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) found in dogs and cats, respectively. In humans, toxocariasis is considered an aberrant infection because humans are incidental hosts, and the parasites cannot completely mature in the human body. Instead, the invasive larvae migrate for months through different organs until they are overcome by the human inflammatory reaction and die. The larvae can survive in tissues for at least 9 years and, possibly, for the life of the host. Three clinical forms of toxocariasis are traditionally described these includevisceral larva migrans (!"#), ocular larva migrans ($"#), and covert toxocariasis. %umerous disease manifestations have also been attributed to these parasites. &iagnosis is based on serologic findings. 'olymerase chain reaction ('()) has been introduced as a diagnostic tool. *xamination of stools has no role in the evaluation of toxocariasis. +hether or not the infection should be treated and, if so, when and how it should be treated is controversial. #ebenda,ole, thiabenda,ole, albenda,ole, and diethylcarbama,ine, among others, are agents used in the treatment. (orticosteroids also have a significant role in therapy. -ee the images below.
!"# is diagnosed mainly in children . clinical forms of toxocariasis that are traditionally described include the following/ Visceral larva migrans (VLM) • 0eneral/ The classic !"# syndrome consists of episodes of fever. asthenia. and positive Toxocara titers.ing. hepatomegaly. anemia.&iagram of the Toxocara canis life cycle image. and vague abdominal symptoms. The patient usually has malaise. coughing and whee. eosinophilia. CLINICAL FORMS The .
5 6@2month2old boy in whom lymphedema was the main clinical manifestation of toxocariasis has been reported. 71:8 (ardiac/ 5lthough infrequently involved.ole.ed. arachnoiditis. The spleen is enlarged less often than is the liver.< in children with the condition. such as fever. the larvae migrate to the eyes.2year2old previously healthy male with a 62wee4 history of fever and night sweats weight loss eosinophilia high erythrocyte sedimentation rate and abnormal chest radiograph findings that revealed bilateral hilar and mediastinal lymphadenopathy and discrete bilateral pleurisy demonstrates that. 71. +hen histologic results are available. and abdominal pain. where they induce an eosinophilic inflammatory reaction. such as urticaria and nodules. • 5fter an initial study demonstrating T canis antibodies in :. and a seroprevalence of . 5 case report that described a :. all layers of the heart can be affected. They lac4 systemic symptoms. The disease is unilateral in most cases. in its acute presentation. static encephalopathy. they usually reveal granulomatous hepatitis. and spinal cord lesions. 'rogression to eosinophilic pneumonia and respiratory failure has been reported. compared with 61< in controls (n=>1).< in controls (n=6. others found a seroprevalence of 6?< in chronic urticaria (n=16>) versus 1. cough.aged 123 years.8 • • • )heumatologic/ Arequently.:). 71. -ystemic disease rarely results in ocular disease. Isolated reports describe diffuse noncavitating pulmonary nodules and pleural effusions.ed lymphadenopathy is an infrequent manifestation of toxocariasis. • &ermatologic • -4in lesions. and eye pain. 7668 It affects females and males with approximately equal frequency. • . The most common presentation is myocarditis. It can be confused with a retinoblastoma. a seroprevalence of >< in chronic urticaria (n=11?). 'yogenic liver abscess concomitant with Toxocara hepatitis has also been reported. monoarthritis.76?8 Ocular larva migrans (OLM) 7618 • • This refers to eye (usually retinal) involvement during Toxocara infection. and small2vessel vasculitis coincidentally occur with !"#. a seroprevalence of 1. 9owever. especially when it is associated with eosinophilia. • +ell syndrome is an eosinophilic cellulitis of un4nown origin. a form of aseptic meningitis in which the +C(s in the cerebrospinal fluid mainly consist of eosinophils. Cy chance. #any organs can be involved in !"#.ing is a common sign of !"#.?< in controls.7168 • 'ulmonary/ +hee. 7198 larval invasion of the brain parenchyma. 0enerali. 'atients with $"# are older than those with !"#. solitary mass lesions that cause sei.8 • 9epatic and lymphatic/ !"# is usually associated with hepatomegaly. strabismus. 5 report described 6 cases with clinical and histologic features of +ell syndrome with positive anti2 Toxocara titers.< of patients with chronic urticaria (n=. 5mong the unusual manifestations described in the literature are "oeffler endomyocarditis7138 and pericardial tamponade.1). #ost patients report a history of recent exposure to puppies or 4ittens. manifestations such as arthralgias.71@8 Two cases of isolated eosinophilic ascites due to Toxocarahave been reported. 7118 %ot only did the symptoms respond to treatment with albenda. Toxocariasis can cause chronic idiopathic urticaria. #ost of the time. migratory cutaneous lesions. $"# manifests as a loss of visual acuity. it is unilateral. leu4ocoria. but the antibody titer also normali. have been described.ures. !"# can be confused with lymphoma. $ne case report describes 9enoch2-chBnlein purpura in a 132year2old male in association with anti2 Toxocara immunoglobulin 0 (Ig0) and Ig* that spontaneously resolved.71>8 (%-/ Toxocariasis is one of the causes of eosinophilic meningitis. $cular toxocariasis is an uncommon disease that occurs primarily in young patients. studies of toxocariasis as the cause of chronic urticaria are inconsistent. and do not have significant eosinophilia. $ther less common entities described in association with !"# are encephalitis. with mild2to2 moderate intermediate or diffuse inflammation.
. among others. whee. The presentation was of a granuloma in the peripheral retina in .:<). The @ patients tested for vitreous or aqueous *"I-5 showed positive titers (6 had negative serologic titers). years.. Clinical mani estations The clinical manifestations of T canis infections depend on the following factors/ • • • • %umber of infective eggs &uration of infection 5natomic location of the larvae 9ost immune response Pathophysiology #ost frequently. These eggs need several wee4s of optimal environmental conditions (1?2.?<). are puppies younger than . and floaters in @ eyes (1:. therefore. toxocariasis is relatively uncommon. lungs. months and lactating female dogs. The main sources of eggs. the larvae hatch in the small intestine.. 9umans are paratenic hosts for T canis. -erum *"I-5 for antibodies to Toxocara was positive in 11 patients (. and optic neuritis.< of cases.ing. uveitis. granuloma in the macula in 6. *osinophilia is less frequent and less pronounced with this form than with !"# and Toxocara antibody titers are lower. sleep disturbances. vitreous abscess.<). and extreme p9 levels. human toxocariasis is caused by T canis. high soil humidity) to develop from noninfective unembryonated forms to infective embryonated eggs. and traction retinal detachment. a canine roundworm. 'aratenic hosts are transport hosts in which the larvae never develop into adult worms.. 76.?< of cases. and gain access to the blood and lymphatic circulation. Dsual symptoms are chronic or recurrent abdominal pain.ing.3<). hepatomegaly. toxocariasis was the etiology in 66 patients (1<).:. but in a pregnant female. The larvae invade the liver. infecting the fetus. In a review of 6. In most dogs. patients with uveitis. mimic4ing endophthalmitis in 6. headache. cystoid macular edema. +hen a dog ingests the infective eggs. 5mong patients with uveitis. The infection is acquired by ingesting T canis embryonated eggs.• • o o o o o o $ther presentations of $"# include endophthalmitis with secondary retinal detachment. Inflammation was unilateral in 9?. The most common symptoms caused by Toxocara uveitis were blurred vision in 1> eyes (3. anorexia.1>. and un4nown in . The adult T canis female worms can excrete as many as 6??. moisture. and failure to thrive.E(. The embryonated eggs are resistant to free. . Covert toxocariasis • • #ost cases of toxocariasis are asymptomatic. Aemale dogs then become reinfected while caring for their puppies. malaise.9<. The term covert toxocariasis refers to a less specific syndrome that was recogni. and other tissues.8 The mean patient age was 1:. the larval maturation process is arrested in most tissues. T canis resumes development and migrates across the placenta. negative in > patients (. confirming that seronegativity does not exclude the diagnosis.. and moderate2to2severe vitreous inflammation. the larvae continue their maturation process. patients (1.ed with the wider use of serodiagnostic assays for Toxocara infection.<). pain or photophobia in > eyes (. migrating from the lungs to the 0I tract via the trachea they achieve their mature forms in the puppiesF intestinal tracts.< of cases. penetrate the intestinal wall.@<)..??? eggs per day. 5dult T canis female worms are usually found in young puppies and lactating female dogs. The primary causes of vision loss were vitreitis. 5fter the birth of the puppies. coughing.
These antigens induce a Th62type (&@G cellular immune response characteri. The cat roundworm. T catis. . and Lagochilascaris minor (opossum ascarid). These.. in turn. Tissue damage is due to the host inflammatory reaction more than the infection itself. 5lthough Toxocara organisms are the most common causes of !"#. case reports have noted other . Infections acquired by ingestion of raw snails and raw lamb have also been reported. has a life cycle similar to that of T canis except that vertical transmission is due to lactation more than transplacental transmission. 9owever. probably because of the defecation patterns of cats.ed by the production of interleu4in @ that promotes the switching of C2cell isotypes to the production of immunoglobulin * (Ig*) and interleu4in .718Baylisascaris procyonis (raccoon ascarid). which ma4e environmental infestation less frequent. T catis causes fewer cases of human infection than T canis. including Ascaris suum. such as par4s. in most cases. $ne report documents @ cases of adult T catis intestinal infection in children. promote eosinophil differentiation and vascular adhesion.-ources of these eggs include areas where dogs defecate.?< of soil samples from public par4s and childrenFs sandboxes are contaminated with Toxocara eggs. usually referred to as Toxocaraexcretory secretory antigens. The larvae produce glycosylated proteins. 5s much as 6?2.oonotic nematodes that cause !"#. humans are paratenic hosts.
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