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Kakimoto M, Murata M, Mitsumoto-Kaseida F, Ogawa E, Matsumoto Y, Kusaga A, Toyoda K, Hayashi T, Ura K, Kanno K, Furusyo N, Tazuma S. Toxocariasis Suspected of Having Infiltrated Directly from the Liver to the Lung through the Diaphragm. Intern Med 2019; 58:2737-2741. [PMID: 31178505 PMCID: PMC6794164 DOI: 10.2169/internalmedicine.2716-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 37-year-old woman presented to our hospital with mild abdominal pain experienced for 2 months and hepatic nodules in segments 3 and 8. Peripheral blood eosinophilia was observed, and toxocariasis was serologically diagnosed. Seventeen days after the first imaging evaluation, a new lesion was found in segment 9 of the right lung, which was contiguous through the diaphragm to the hepatic nodule in segment 8. After treatment with albendazole, the liver and lung nodules disappeared. We suspect that larvae had directly invaded the lung from the liver, through the diaphragm.
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Affiliation(s)
- Masaki Kakimoto
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Masayuki Murata
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | | | - Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Yuji Matsumoto
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Akira Kusaga
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Kazuhiro Toyoda
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Takeo Hayashi
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Kazuya Ura
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Keishi Kanno
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Norihiro Furusyo
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Susumu Tazuma
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
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Ko KD, Lee JJ, Kim KK, Suh HS, Hwang IC, Choi SJ. HEPATIC VISCERAL LARVA MIGRANS DUE TO TOXOCARA CANIS IN A 72-YEAR-OLD MAN. Southeast Asian J Trop Med Public Health 2015; 46:181-183. [PMID: 26513919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Hepatic toxocariasis is visceral larva migrans caused by Toxocara. We report a case of hepatic toxocariasis detected incidentally during a health checkup. The patient had elevated levels of eosinophils, total IgE, and anti-Toxocara IgG antibodies. On contrast-enhanced computed tomography (CT) imaging he had a single, 2.16 cm, oval, ill-defined, low-attenuation hepatic nodule which was best appreciated during the portal venous phase of the scan. Clinicians should consider hepatic toxocariasis as a possible diagnosis in any individual who presents with eosinophilia of unknown etiology and an ill-defined hepatic lesion on CT imaging.
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Manuel AM, Kuljit S, Gopalakrishnan G, Suresh KG, Balraj P. The role of worm infestation in allergic rhinitis. Trop Biomed 2012; 29:360-365. [PMID: 23018498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose of this study is to determine the relevance of the hygiene hypothesis; that is to determine if worm infestation has a protective role against the development of allergic rhinitis. A prospective case controlled study was conducted. Specific IgG levels to Toxocara were studied in 85 patients confirmed to have allergic rhinitis and were compared to levels in another 85 controls, with no form of allergy. The IgG assay was done using ELISA technique. There was a higher incidence of positive specific IgG to Toxocara in the controls as compared to allergic patients. The values were statistically significant [Chi square test (p=0.002)]. This negative association between worm infestation and allergic rhinitis suggests that a previous worm infestation could protect against the development of allergic rhinitis.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Animals
- Antigens, Helminth/blood
- Case-Control Studies
- Child
- Enzyme-Linked Immunosorbent Assay
- Humans
- Immunoglobulin E/blood
- Immunoglobulin G/blood
- Incidence
- Larva Migrans, Visceral/complications
- Larva Migrans, Visceral/epidemiology
- Larva Migrans, Visceral/parasitology
- Longitudinal Studies
- Middle Aged
- Occupations
- Prevalence
- Prospective Studies
- Rhinitis, Allergic
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Perennial/parasitology
- Toxocara canis/immunology
- Young Adult
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Affiliation(s)
- A M Manuel
- ORL Dept, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Fukae J, Kawanabe T, Akao N, Kado M, Tokoro M, Yokoyama K, Hattori N. Longitudinal myelitis caused by visceral larva migrans associated with Toxocara cati infection: case report. Clin Neurol Neurosurg 2012; 114:1091-4. [PMID: 22424728 DOI: 10.1016/j.clineuro.2012.02.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 11/14/2011] [Accepted: 02/11/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Jiro Fukae
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
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5
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Affiliation(s)
- Jae Hoon Lim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Povazan D, Djurić M, Uzurov-Dinić V, Lalosević D, Lalosević V, Secen S, Povazan A. Adult human case of toxocariasis with pulmonary migratory infiltrate and eosinophilia. VOJNOSANIT PREGL 2011; 68:881-885. [PMID: 22165756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Toxocariasis is a zoonosis which is in Serbia characterized with a very high infection rate of dogs and excessive contamination of the soil with the eggs of Toxocara canis, the agent of the disease. Toxocara-induced infections have in recent years been established in a few hundreds of children, but toxocariasis has rather rarely been diagnosed in adults. CASE REPORT We reported toxocariasis (visceral larva migrans) in an adult, manifested by migratory pulmonary infiltrates and positive serological test finding to Toxocara. CONCLUSION Human toxocariasis is a rare disease in adults, therefore it should be considered in adult patients presented with eosinophilia and migratory pulmonary infiltrates.
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Affiliation(s)
- Djordje Povazan
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
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Affiliation(s)
- Louis Kreitmann
- Department of Respiratory and Critical Care Medicine, Schaffner Hospital, Lens, France
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Izumikawa K, Kohno Y, Izumikawa K, Hara K, Hayashi H, Maruyama H, Kohno S. Eosinophilic pneumonia due to visceral larva migrans possibly caused by Ascaris suum: a case report and review of recent literatures. Jpn J Infect Dis 2011; 64:428-432. [PMID: 21937827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report the case of a 62-year-old man who developed eosinophilic pneumonia due to visceral larva migrans (VLM) that was possibly caused by Ascaris suum. The patient, a resident of the middle Kyushu area who was found of eating raw porcine liver, complained of dry cough without dyspnea. The chest radiography showed a migration of infiltrative shadow. Transbronchial lung biopsy of the right middle lobe revealed massive infiltration of eosinophils. The multi-dot enzyme-linked immunosorbent assay (ELISA) and microtiter plate ELISA showed positive results for A. suum; therefore, the patient was diagnosed with VLM caused by A. suum. The patient was administered albendazole (600 mg/day) for 28 days; he recovered successfully with no adverse effects except mild liver dysfunction. Several cases of VLM caused by A. suum have been reported in Japan, with a majority of the cases being reported in Kyushu. Careful history taking of the patient's area of residence and dietary habit is essential for the diagnosis of this parasitic disease with underestimated prevalence.
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Affiliation(s)
- Koichi Izumikawa
- Department of Internal Medicine, Izumikawa Hospital, Nagasaki 859-1504, Japan. koizumik @nagasaki-u.ac.jp
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Chandrashekhara SH, Sharma R, Bagh S, Garg P. Image of the month. Hepatic visceral larva migrans due to Toxocara Canis. Gastroenterol Clin Biol 2010; 34:573-574. [PMID: 21036500 DOI: 10.1016/j.gcb.2010.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 07/19/2010] [Indexed: 05/30/2023]
Affiliation(s)
- S H Chandrashekhara
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
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Sayar D, Mazilis A, Kassem E, Klein A. [Toxocariasis as a cause of hypereosinophilia]. Harefuah 2009; 148:14-89. [PMID: 19320382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Toxocariasis is one of the causes of eosinophilia in peripheral blood and provokes eosinophilic infiltration in internal organs. In Israel, the number of cases of toxocariasis is very low, 3 cases annually, according to the records at the Ministry of Health. Many cases of eosinophilia might be misdiagnosed as hypereosinophilia syndrome (HES), if serological testing for Toxocara is not conducted, leading to inappropriate treatment. The test is for specific serum IgG antibody of Toxocara canis antigen measured by enzyme-linked immunosorbent assay (ELISA). The authors present a 4 year old girl with hypereosinophilia of 40,000 cell/microl, without involvement of target organs. The authors found that toxocara was the cause of hypereosinophilia. After appropriate treatment the number of eosinophils decreases, presenting a measurement of the parasite activity.
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Affiliation(s)
- Dror Sayar
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel affiliated to the Rappaport Faculty of Medicine, Technion-Israel Technology Institution
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Matsuki Y, Fujii T, Nakamura-Uchiyama F, Hiromatsu K, Nawa Y, Hayashi T, Ohtomi S. Toxocariasis presenting with multiple effusions in the pericardial space, thoracic cavity, and Morrison's pouch. Intern Med 2007; 46:913-4. [PMID: 17575389 DOI: 10.2169/internalmedicine.46.6427] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yasunori Matsuki
- Department of Medicine, Japan Defense Force Central Hospital, Tokyo.
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12
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Abstract
A 21-year-old woman admitted for a low-grade fever, dry cough, polyarthralgia, and general fatigue was found to have elevateal accustomed to eating raw meat and cattle liver peripheral blood eosinophil counts and serum IgE. Chest X-ray imaging and computed tomography (CT) showed multiple small nodules in both lung fields. A multiple dot-ELISA assay of her serum showed that she had visceral larva migrans caused by Ascaris suum or Toxocara canis. Following treatment with albendazole, she developed myelopathy and was again admitted. A cerebrospinal fluid examination showed increased eosionophils and significant antibody elevation against T. canis. Her disease was considered to have entered the central nervous system, one of the target organs of visceral larva migrans. She was successfully treated with dietylcarbamazine and has shown no reccurrence. This case showed the different manifestations of visceral larva migrans and the rising incidence of this disease in Japan raises concerns about associated of diet.
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Affiliation(s)
- Mio Mitamura
- Department of Internal Medicine, Saga Medical School
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Musso C, Castelo JS, Tsanaclis AMC, Pereira FEL. Visceral larva migrans granulomas in liver and central nervous system of children who died of bacterial or viral meningitis. Clin Neuropathol 2006; 25:288-90. [PMID: 17140159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
MESH Headings
- Animals
- Autopsy
- Brain/microbiology
- Brain/parasitology
- Brain/pathology
- Child, Preschool
- Disease Vectors
- Female
- Granuloma/parasitology
- Granuloma/pathology
- Humans
- Infant
- Larva Migrans, Visceral/complications
- Larva Migrans, Visceral/pathology
- Larva Migrans, Visceral/physiopathology
- Liver/parasitology
- Liver/physiopathology
- Male
- Meningitis, Bacterial/mortality
- Meningitis, Bacterial/parasitology
- Meningitis, Bacterial/physiopathology
- Meningitis, Viral/mortality
- Meningitis, Viral/parasitology
- Meningitis, Viral/physiopathology
- Toxocara canis/microbiology
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14
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Abstract
An unusual presentation of visceral larva migrans observed in a patient is reported. A 5-year-old boy suffering fever, abdominal pain, tenderness, and rigidity in the right lower and upper quadrant of the abdomen was operated on, with the false diagnosis of acute abdomen, and exploratory surgery was carried out. The pathological examination of the liver biopsy revealed eosinophil-rich necrotizing granulomatous inflammation with Toxocara spp larva. The diagnosis was also confirmed by serologic results. Clinicians should remember that toxocaral visceral larva migrans may rarely mimic an acute abdomen and cause unnecessary operations.
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Affiliation(s)
- Mustafa Inan
- Department of Pediatric Surgery, Faculty of Medicine, University of Trakya, 22030 Edirne, Turkey.
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15
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Macarie S, Călugăru M, Kaucsar E, Binţinţan R. [Toxocara canis central chorioretinitis]. Oftalmologia 2005; 49:22-4. [PMID: 16408670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This issue presents the case of a patient which presents monolateral chorioretinitis caused by Toxocara canis.
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Affiliation(s)
- S Macarie
- Clinical oftalmologie, UMF Cluj-Napoca
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Abstract
A growing body of clinical cases suggests that a kind of nematode larva, type X larva of the suborder Spirurina that inhabits firefly squids (Watasenia scintillans, or 'Hotaru-ika' in Japanese), can cause acute ileus in humans. However, the larva itself has rarely been found in the wall of the obstructed intestine. We describe here a case of acute ileus, in which a type X spirurina larva was found histologically. A 60-year-old Japanese man suffered from acute abdomen, and an emergency laparotomy revealed a marked stenosis of the ileum. Histological study of the surgically resected ileum showed severe eosinophilic enteritis and a nematode larva. The morphological features of this larva were identical to those of the type X spirurina larva. Interestingly, the larva that was found existed within a small blood vessel, suggesting that the larva migrans of type X spirurina can take place via vasculature. The patient in the present case did not recall ingesting raw squids prior to the onset of his disease. Hence, this indicates that even if the ingestion of raw firefly squids is uncertain, spirurina infection should be included in the differential diagnosis of acute ileus or eosinophilic enteritis.
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Affiliation(s)
- Toshihiko Miyake
- Department of Pathology, Shakaihoken Kobe Central Hospital, Kobe, Japan
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17
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Yoshida S, Matsui M, Wang HY, Oeda T, Sasaki T, Komure O, Ozawa K, Konisi T, Saida T, Yoshikawa H, Nawa Y. [A case of myeloradiculitis as a complication of visceral larva migrans due to Ascaris suum]. Rinsho Shinkeigaku 2004; 44:198-202. [PMID: 15233274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
A 35-year-old man noticed a tingling sensation and subsequent slight weakness in the distal part of the left lower extremities, which extended to the left thigh over the following 8 months, when he developed a urinary disturbance. He was admitted to a local hospital and diagnosed as having myelitis, because of the presence of a gadolinium (Gd)-enhanced lesion in the lumbar spinal cord corresponding to the tenth thoracic vertebra (Th10) level. The symptoms disappeared along with some residual sensory disturbance following intravenous administration of 1 g of methylprednisolone (IVMP) for 3 days. However, 4 months later, the patient gradually developed gait disturbance, dysuria, impotence, and fecal incontinence, and was admitted to our hospital in May 2001. A neurological examination revealed the presence of myeloradiculopathy causing a slight weakness in the left hamstring muscles, with positive Babinski and Lasegue signs on the same side. In addition, deep tendon reflexes were absent in the 4 extremities and vibration sense was moderately decreased in the lower extremities, though the results of electrophysiological tests of motor and sensory nerves were normal. A magnetic resonance imaging (MRI) study showed a Gd-enhanced lesion in the spinal cord at the Th8-9 vertebrae level, which was 1 to 2 vertebrae above the initially detected lesion. A lumbar puncture yielded cerebrospinal fluid (CSF) containing mononuclear cells at 7/mm3 that were comprised of an increasd number of CD4+CD25+ activated helper T cells; however, no myelin basic protein or oligoclonal IgG band was present. Serological examinations were negative for the presence of collagen/vascular disorders as well as viral infection due to CMV, EBV, HSV, VZV, and HTLV-1, however, positive for specific antibodies against Ascaris suum in both serum and the CSF, confirming the diagnosis of chronic myeloradiculitis due to visceral larva migrans. The patient was first treated with a single course of a daily 600-mg dose of oral albendazole for 4 weeks, which was resulted in restoration of muscle weakness, as well as disappearance of the Lasègue sign. However, in contrast to the clinical improvement, the CSF sample obtained immediately after completing the treatment showed a worsening trend, as the CSF cell count had increased with a manifestation of marked eosinophilia and CD4+CD25+ cells were also increased. Thereafter, 3-day IVMP treatment was performed twice in cojunction with 3 courses of oral albendazole therapy for the subsequent 4 months, which resulted in normalization of all laboratory measurements concerning the CSF along with a decrement trend in serum and CSF antibody titers specific to Ascaris suum. Our results suggest that neurological involvement due to visceral larva migrans can be efficaciously treated with not only helminthic drugs but also intravenous corticosteroids.
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Niedworok M, Płaneta-Małecka I. [Clinical course of toxocarosis in children]. Wiad Parazytol 2004; 50:461-4. [PMID: 16865953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The aim of the study was to monitor the clinical course of T. canis infection in children with particular consideration of the estimation of infected children's immune system. The study comprised 52 children, aged 3 to 18 years, diagnosed and treated at the I Department of Paediatrics and Gastroenterology, Institute Polish Mother Health Centre, in whom infection with Toxocara canis larva was confirmed with serologic test. The control group included 38 children, aged 3 to 16 years in whom no infection with this parasite was detected in serologic test. In the investigated children subjective and physical examinations were performed, clinical symptoms, changes in organs, haematological, biochemical investigations and selected parameters of humoral and cellular immunity were analysed. In children with toxocarosis most frequently not localized abdominal pain, subfebrile body temperature and generalized lymphadenitis were observed. Significantly higher percentage of eosinophil cells and immunoglobulin E serum concentration with decreased percentage of lymphocytes CD3+, CD4+ and CD4/CD8 ratio were found in the investigated children. Toxocarosis diagnosis is difficult because its clinical symptoms are differentiated and not characteristic, what requires broadening of differential diagnosis concerning numerous entities.
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Affiliation(s)
- Małgorzata Niedworok
- I Klinika Pediatrii i Gastroenterologii, Instytutu Centrum Zdrowia Matki Polki, Lódź
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Abstract
We report a case of visceral larva migrans in an adult with fever, night sweats, weight loss, hilar and mediastinal lymphadenopathy, bilateral pleural effusion, and eosinophilia-mimicking lymphoma. Visceral larva migrans was diagnosed subsequently because of negative findings for malignancy and positive serologic test result for Toxocara canis. Progressive improvement was observed with albendazole therapy.
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Affiliation(s)
- Claude Bachmeyer
- Département de Médecine Interne, Center Hospitalier Laënnec, Creil, France.
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20
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Abstract
A 26-year-old man who was diagnosed with myocarditis presented eosinophilia after having eaten raw meat several times before the admission. Since the antibody titer against Toxocara canis was high, we diagnosed that he had visceral larva migrans due to Toxocara canis associated with myocarditis and eosinophilia. He was then treated with oral albendazole and prednisolone for 4 weeks and eosinophil count and hepatic enzymes were normalized along with the decrease in the antibody titer. We consider that his myocarditis was probably caused by direct larval migration and/ or by hypersensitivity reaction, for which combined therapy with albendazole and prednisolone was effective.
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Affiliation(s)
- Kohtaro Abe
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka
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21
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Sakakibara A, Baba K, Niwa S, Yagi T, Wakayama H, Yoshida K, Kobayashi T, Yokoi T, Hara K, Itoh M, Kimura E. Visceral larva migrans due to Ascaris suum which presented with eosinophilic pneumonia and multiple intra-hepatic lesions with severe eosinophil infiltration--outbreak in a Japanese area other than Kyushu. Intern Med 2002; 41:574-9. [PMID: 12132528 DOI: 10.2169/internalmedicine.41.574] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 32-year-old man presented with the chief complaint of severe cough. Examination of peripheral blood showed a marked increase in eosinophils. Chest CT demonstrated multiple ground glass opacities in both lungs. Bronchoalveolar lavage showed abundant eosinophils. Abdominal CT demonstrated multiple low attenuation areas in the liver. Liver biopsy with ultrasonography revealed severe eosinophil infiltrations around the portal veins. Serologically, a multi-dot enzyme linked immunosorbent assay (DOT-ELISA) and ELISA inhibition test using microtiter plates were positive for Ascaris suum. Thus, visceral larva migrans due to Ascaris suum was diagnosed. Outbreaks of this disease in Japan have previously been confined to the Kyushu area. The present case which occurred outside that area, illustrates the importance of constant attention to the epidemiology of this disease.
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Affiliation(s)
- Ayako Sakakibara
- Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute
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22
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Oficjalska-Młyńczak J, Duda A, Muzyka-Woźniak M, Zajac-Pytrus H, Marek J. [Pars plana vitrectomy in treatment of ocular toxocariasis complications--case report]. Klin Oczna 2002; 103:225-7. [PMID: 11975023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Ocular toxocariasis in adults may cause serious diagnostic and therapeutic problems. We describe a case of a 54-year-old farmer who developed peripheral granuloma with dense connective tissue strands joined to the disc. The diagnosis was confirmed by high ELISA titers in the serum and vitreous body. We performed pars plana vitrectomy with epiretinal membrane removal and laser photocoagulation of the inferior retina, obtaining improvement of visual acuity. After a few weeks the patient returned with central retinal detachment and macular hole. After the second vitrectomy with use of silicon oil we obtained reattachment of the retina but without functional improvement.
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Abstract
A 38-year-old woman presented with worsening cough, blood eosinophilia, and pulmonary infiltrates. Bronchoalveolar lavage showed 96.4% eosinophils. The diagnosis of visceral larva migrans (VLM) was made based on the positive results in enzyme-linked immunosorbent assay for Toxocara canis together with clinical symptoms and laboratory data. Pulmonary infiltrates due to VLM generally manifest as a transient form of Löffler's syndrome or simple eosinophilic pneumonia mainly in children. Here we report an adult case of VLM, with pulmonary infiltrates pathologically proven to be eosinophilic pneumonia, which persisted for 7 weeks before anthelmintic treatment with albendazole and manifested as chronic eosinophilic pneumonia.
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Affiliation(s)
- Koji Inoue
- Department of Internal Medicine, National Kinki-Chuo Hospital for Chest Diseases, Sakai, Osaka
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Sakai K, Hirasawa Y, Hashimoto A. [A case of toxocariasis with eosinophil-rich pleural effusion]. Nihon Kokyuki Gakkai Zasshi 2002; 40:494-8. [PMID: 12325335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
A 68-yr-old man presented with fever, cough, and appetite loss. On admission, clinical examination revealed pleural effusion (with eosinophils accounting for 25% of the cellular component), eosinophilia, and mildly elevated liver enzymes. A diagnosis of toxocariasis was reached on the basis of a positive enzyme-linked immunosorbent assay for Toxocara canis, and the efficacy of steroid and tiabendazole. Typical thoracic involvement of toxocariasis causes cough, wheezing, transient infiltration shadows on the radiographs, and other symptoms of Löffler's syndrome. The infiltration shadows reflect the migration of the larvae through the lung, which involves their breaking through the alveolar walls. We report a rare case of toxocariasis with thoracic and pleural involvement without transient pulmonary infiltrates.
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Affiliation(s)
- Kimiko Sakai
- Department of Respiratory Medicine, Kitaishikai Uchiyama Hospital, 275-1, Shiromawari, Uchiko-cho, Kita-gun, Ehime, 791-3310, Japan
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Azuma K, Yashiro N, Kinoshita T, Yoshigi J, Ihara N. Hepatic involvement of visceral larva migrans due to Toxocara canis: a case report--CT and MR findings. Radiat Med 2002; 20:89-92. [PMID: 12041704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Imaging findings of hepatic lesions of visceral larva migrans are reported. A 44-year-old man presented with chills, eruptions, marked leukocytosis (31,400/microlitter), and eosinophilia (eosinophil, 72%). Multiple liver nodules were detected as low-density lesions on computed tomography (CT). They were visualized as high signal intensity lesions on T2-weighted, and as low signal intensity lesions on T1-weighted magnetic resonance imaging (MRI). The patient was diagnosed as having visceral larva migrans due to Toxocara canis, by Toxocara immnoserological test. After antihelmintic therapy, multiple liver nodules disappeared on CT. We consider that the differential diagnosis of multiple liver nodules should include visceral larva migrans.
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Affiliation(s)
- Koichiro Azuma
- Department of Radiology, Kameda Medical Center, Kamogawa, Chiba, Japan
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26
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Ardiles A, Chanqueo L, Reyes V, Araya L. [Toxocariasis in an adult manifested as hypereosinophilic syndrome with predominant neurological involvement. Clinical case]. Rev Med Chil 2001; 129:780-5. [PMID: 11552447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Hypereosinophilic syndrome is characterized by persistent hypereosinophilia and signs or symptoms due to organ involvement, specially nervous system, heart and skin. It can be primary or secondary to allergies, parasites or cancer. Toxocariasis is an uncommon parasitic disease in adults. There is a variant, called visceral larva migrans, that can involve different organs, and among those, the central nervous system. We report a 61 years old male, with a cerebrovascular disease. There were focalizing symptoms, the CAT scan showed multiple ischemic lesions and a peripheral eosinophilia of 12,152 cells/mm3 was present. Anti toxocara IgG antibody titers were 1/1000. The patient was treated with albendazole for 14 days. After a 2 years follow up the patients is in good conditions and, for the first time, his eosinophil count is within normal limits.
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Affiliation(s)
- A Ardiles
- Policlínico de Medicina Integral, Servicio de Medicina, Hospital San Juan de Dios, Huérfanos 3255, Santiago
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27
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Kawajiri M, Osoegawa M, Ohyagi Y, Ochi H, Furuya H, Nawa Y, Kira J. [A case of myelitis caused by visceral larva migrans due to Ascaris suum presenting only with Lhermitte's sign]. Rinsho Shinkeigaku 2001; 41:310-3. [PMID: 11771161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
A 27-year-old woman was admitted because of pain radiating through her back on neck flexion that had begun a month ago. She frequently ate raw beef liver. General physical examination revealed no abnormal findings, but she showed Lhermitte's sign neurologically. Fecal examination revealed no worm eggs. Blood cell counts showed mild eosinophilia (8.2%). The IgE level was mildly increased to 397 IU/ml (normal < 250). Cerebrospinal fluid examination showed 7 cells/microliter with 50% eosinophils. A test for anti-Ascaris suum IgG antibody was strongly positive in serum as well as in cerebrospinal fluid. Cervical MRI showed high-intensity areas in the spinal cord extending from the lower medulla to the C4 spine level on the T2-weighted images, and part of the lesion at the C3 spine level was enhanced by gadolinium. Treatment with albendazole 500 mg/day for six weeks ameliorated the Lhermitte's sign and MRI lesions, and reduced the anti-Ascaris suum antibody titers in the serum and cerebrospinal fluid. Larva migrans of Ascaris suum involving the central nervous system is considered to be extremely rare, but such cases showing mild neurologic impairment without systemic symptoms may have been overlooked.
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Affiliation(s)
- M Kawajiri
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
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28
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Osoegawa M, Matsumoto S, Ochi H, Yamasaki K, Horiuchi I, Kira YO, Ishiwata K, Nakamura-Uchiyama F, Nawa Y. Localised myelitis caused by visceral larva migrans due to Ascaris suum masquerading as an isolated spinal cord tumour. J Neurol Neurosurg Psychiatry 2001; 70:265-6. [PMID: 11271166 PMCID: PMC1737218 DOI: 10.1136/jnnp.70.2.265] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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29
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Magnaval JF, Morassin B. Henoch-Schönlein purpura associated with Toxocara canis infection. J Rheumatol 2000; 27:818-9. [PMID: 10743833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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30
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Kinceková J, Reiterová K, Dubinský P. Larval toxocariasis and its clinical manifestation in childhood in the Slovak Republic. J Helminthol 1999; 73:323-8. [PMID: 10654400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Results are presented of 90 children aged 1-15 years hospitalized with toxocariasis. Blood count analysis and laboratory examination were done by routine clinical laboratory methods. Anti-Toxocara antibodies were detected in the serum of patients using an ELISA method. Demographic analysis of the children's families exposed to the risk of disease allowed estimation of age-specific rates for clinical toxocariasis. The probability of toxocaral infection and the intensity of its clinical manifestations in children are determined by the epidemiology of this zoonosis and by the risk factors in the family. The presence of high titres of specific IgG antibodies in all age categories correlates with the clinical manifestations of toxocariasis. The highest admission rate is in the age categories of 3-5 years (43.3%) and 6-10 years (36.7%). Laboratory findings show that the most conspicuous changes occur in the age category 1-5 years. The high percentage of seropositive dog-keeping and puppy-breeding families and the possibility of infection with repeated doses of larvae stimulate eosinophilia, which prevails in children under the age of five years. We present the percentage of patients whose parameters showed deviations from the reference values for a particular age category. Analyses of laboratory indices and of clinical manifestations will contribute to the accuracy of diagnosis and effectiveness of treatment of this disease.
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Affiliation(s)
- J Kinceková
- Parasitological Institute of the Slovak Academy of Sciences, Kosice, Slovak Republic.
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31
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Abstract
Little is known about preexisting lesions in livers of children with pyogenic liver abscess (PLA). Study of these lesions may elucidate possible predisposing factors for the disease. In Vitória, state of Espirito Santo, Brazil, PLA in children is frequently associated with helminthic infections and eosinophilia. We hypothesize that nematode infection with larvae migrating through the liver is a predisposing factor for PLA, because the infection induces immunomodulation and likely trapping of bacteria in liver granulomas. In this report, we describe observations of 22 cases of PLA in children studied at autopsy (16 cases) or in surgical biopsies (6 cases), including 17 boys and 5 girls ranging in age from 1 to 13 years (mean 4.6 years, median 3.5 years). Multiple abscesses in both lobes were found in 13 cases and a single abscess was found in the right lobe in 10 cases. All cases showed histologically classical pyogenic inflammation without morphological evidence of amoebiasis. In six cases there were granulomas similar to those caused by larva migrans visceralis (from Toxocara or other nematodes) in liver tissue not affected by the abscess. Nematode antigens in central areas of necrosis of granuloma in all six cases and fragments of a larva, possibly of Toxocara, were found on samples immunohistochemically stained with polyclonal anti-Toxocara antibodies. There were numerous eosinophils in abscesses with Charcot-Leyden crystals. Eosinophils were found frequently in portal triads far from the abscess wall. In four cases, in which bile duct ascariasis was found, worms were noted in the bile ducts, and eggs were found in liver parenchyma surrounding the abscess in two cases. Foreign-body granulomas were found in one case in which penetrating trauma was the cause of abscess. In one case there was one histiocytic granuloma whose origin was not determined. The observation of six cases of granuloma similar to larva migrans visceralis (or produced by other nematode larva) in liver tissue not directly affected by the abscess supports the hypothesis that helminth infections with larva migrating through the liver are a predisposing factor for pyogenic hepatic abscess in children.
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Affiliation(s)
- F E Pereira
- Department of Pathology, Núcleo de Doenças Infecciosas CBM-UFES, Av Marechal Campos 1468, 29040-091 Vitória, ES Brazil
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32
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Rayes A, Teixeira D, Nobre V, Serufo JC, Gonçalves R, Valadares L, Lambertucci JR. Visceral larva migrans syndrome complicated by liver abscess. Scand J Infect Dis 1999; 31:324-5. [PMID: 10482069 DOI: 10.1080/00365549950163699] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
We describe a case of visceral larva migrans syndrome complicated by liver abscess, pericardial effusion and ascites. To our knowledge, these findings have not been reported previously. The structural and immunological alterations caused by visceral larva migrans are thought to lead to the development of visceral abscesses.
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Affiliation(s)
- A Rayes
- Department of Internal Medicine, Infectious Disease Branch, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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33
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Abstract
The association between hepatic abscesses and schistosomiasis mansoni was confirmed by clinical and experimental studies. Other parasites may cause systemic immunologic changes and local structural alterations in the affected organs that can facilitate the seeding of these areas by bacteria. Tropical pyomyositis, pyogenic liver and renal abscesses are frequent diseases in tropical areas. The visceral larva migrans syndrome is caused by the presence, in the human body, of larvae of worms that have other animals as their definitive host, most commonly being caused by Toxocara canis. The larvae migrate to various body organs leading to many inflammatory reactions in the form of granuloma and tissue necrosis. In this review we discuss the possible host-parasite-bacteria interactions that would favour the formation of abscesses in the organs involved by the larva of T. canis and present preliminary results of a clinical and experimental study undertaken during the last four years to define the role of this parasite in the pathogenesis of the abscesses.
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Affiliation(s)
- A A Rayes
- Departamento de Clínica Medica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte
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34
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Abstract
We described a patient with encephalopathy associated with visceral larva migrans (VLM) caused by Ascaris suum. He suffered from drowsiness, quadriparesis, eosinophilia and elevated serum IgE levels. Brain magnetic resonance (MR) imaging revealed multiple cerebral cortical and white matter lesions. Serological tests indicated recent infection with A. suum. Pulse steroid therapy relieved the patient's central nervous system symptoms and marked improvement of lesions on brain MR images. We concluded that the encephalopathy in this patient was probably caused by VLM due to Ascaris suum.
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Affiliation(s)
- Y Inatomi
- Department of Neurology, Kumamoto University School of Medicine, Japan
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35
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Sapunar J, Fardella P. [Visceral larval migrans (Human toxocariasis) cause of hypereosinophilia and visceral granulomas in adults]. Bol Chil Parasitol 1999; 54:21-4. [PMID: 10488586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A 24-year-old woman 2-3 months after a normal parturation presented geophagy. Due to hypermenorrhea she consulted a gynecologist and in a hemogram a 57% (6,893 x mm3) hypereosinophilia was detected. A chest TAC showed bilateral pulmonary nodules. The following tests resulted positive: ELISA IgG for toxocariasis 1:1000, isohemagglutinins anti A 1:2048 and anti B 1:512. The patient was treated with albendazole and prednisone during 10 days. One month after treatment eosinophilia decreased to 2.590 x mm3 and ELISA IgG for toxocariasis descended to 1:128. Different aspects of human toxocariasis are commented. When hypereosinophia is observed in adult patients, toxocariasis must be checked.
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Affiliation(s)
- J Sapunar
- Departamento de Medicina, Hospital Clínico, Universidad de Chile
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36
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Lambertucci JR, Rayes A, Serufo JC, Teixeira DM, Gerspacher-Lara R, Nascimento E, Brasileiro Filho G, Silva AC. Visceral larva migrans and tropical pyomyositis: a case report. Rev Inst Med Trop Sao Paulo 1998; 40:383-5. [PMID: 10436659 DOI: 10.1590/s0036-46651998000600008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report a case of tropical pyomyositis in a boy who presented with a severe febrile illness associated with diffuse erythema, and swelling in many areas of the body which revealed on operation extensive necrotic areas of various muscles that required repeated débridement. The patient gave a history of contact with dogs, and an ELISA test for Toxocara canis was positive. He also presented eosinophilia and high serum IgE levels. Staphylococcus aureus was the sole bacteria isolated from the muscles affected. We suggest that tropical pyomyositis may be caused by the presence of migrating larvae of this or other parasites in the muscles. The immunologic and structural alterations caused by the larvae, in the presence of concomitant bacteremia, would favour seeding of the bacteria and the development of pyomyositis.
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Affiliation(s)
- J R Lambertucci
- Departamento de Clínica Médica, Faculdade de Medicina da UFMG, Belo Horizonte, MG, Brazil.
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37
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De Cock C, Lemaitre J, Deuvaert FE. Löeffler endomyocarditis: a clinical presentation as right ventricular tumor. J Heart Valve Dis 1998; 7:668-71. [PMID: 9870201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A four-year-old girl presented with an apical mass of the right ventricle, pulmonary embolism and hypereosinophilia, and was shown to be infected with Toxocara canis. Cardiac involvement was represented by endomyocardial fibrosis, mainly at the apex of the right ventricle, mural thrombi and tricuspid regurgitation. Hypereosinophilia appears to be the head point at the basis of multiple organ damage in Löeffler endomyocarditis. The disease mechanism proposed is the eosinophilic production of peroxidases, which are cytotoxic when released in large amounts into the blood flow. Treatment is based on etiologic and corticosteroid therapy (prednisolone 1-2 mg/kg/day); surgical therapy is indicated in the end stages of the pathologic process.
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Affiliation(s)
- C De Cock
- Department of Cardiac Surgery, Hopital Universitaire des Enfants, Free University of Brussels, Belgium
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38
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Abstract
This is a case of visceral larva migrans and hypereosinophilia syndrome with persistently elevated white blood cell count despite adequate medical therapy in a 4-year-old boy with leukocytosis and splenomegaly. Medical history included reactive airway disease and geophagia (pica). Serology for Toxocara canis revealed elevated IgG and IgM titers. Ophthalmologic evaluation ruled out ocular larva migrans. After 5 days of thiabendazole therapy, leukocytosis persisted, and a second course of anthelmintics was prescribed. Two weeks later, a decrease in leukocytosis was noted. Thiabendazole therapy was continued for 15 more days. Repeated serology for T canis revealed a decreased IgM titer and a further elevated IgG titer. Follow-up showed increased physical activity, improved respiratory status, and resolution of splenomegaly.
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Affiliation(s)
- C A Arango
- Division of Pediatric Infectious Disease/Immunology, University of Florida Health Science Center, Jacksonville, USA
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39
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Oteifa NM, Moustafa MA, Elgozamy BM. Toxocariasis as a possible cause of allergic diseases in children. J Egypt Soc Parasitol 1998; 28:365-72. [PMID: 9707665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Allergic diseases are common in young children yet the cause of allergy remains unknown in most of them. The association of Toxocara infection with two common allergic diseases in children was investigated. Sera from 60 children (average age 4-6y) suffering from idiopathic bronchial asthma or chronic urticaria were tested for toxocariasis using ELISA test and compared to 30 apparently healthy age matched children . Seropositive children were investigated for evidence of sensitization by measuring serum specific IgE concentration and eosinophil count. The frequency of Toxocara seropositivity was 26.6%, 13.3% and 30% in asthmatic, chronic urticarial and control children respectively. The seropositive allergic children showed significant increase in IgE and eosinophil levels when compared to controls. A contribution of toxocariasis to the allergic sensitization was suggested.
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Affiliation(s)
- N M Oteifa
- Department of Parasitology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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40
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Abstract
BACKGROUND The etiology of Wells' syndrome or eosinophilic cellulitis is unknown. Various triggering factors, such as myeloproliferative disorders, lymphoma, infections/infestations, insect bites and drugs have been reported. In 1979, Wells was the first who pointed out some common features of eosinophilic cellulitis and skin lesions in toxocariasis. OBJECTIVE We report 2 patients who exhibited the characteristic clinical and histological features of Wells's syndrome together with elevated antibody titers to the excretory-secretory antigen of Toxocara canis. RESULTS In both patients, the skin lesions disappeared after oral albendazole treatment and no recurrences were observed. The clinical response was followed by a normalization of the Toxocara antibody titer. In contrast, a patient with eczematoid skin lesions, eosinophilia and an elevated Toxocara antibody titer did not benefit from albendazole treatment despite serological normalization. CONCLUSION Taken together, these cases lend support to a causal relationship of Toxocara in selected patients with Wells' syndrome.
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Affiliation(s)
- M A Hurni
- Dermatological Clinic, University of Berne, Inselspital, Berne, Switzerland
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41
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Mazmanian MV, Tumol'skaia NI, Chervinskaia TA. [The interrelation of Toxocara invasion with bronchial asthma]. Med Parazitol (Mosk) 1998:54-59. [PMID: 9691624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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42
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Abstract
An unusual case of life-threatening visceral larva migrans (toxocariasis) is reported herein. The patient was admitted with acute dyspnea and bilateral pleural effusion; rapidly pericardial tamponade developed. Blood and body fluid eosinophilia were elevated. Extensive investigations revealed no malignant process or vasculitis, but Toxocara infection was confirmed by rising specific antibody titers. The high seroprevalence of Toxocara antibodies, particularly in children, suggests that a diagnosis of visceral larva migrans should be considered before a diagnosis of systemic hypereosinophilic syndrome even when clinical presentation is unusual. Prophylaxis against this widespread polymorphic zoonotic infection is desirable in view of the potentially dramatic consequences of infestation.
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Affiliation(s)
- I Herry
- Service de Pneumologie, Hôpital Laennec, Paris, France
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Bourée P, Grimault E, Fromentin J, Tandjaoui-Lambiotte H, Tazi A, Battesti JP. [Visceral larva migrans in adults with severe pulmonary manifestations]. Presse Med 1997; 26:70-2. [PMID: 9082413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Toxocariosis, the most frequent cause of visceral larva migrans, is usually a disease of children due to ingestion of eggs from the roundworm of dogs (Toxocara canis). Clinical expression varies from an symptomatic state to fuminant disorders; hepatomegaly with fever is frequent. Severe symptoms (rarely in adults) may occur. CASE REPORT A 42-year-old male with no past medical history complained of sudden onset pulmonary disorders. Laboratory findings included eosinophilia on blood tests, a severe respiratory obstructive syndrome and positive serum tests for Toxocara canis. All clinical and biological abnormalities regressed in a few weeks. DISCUSSION Diagnosis of visceral larva migrans is exceptional in adults and can only be proven by positive serological tests. Correct treatment remains under debate.
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Affiliation(s)
- P Bourée
- Département des Maladies parasitaires et tropicales, Hôpital de Bicêtre, Le Kremlin-Bicêtre
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44
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Schinkewitch P, Kessler R, Candolfi E, Weitzenblum E. [Acute respiratory insufficiency in parasitic eosinophilic pneumonia]. Rev Mal Respir 1997; 14:61-3. [PMID: 9082509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report a case of bilateral eosinophilic pneumonia in a 33 year old man. This case developed rapidly into acute respiratory failure and required artificial ventilation. Intravenous corticosteroid therapy produced a rapid improvement in the clinical picture. There was hyper-eosinophilia in both the blood and the alveoli which leads to a search for a parasitic aetiology. The different parasitic serologies were negative except for Toxocaracanis. The ELISA index was strongly positive at 2,597. Treatment with thiabendazole was started.
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Affiliation(s)
- P Schinkewitch
- Service de Pneumologie Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg
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45
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López-Vélez R, Turrientes MC, Malo Q, Fenoy MS, Guillén JL. [2 cases of toxocariasis (visceral larva migrans)]. Enferm Infecc Microbiol Clin 1996; 14:548-50. [PMID: 9035713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Different epidemiological studies have demonstrated that specific anti-Toxocara antibodies are detected in the serum of a high percentage of the Spanish population. But very few clinical cases of visceral larva migrans are being confirmed. METHODS AND RESULTS Two cases of visceral toxocarosis, in two sisters, are described. In the first, the prevailing clinic was swelling of joints and upper respiratory tract symptoms; and asthma and cutaneous allergic manifestations in the second patient. Both cases presented with an elevated blood eosinophil count, high levels of total IgE and high titlers of anti-Toxocara antibodies. All symptoms disappeared after treatment with diethylcarbamazine and they remain asymptomatic several months after. CONCLUSIONS In pediatric population, toxocarosis should be ruled out in every patient with respiratory symptoms, allergic cutaneous manifestations and elevated blood eosinophil count. The anti-Toxocara antibodies assay is of great value in establishing the diagnosis of this parasitic disease.
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Affiliation(s)
- R López-Vélez
- Unidad de Medicina Tropical y Parasitología Clínica, Hospital Ramón y Cajal, Madrid
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46
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Lund-Tønnesen S. [Visceral larva migrans. A rare cause of eosinophilia in adults]. Tidsskr Nor Laegeforen 1996; 116:2660-1. [PMID: 8928142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Toxocariasis is a cosmopolitan infection of dogs and cats with a roundworm resembling Ascaris. Man becomes infected by ingesting eggs from the environment. The infection occurs mainly in children. There are two distinct syndromes: visceral larva migrans and ocular toxocariasis. The author describes the case of a 70 year old Norwegian female with visceral larva migrans. One month after a visit to Spain she developed fever, hepatomegaly and marked eosinophilia. Liver biopsy revealed subacute hepatitis with eosinophilic leucocyte infiltration. Toxocara ELISA was strongly positive. Treatment with albendazol 400 mg b.i.d. and prednisone 10 mg daily for three weeks was successful. A clinical relapse after three months was treated in the same way for one month. Prolonged treatment is recommended. To our knowledge, this is the first reported case of visceral larva migrans in an adult Norwegian. Epidemiology, diagnosis and treatment are discussed.
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Affiliation(s)
- S Lund-Tønnesen
- Infeksjonsseksjonen Medisinsk avdeling, Haukeland Sykehus 5021, Bergen
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47
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Barra LA, dos Santos WF, Chieffi PP, Bedaque EA, Salles PS, Capitão CG, Vianna S, Hanna R, Pedretti Júnior L. [Visceral larva migrans: a mixed form of presentation in an adult. The clinical and laboratory aspects]. Rev Soc Bras Med Trop 1996; 29:373-6. [PMID: 8768588 DOI: 10.1590/s0037-86821996000400011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We relate a case of an 18-year-old man, resident of Xapuri (state of Acre, Brazil), with a history of repeated episodes of meningoencephalitis (three in one year), each one was examined by a local doctor. In our service (Emílio Ribas Institute of Infectology) we observed a patient with polyjoint aches, radiological and bronchoscopic pulmonary alterations (without clinical features), meningeal and brain stem manifestations--with normal brain computed tomography and cerebrospinal fluid. Blood eosinophils and serological Toxocara canis test (ELISA) were greatly increased. With the hypothesis of Toxocariasis (visceral larva migrans) we administered thiabendazole that brought complete clinical and laboratory remission. Inspite of a new episode of headache with meningeal manifestation approximately one month later (treated with dexamethasone resulting in a full remission after three days) we have not found other manifestations in approximately three and a half years of ambulatory care.
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Affiliation(s)
- L A Barra
- Instituto de Infectologia Emílio Ribas, Instituto de Medicina Tropical de São Paulo, Brasil
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48
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Molitor L. A 52-year-old man with wheezing, fever, and abdominal pain. J Emerg Nurs 1996; 22:158-9. [PMID: 8716313 DOI: 10.1016/s0099-1767(96)80272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Nelson S, Greene T, Ernhart CB. Toxocara canis infection in preschool age children: risk factors and the cognitive development of preschool children. Neurotoxicol Teratol 1996; 18:167-74. [PMID: 8709928 DOI: 10.1016/0892-0362(95)02018-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Risk factors for Toxocara canis (T. canis) infection were evaluated in a prospective study of disadvantaged preschool children. In addition, the hypothesis that T. canis exposure is associated with lower intelligence was tested. Seropositivity was tested at 2 years, 3 years, and at 4 years 10 months (4-10). Intelligence was measured at age 4-10 by the Full Scale IQ of the Wechsler Preschool and Primary Scales of Intelligence (WPPSI). Pica and ownership of a dog were unrelated to seropositivity. Seropositive children had lower scores on the Mental Development Index (MDI) of the Bayley Scales of Infant Development at age 1 year (prior to likely exposure). They also had less favorable scores on a measure of the quality of childrearing. These findings suggest that, for disadvantaged children, lower initial intelligence and less advantageous child rearing are risk factors for T. canis exposure. Seropositive children also had higher blood lead levels, probably as a result of the common pathway of hand to mouth transmittal. Seropositivity at 3 years, at age 4-10, or, cumulatively, at any of the age 2, 3, or 4-10 assessments was associated with the WPPSI IQ after adjustment for sociodemographic factors. Exposure at age 4-10-years was significantly associated with reduced IQ scores (p = 0.030). However, when the age 1 year MDI score was controlled, the estimate became nonsignificant. We, thus, can neither confirm nor deny a relationship of T. canis and intelligence, but the importance of considering prior developmental status is emphasized.
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Affiliation(s)
- S Nelson
- Bolton-Brush Growth Study Center, Case Western Reserve Univerisity, Cleveland, OH 44106-4905, USA
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Boschetti A, Kasznica J. Visceral larva migrans induced eosinophilic cardiac pseudotumor: a cause of sudden death in a child. J Forensic Sci 1995; 40:1097-9. [PMID: 8522917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A case of fatal cardiac larva migrans in a 10-year-old boy is described. The autopsy findings were quite dramatic, with a bosselated, sessile polypoid mass involving the left ventricular myocardium and protruding into the ventricular lumen. The precise morphologic characterization of the zoonotic ascarid larva was impaired by advanced resorption of the larva by an inflammatory infiltrate. Nonetheless, morphometry of the larval remnants strongly suggested the raccoon ascarid, Baylisascaris procyonis, as the causative agent.
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Affiliation(s)
- A Boschetti
- Medical Examiner for Suffolk County, Commonwealth of Massachusetts, Boston, USA
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