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(Visceral or Ocular Larva Migrans)
Toxocariasis is human infection with nematode ascarid larvae that ordinarily infect animals. Symptoms are fever, anorexia, hepatosplenomegaly, rash, pneumonitis, asthma, or visual impairment. Diagnosis is by enzyme immunoassay. Treatment is with albendazole or mebendazole. Corticosteroids may be added for severe symptoms or eye involvement.
The eggs of Toxocara canis, T. cati, and other animal ascarid helminths mature in soil and infect dogs, cats, and other animals. Humans may accidentally ingest eggs in soil contaminated by stool from infected animals or may ingest infected transfer hosts (eg, rabbits). The eggs hatch in the human intestine. Larvae penetrate the bowel wall and may migrate through the liver, lungs, CNS, eyes, or other tissues. Tissue damage is caused by focal eosinophilic granulomatous reactions to the migrating larvae. The larvae usually do not complete their development in the human body but can remain alive for many months.
This syndrome consists of fever, anorexia, hepatosplenomegaly, rash, pneumonitis, and asthmatic symptoms, depending on the affected organs.
VLM occurs mostly in 2- to 5-yr-old children with a history of geophagia. The syndrome is self-limiting in 6 to 18 mo if egg intake ceases. Deaths due to invasion of the brain or heart occur rarely.
This syndrome, also called ocular toxocariasis, usually has no or very mild systemic manifestations. OLM lesions consist mostly of granulomatous reactions to a larva in the retina; the larva may cause visual impairment.
OLM occurs in older children and less commonly in young adults. The lesion may be confused with retinoblastoma or other intraocular tumors.
Diagnosis is based on clinical, epidemiologic, and serologic findings. Enzyme immunoassay (EIA) is currently recommended. However, serum antibody titers may be low or undetectable in patients with OLM. Isoagglutinins are frequently elevated, but this finding is nonspecific. Hyperglobulinemia, leukocytosis, and marked eosinophilia are common. CT or MRI can show multiple, ill-defined, 1.0- to 1.5-cm oval lesions scattered in the liver or poorly defined subpleural nodules in the chest.
Biopsies of the liver or other affected organs may show eosinophilic granulomatous reactions, but larvae are difficult to find in tissue sections and biopsies are low yield. Stool examinations are worthless. OLM should be distinguished from retinoblastoma to prevent unnecessary surgical enucleation of the eye.
Asymptomatic patients and patients with mild symptoms do not require anthelminthic therapy because infection is usually self-limited. For patients with moderate to severe symptoms, mebendazole 100 to 200 mg po bid for 5 days or albendazole 400 mg po bid for 5 days is often used, but the optimal duration of therapy has not been determined.
Antihistamines may suffice for mild symptoms. Corticosteroids (prednisone 20 to 40 mg po once/day) are indicated for patients with severe symptoms. Corticosteroids, both local and oral, are also indicated for acute OLM.
Laser photocoagulation has been used to kill larvae in the retina.
Drug NameSelect Brand Names
mebendazoleNo US brand name
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