also help to increase the awareness about this infection.

Toxocariasis, Intestinal Parasitoses and Eosinophilia in Schoolchildren from Argentina

The purpose was to analyze the relationship between toxocariasis, intestinal parasitosis, eosinophilia, pet ownership and signs and symptoms present in 370 schoolchildren (3-12 years old) of Argentina. The positive serology for toxocariasis was 19.5%, associated with eosinophilia and possession of cats as pets. The stool testing revealed 70.0% of parasitized children. Its frequency was 44.9% helminthes and 53.5% protozoan resulting single significant presence of protozoa in children aged 10-12 years. The species were: Blastocystis hominis (45.7%), Enterobius vermicularis (43.2%), Giardia intestinalis (16.2%), Hymenolepis nana (2.4%), Ascaris lumbridoides (1.6%) and Trichuris trichiura (0.3%). The survey showed 13.0% of children with sporadic abdominal pain and 13.5% with pruritus ani. The results indicate relationship between positive serology and eosinophilia compatible with a clinical aspect of covert toxocariasis self-limiting, associated with cats ownership; in school children from our region who also have high frequency of intestinal parasitoses.

The Prevalence of Toxocariasis and Diagnostic Value of Serologic Tests in Asymptomatic Korean Adults

Purpose

Toxocariasis is the most common cause of peripheral blood eosinophilia in Korea and produces eosinophilic infiltration in various organs, including the lung. However, the prevalence of toxocariasis in the general population is rarely reported.

Methods

We investigated the seroprevalence of Toxocara larval antibody among asymptomatic people who attended Samsung Medical Center for a health checkup, including low-dose chest computed tomography (CT) between March 2012 and December 2013. A total of 633 people (400 men and 233 women) were prospectively recruited.

Results

The Toxocara-seropositive rate was 51.2% using the current cutoff value based on Toxocara enzyme-linked immunosorbent assay (ELISA) (67.0% for men and 24.0% for women). In the multivariate-adjusted model, age (odds ratio [OR], 1.08; 95% confidence intervals [CI], 1.04-1.11), male sex (OR, 3.47; 95% CI, 2.26-5.33), rural residence (OR, 1.55; 95% CI, 1.05-2.30), and history of raw liver intake (OR, 8.52; 95% CI, 3.61-20.11) were significantly associated with Toxocara seropositivity. When subjects were divided into 3 groups using cutoff values base on weak positive and strong positive control optical densities (ODs), the ORs for peripheral blood eosinophilia and serum hyperIgEaemia were 0.31 (95% CI, 0.02-2.89) in the weakpositive group and 36.64 (95% CI, 11.73-111.42) in the strong positive group compared to the seronegative group. Similarly, ORs for the solid nodule with surrounding halo were 2.54 (95% CI, 0.60-10.84) in the weak positive group and 15.08 (95 CI 4.09-55.56) in the strong positive group compared to the seronegative group.

Conclusions

The study indicated that the Toxocara-seropositive rate obtained by using the current cutoff value based on ELISA was high in the asymptomatic population in Korea. The results of this study suggest that active toxocariasis may be more frequently seen in the Toxocara-strong positive group than in the Toxocara-weak positive group.

Seroepidemiology of Toxocariasis and Its Clinical Implications in Gwangju and Jeonnam-province, Korea

We investigated the seroepidemiological, clinical, and laboratory characteristics of patients suspected to have toxocariasis in Gwangju and Jeonnam-province, Korea. In total, 228 specimens were analyzed for anti-Toxocara canis IgG at two university hospitals from 2010 to 2012. The overall seropositive rate was 67.1%, and the seropositive rates among the eosinophilic and non-eosinophilic groups were 76.1% (105/138) and 53.3% (48/90), respectively. Risk factors for eosinophilia and toxocariasis were male sex (odds ratios [OR]=2.632 and 3.477, respectively) and a history of ingesting raw meat (OR=2.884 and 3.274, respectively), especially raw cow liver (OR=2.089 and 10.038, respectively). T. canis seropositivity (OR=5.807, P=0.004) and a history of consuming raw cow liver (OR=2.766, P=0.052) were risk factors for organ involvement. The anti-T. canis IgG level showed weakly positive correlations with eosinophil counts (r=0.234, P<0.001) and the duration of eosinophilia (r=0.155, P=0.019). Although limited to the regions of Gwangju and Jeonnam-province, this study supports the opinion that toxocariasis is a reasonable focus as a cause of eosinophilia and that it is also associated with organ involvement.

Cross-reactivity of Toxocariasis with Crude Antigen of Toxascaris leonina Larvae by ELISA

Roundworms of Toxocara canis and Toxascaris leonina are common gastrointestinal helminths of canids over the world. Humans are infected with T. canis larvae through ingestion of infective eggs in contaminated environments or larvae by consumption of raw or uncooked meat or livers. Recently, patients of clinically diagnosed toxocariasis are increasing and require correct diagnosis in Korea. The present study investigated serological cross-reactivity between crude antigens of T. canis (TCLA) and T. leonina (TLLA) larvae. We collected serum specimens from 177 toxocariasis patients who were clinically suspected in the Seoul National University Hospital and 115 healthy controls. An ELISA method for toxocariasis was used to evaluate diagnostic efficacy of TLLA for serodiagnosis of human toxocariasis. The IgG ELISA using TLLA gave 14 (14.3%) positives of 98 TCLA positive specimens among 177 suspected toxocariasis patients. Most of them showed high absorbances with TCLA. In conclusion, there is a partial cross reaction between serum specimens of toxocariasis and TLLA.

Anti-Toxocara spp. antibodies in an adult healthy population: serosurvey and risk factors in Southeast Brazil

OBJECTIVE

To evaluate the frequency of anti-Toxocara spp. antibodies in an adult healthy population.

METHODS

The study was performed by interviewing 253 blood donors, from 19 to 65 years of age, in a hematological centre in Presidente Prudente, São Paulo, southeast Brazil. A survey was applied to blood donors in order to evaluate the possible factors associated to the presence of antibodies, including individual (gender and age), socioeconomic (scholarship, familial income and sanitary facilities) and habit information (contact with soil, geophagy, onycophagy and intake of raw/undercooked meat) as well as the presence of dogs or cats in the household. ELISA test was run for detection of the anti-Toxocara spp. IgG antibodies. Bivariate analysis followed by logistic regression was performed to evaluate the potential risk factors associated to seropositivity.

RESULTS

The overall prevalence observed in this study was 8.7% (22/253). Contact with soil was the unique risk factor associated with the presence of antibodies (P=0.017 8; OR=3.52; 95% CI=1.244-9.995).

CONCLUSIONS

The results of this study reinforce the necessity in promoting preventive public health measures, even for healthy adult individual, particularly those related to the deworming of pets to avoid the soil contamination, and hygiene education of the population.

Significance of serum antibody test for toxocariasis in healthy healthcare examinees with eosinophilia in Seoul and Gyeongsangnam-do, Korea

There have been numerous reports on the relationship between eosinophilia and toxocariasis. The present study investigated seropositive rates of toxocariasis among healthy people with or without eosinophilia in urban and rural areas, and assessed risk factors for positive antibody test. A total of 610 healthy people, who visited health check-up (Medicheck®, Korea Association of Health Promotion), 310 from Seoul and 300 from Gyeongsangnam-do, were subjected for this study. Their serum samples were tested by ELISA with the crude antigen of Toxocara canis larvae. Cross-reactions with other tissue invading helminth antigens were also investigated. Total antibody positive rate of toxocariasis was 8.7% of the 610 subjects. When the subjects were grouped into 3 by their eosinophil counts, the antibody positive rates significantly differed by the groups; 5.9% (18/306) in the group<350/µL, 10.0% (11/110) in the group 350-500/µL, and 12.4% (24/194) in the group>500/µL (P=0.028). A total of 22 serum samples cross-reacted with other tissue-invading helminth antigens. A questionnaire analysis recognized drinking alcohol and smoking as significant risk factors of toxocariasis. In conclusion, toxocariasis antibody positive rate is correlated with eosinophil counts. It is recommended that healthy subjects with eosinophilia by routine health examination and risk factors undergo Toxocara serology by multiantigen ELISA to investigate etiology.

Ocular toxocariasis: clinical features, diagnosis, treatment, and prevention

Despite being one of the most common zoonotic infections worldwide, human toxocariasis has been one of the neglected tropical diseases. Although most human infections are asymptomatic, two main syndromes of human toxocariasis are classically recognized: systemic toxocariasis, which encompasses diseases in major organs; and ocular toxocariasis (OT), disease in the eye or optic nerve, caused by the migration of Toxocara larvae into the eye. OT is usually a unilateral disease, which typically presents as retinal granuloma, a yellowish or whitish inflammatory mass, in the posterior pole or peripheral retina. Granuloma itself or other comorbid conditions such as epiretinal membrane, macular edema, and retinal detachment can lead to permanent retinal damage and visual loss in eyes with OT. OT is diagnosed clinically by identification of clinical signs on ophthalmologic examination. Serological tests, such as enzyme-linked immunosorbent assay (ELISA) for detection of serum antibody against the Toxocara larvae, can confirm the diagnosis. In addition, serum immunoglobulin E and detection of ocular fluid antitoxocara antibody by ELISA may give additional aid to the diagnosis. Standard treatment of OT is corticosteroid in patients with active intraocular inflammation. Although the role of anthelmintic therapy is unclear, favorable outcome has been reported by combined corticosteroid and albendazole therapy in eyes with active inflammation. Prevention, by increasing public awareness and reducing the risk of infection, is also important. Recently, the association between ingestion of uncooked meat or liver and toxocariasis was reported, especially in adult patients. Future research on the potential source of infection, diagnosis, and treatment should be performed.

Serodiagnosis of toxocariasis by ELISA using crude antigen of Toxocara canis larvae

Toxocariasis is a worldwide zoonosis caused by larvae of ascarid nematodes of dogs or cats, Toxocara canis or T. cati. Diagnosis of human toxocariasis currently relies on serology that uses T. canis excretory-secretory antigen to detect specific IgG antibodies by ELISA. We investigated the serodiagnostic efficacy of ELISA using crude antigen of T. canis larvae (TCLA). Serum specimens of 64 clinically confirmed toxocariasis, 115 healthy controls, and 119 other tissue-invading helminthiases were screened by ELISA using TCLA. The ELISA using TCLA showed 92.2% (59/64 patient samples) sensitivity and 86.6% (103/119) specificity. Its positive diagnostic predictivity was 78.7% and negative predictivity was 97.8%. No serum of healthy controls reacted but that of anisakiasis (45.5%), gnathostomiasis (19.2%), clonorchiasis (15.8%), sparganosis (11.1%), and cysticercosis (6.3%) cross-reacted. Immunoblot analysis on TCLA recognized antigenic proteins of 28- and 30-kDa bands in their dominant protein quantity and strong blotting reactivity. The present results indicate that the ELISA using our TCLA antigen is acceptable by the sensitivity and specificity for serodiagnosis of human toxocariasis. ELISA with TCLA is recommended to make differential diagnosis for patients with any sign of organ infiltration and eosinophilia.