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Toxocariasis ˌtäk-sə-kə-ˈrī-ə-səs

(Visceral Larva Migrans)

by Richard D. Pearson, MD

Toxocariasis is infection caused by larvae of the roundworms Toxocara canis or Toxocara cati.

  • Young children can acquire the infection when they eat soil contaminated with animal stool (feces) that contain the roundworm eggs.

  • Most often, the infection causes fever, cough or wheezing, and an enlarged liver, but it may cause vision problems.

  • Doctors confirm the diagnosis by identifying antibodies to the roundworm in a sample of blood.

  • Regularly deworming dogs and cats can help prevent the infection.

  • Treatment is usually unnecessary but may include antiparasitic drugs and corticosteroids.

Toxocariasis occurs mainly in young children, who acquire Toxocara eggs by ingesting soil contaminated by the feces of dogs, cats, or other animals that carry the parasite. Sandboxes, where dogs and cats often defecate, pose a particular hazard for exposure to the eggs. Children frequently transfer the eggs from their hands to their mouth and may eat the contaminated sand. Occasionally, adults ingest eggs picked up from contaminated soil, other surfaces, or hands and become infected. Adults and children who have a craving for nonfoods, such as soil or clay (a condition called pica), are at particular risk.

After the eggs are swallowed, larvae hatch in the intestine. The larvae penetrate the intestinal wall and spread through the bloodstream. Almost any tissue of the body may be affected, but the liver and lungs are most commonly involved. The larvae can remain alive for many months, causing damage by moving through tissues and stimulating inflammation. The larvae do not mature to adulthood in people. They require another host for maturation: dogs, cats, or other animals.

Symptoms of Toxocariasis

Toxocariasis symptoms may start within several weeks after eggs are ingested. Fever, cough or wheezing, and liver enlargement are the most common. Some people have a rash, spleen enlargement, or recurring pneumonia. They may lose their appetite.

When larvae infect the eyes, inflammation and decreased vision may result.

Diagnosis of Toxocariasis

  • Blood tests to detect antibodies to the parasite

A doctor may suspect toxocariasis in a person who has an enlarged liver, inflammation of the lungs, a fever, and high levels of eosinophils (a type of white blood cell). The diagnosis is confirmed by identifying Toxocara antibodies in the blood. ( Antibodies are proteins produced by the immune system to help defend the body against attack, including by that parasites.)

Rarely, a sample of liver or other tissue is obtained and examined (biopsied) for evidence of larvae or inflammation resulting from their presence.

Prevention of Toxocariasis

Prevention involves deworming dogs and cats regularly. Covering sandboxes when not in use prevents animals from defecating in them.

Children should be discouraged from eating nonfoods, such as soil and clay, as should adults who have such cravings.

Treatment of Toxocariasis

  • If needed, albendazole or mebendazole (drugs used to eliminate worms—antihelminthic drugs) plus corticosteroids

In most people with toxocariasis, the infection resolves on its own, and treatment is unnecessary. Albendazole or mebendazole plus corticosteroids is given when symptoms are severe or the eyes are infected.

Occasionally, laser photocoagulation (application of an intense beam of light) is used to kill larvae in the eyes.

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  • ALBENZA
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