CASE BY CASE: PARASITOLOGY PEER REVIEWED

CASE BY CASE: PARASITOLOGY

Toxocara cati Infection in Cats

Timothy Wu, MS, DVM, DACVP
Cornell University College of Veterinary Medicine, Ithaca, New York

Toxocariasis in cats, caused by infection with Toxocara intestine. In contrast, when a cat is infected via
cati (syn. Toxocara mystax [Zeder, 1800]), is diagnosed ingestion of larvae in a paratenic host (e.g., a mouse or,
worldwide; in the United States, T cati was detected by less commonly, an earthworm, cockroach, chicken, or
fecal flotation for 4% of cats in 2022, although those sheep), the larvae mature without migrating to the liver

JK Lin/shutterstock.com. Opposite: courtesy Timothy Wu; created with biorender.com

results may underestimate the exact prevalence.1
Although cases have been reported in every U.S. state,
risk for infection is higher in the northeastern states but
is also high in certain southern states (e.g., Mississippi)
and midwestern states (e.g., South Dakota).1
PARASITE LIFE CYCLE
In cats infected via ingestion of larvated eggs in feces or
soil, the larvae will migrate through the liver, lungs,
and trachea, where they are ultimately coughed up and
swallowed, and then mature to adults in the small
or lungs. Rarely, kittens are infected by transmammary
transmission from an acutely infected lactating queen;
in these kittens, larvae mature without
hepatopulmonary migration.2,3 The prepatent period
(before eggs are shed in the feces) is 8 weeks. Compared
with Toxocara canis (T canis), the life cycle of T cati
(FIGURE 1) nematodes differs in that tracheal migration
and maturation to adult worms continue into
adulthood in cats (whereas tracheal migration is
considered unlikely in dogs greater than 2 months old)
and because transplacental transmission is not
considered a route of infection for T cati.2

Abstract
Toxocara is a genus of ascaridoid nematodes that inhabit the small intestine of mammals as adults. Toxocara cati
(T cati) is a roundworm that infects cats through ingestion of eggs in soil or feces, ingestion of larvae in paratenic
hosts, or, rarely, via transmammary transmission. Clinical signs in cats are uncommon but can involve the
gastrointestinal and/or respiratory tracts. Although not considered life-threatening, T cati infections should be
diagnosed and treated as they represent a zoonotic risk for humans and are difficult to eradicate from a
contaminated environment.

28 JANUARY/FEBRUARY 2023 todaysveterinarypractice.com

 PEER REVIEWED CASE BY CASE: PARASITOLOGY

Take-Home Points

ƒ Toxocara cati is a common
parasite that infects cats of
all ages.
ƒ Infection can occur by ingesting
eggs in soil or feces, by ingesting
larvae in paratenic hosts, or,
rarely, through transmammary
transmission.
ƒ Clinical signs are uncommon but
may include diarrhea, vomiting,
and coughing.
ƒ Many drugs are available for
treatment, and some can prevent
vertical transmission of the
parasites to offspring.
ƒ Toxocara cati has zoonotic
potential; therefore,
environmental decontamination is
valuable, although often difficult.
ƒ Infection can be prevented by
early diagnosis and treatment
as well as restricting hunting by
cats.

DIAGNOSIS gastric ulcers and pulmonary artery hypertrophy with

Infected kittens will exhibit illthrift, diarrhea, and a
pot-bellied appearance; adult cats may vomit, and adult
ascarids are occasionally found in the vomitus.1
Necropsy of currently or previously infected cats may
reveal focal scarring of the liver secondary to hepatic
migration of larvae, but this finding is considered
incidental. Larval migration through the lungs may
result in hemorrhage and inflammation of the
pulmonary alveoli, resulting in overt pulmonary
disease.1 Previous reports have described perforated
T cati infection, but these findings have not been
corroborated in recent years.4,5 Typically, the clinical
signs of T cati infection are not as severe as those
caused by T canis infection in dogs (which can be fatal
after intestinal obstruction or rupture).3
Adult worms can be found not only in the vomitus of
infected cats but also in the feces of cats after
appropriate treatment. Male T cati worms are typically
3 to 6 cm long while the females are generally longer,

Single-celled egg
Adults in small intestine

2–4 weeks

Embryonated egg
with L3 larva
Larvae coughed up
and swallowed

Ingestion of Ingestion of Ingestion by

paratenic Hepatopulmonary eggs paratenic
hosts migration hosts

Transmammary
infection in kittens by
acutely infected queen L3 larvae encyst in
paratenic hosts

FIGURE 1. Life cycle of Toxocara cati parasites.

todaysveterinarypractice.com JANUARY/FEBRUARY 2023 29

 CASE BY CASE: PARASITOLOGY PEER REVIEWED
Antigen testing enables
detection of prepatent infections
and infections in which
only males are present, and
therefore no eggs are shed.
ranging from 4 to 10 cm.3 T cati worms are
recognizable by their broad cervical alae, resulting in an
arrowhead shape, for which they are named (toxo =
“arrow,” cara = “head”). These alae, coupled with the
often ventrally curved anterior end, give these
nematodes a cobra-like appearance. Examination of the
anterior end may also reveal a glandular esophageal
bulb, although visualization of this structure may
require staining the specimen.2
T cati eggs are distinguished by their dark brown to
black coloration and round to elliptical, thick-shelled,
pitted walls containing a single-celled embryo
(FIGURE 2).6 Egg sizes vary, but they are generally
described as being 61 to 65 × 71 to 75 µm. Aside from
identification of adult worms or eggs, T cati infection
can also be diagnosed by fecal antigen test.1 Antigen
testing enables detection of prepatent infections and
infections in which only males are present, and
therefore no eggs are shed.
TREATMENT
Treatment of toxocariasis typically involves
benzimidazoles (e.g., fenbendazole), which are
considered more effective than other drugs against
larval ascarids.3 In addition, benzimidazoles may
prevent vertical transmission of parasites in dogs and
cats.2 Other drugs (e.g., piperazine, ivermectin,
eprinomectin, moxidectin, selamectin, emodepside,
milbemycin oxime, pyrantel pamoate) have also been
used as treatment.3 Of note, emodepside (available as a
topical solution in combination with praziquantel) has
also been shown to reduce vertical transmission.7
Although approved for treatment, piperazine may be
less effective than the other drugs listed.1 Pyrantel
pamoate is the only drug labeled for kittens as young as
2 weeks of age.2
30 JANUARY/FEBRUARY 2023 todaysveterinarypractice.com
The Companion Animal Parasite Council recommends
testing kittens for intestinal parasites at least 4 times in
the first year of life and twice a year thereafter.1
Although the prepatent period for T cati infection is
8 weeks, to combat any potential of hookworm
infection, treatment for parasitic infection should be
initiated at 2 weeks of age and repeated every 2 weeks
until regular broad-spectrum parasite control is begun.1
OUTCOMES
Although the consequences of T cati infection are not
as lethal for cats as are the consequences of T canis
infection for dogs, T cati infection remains a threat to
humans (although less so than T canis), who may
acquire the infection by ingesting eggs in contaminated
soil or larvae in raw meat from paratenic hosts, most
commonly raw liver.2 Eggs passed in cat feces develop
to larvae in the environment after 2 to 4 weeks, after
which time they are infective.1 The eggs are very hardy
in the environment and can remain infective for years.
Infected humans can experience a variety of conditions
secondary to larval migration throughout the body,
including visceral larva migrans (which causes
hepatomegaly and pulmonary disease) and ocular larva
migrans (which causes granulomatous retinitis and
potentially blindness).1,2 Covert toxocariasis may also
develop in humans, with nonspecific clinical signs such
as chronic abdominal pain.1
PREVENTION
Decontamination of the environment is difficult
because T cati eggs are resistant to many common
FIGURE 2. Toxocara cati egg as seen on fecal flotation. The
egg is circular and has a thick, pitted shell and a single-
celled embryo. Bar indicates 100 μm.

disinfectants.2 The most effective method, although not
always the easiest, is to cover the eggs with concrete or
a foot of gravel.2 The best way to avoid zoonotic
infection is to prevent contamination by routinely
testing and treating infected animals, preventing
hunting behaviors, promptly removing feces from the
environment, and stopping indiscriminate defecation.
CASE SCENARIO
Signalment and History
A 9-week-old, intact male domestic shorthaired kitten
was presented to an animal hospital for evaluation of
general unthriftiness and diarrhea. The clients had
recently adopted the kitten from a neighbor, whose
outdoor barn cat had given birth. Questions posed to
the neighbor indicated that the barn cat had recently
had repeated bouts of vomiting, with “white sticks”
appearing in the vomitus, which were saved in a plastic
bag and brought in by the kitten’s owner for evaluation.
Physical Examination
The results of physical examination were unremarkable
except for vague intestinal thickening detected by
abdominal palpation.
Diagnostic Test Results
The “white sticks” from the vomitus of the adult cat
were thin white nematodes, some as long as 12 cm,
with 3 large fleshy lips at the anterior end and
prominent lateral alae (FIGURE 3).2 The 3 lips and
FIGURE 3. Adult Toxocara cati nematode, anterior end. The
prominent fleshy lips and broad lateral alae form a right
angle at the junction of the posterior margin and the body.
PEER REVIEWED CASE BY CASE: PARASITOLOGY
cervical alae were consistent with an ascaridoid
nematode, possibly T cati or Toxascaris leonina. The
prominence of the lateral alae and the almost 90˚ angle
at the junction of the posterior margin with the body
differentiated this nematode from T leonina worms, in
which the alae are much narrower and taper at the
posterior junction with the body.3
Fecal examination consisted of centrifugal flotation
with zinc sulfate (1.18 specific gravity). Examination
revealed 65 × 75–µm dark brown eggs with thick,
rough, pitted shells (FIGURE 2), which differentiated
these eggs from those of T leonina eggs, which have a
smooth outer shell wall.1
The 3 lips and cervical alae
were consistent with an
ascaridoid nematode, possibly
T cati or Toxascaris leonina.
Treatment Plan
A topical broad-spectrum dewormer containing
moxidectin and imidacloprid was applied to the kitten.
The client was advised to monitor the kitten for adverse
effects (e.g., hypersalivation, lethargy, application site
pruritus or alopecia, decreased appetite, vomiting,
ataxia) and to discontinue treatment if any were noted.8
Outcome
After treatment, the kitten expelled adult worms in the
feces for the next few days and rapidly improved. On
follow-up examination 2 weeks later, fecal flotation
with centrifugation was performed to evaluate drug
effectiveness, and no eggs were found. The client was
instructed to continue topical application once
monthly to treat any newly acquired internal parasites
or ectoparasites (e.g., fleas, ear mites) and to prevent
heartworm infection.
SUMMARY
T cati infection is a common, non–life-threatening
condition of kittens and adult cats. Kittens can acquire
todaysveterinarypractice.com JANUARY/FEBRUARY 2023 31
 CASE BY CASE: PARASITOLOGY PEER REVIEWED
VETORYL CAPSULES ®

(trilostane)
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Approved by FDA under NADA # 141-291
Manufactured for:
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Method of use covered by
US patent No. 9,283,235.
this infection through transmammary transmission if
the queen is acutely infected while lactating. Other,
more common, routes of infection include ingestion of
larvated eggs in contaminated soil or feces or encysted
larvae in paratenic hosts. Diagnosis and treatment are
rather straightforward; diagnosis often depends on fecal
flotation results, and treatment involves available drug
formulations. Although not often a severe infection in
cats, recognizing and treating toxocariasis are important
because they represent a human health hazard as well,
and because infective eggs are difficult to eradicate after
an environment has been contaminated.
References
1. Companion Animal Parasite Council. Ascarid: cat. Updated September
12, 2022. Accessed August 15, 2022. https://capcvet.org/guidelines/
ascarid
2. Bowman DD. Georgis’ Parasitology for Veterinarians. 11th ed. Elsevier
Saunders; 2020.
3. Taylor MA, Coop RL, Wall RL. Veterinary Parasitology. 4th ed. Wiley
Blackwell; 2016.
4. Aoki S, Yamagami T, Saeki H, Washizu M. Perforated gastric ulcer
caused by Toxocara cati in a cat. J Jap Vet Med Assoc.
1990;43:207-210. doi:10.12935/JVMA1951.43.207
5. Swerczek TW, Nielsen SW, Helmboldt CF. Ascariasis causing pulmonary
arterial hyperplasia in cats. Res Vet Sci. 1970;11(1):103-105.
6. Zajac AM, Conboy GA, Little SE, Reichard MV. Veterinary Clinical
Parasitology. 9th ed. Wiley Blackwell; 2021:60-61.
7. Böhm C, Petry G, Schaper R, Wolken S, Strube C. Prevention of
lactogenic Toxocara cati infections in kittens by application of an
emodepside/praziquantel spot-on (Profender®) to the pregnant queen.
Parasitol Res. 2015;114(suppl 1):S169-S178. doi:10.1007/s00436-015-
4523-y
8. Advantage Multi for Cats. Package insert. Elanco Animal Health
Incorporated; 2022.
Timothy Wu
Dr. Wu received his DVM degree in 2017
and completed a residency in anatomical
pathology in 2020, both at Cornell
University. He is currently participating
in a combined PhD/residency program in
parasitology at Cornell, with sponsorship
through the National Center for Veterinary
Parasitology and IDEXX Laboratories. Dr. Wu
is a third-year PhD student, studying with
Dr. Dwight Bowman, MS, PhD, and training
as a clinical parasitology resident in the New
York State Animal Health Diagnostic Center.
His long-term goal is to work in an academic
setting, where he can combine his passion
for pathology and parasitology in a teaching
and diagnostic setting.

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