No CrossRef data available.
Article contents
Toxocariasis in humans: clinical expression and treatment dilemma
Published online by Cambridge University Press: 12 April 2024
Abstract
A new scheme of clarifying clinical forms of toxocariasis is proposed to include: (i) systemic forms: classical VLM and incomplete VLM; (ii) compartmentalized forms: ocular and neurological toxocariasis; (iii) covert toxocariasis; and (iv) asymptomatic toxocariasis. The following markers are helpful in defining clinical forms namely, patient characteristics and history, clinical symptoms and signs, positive serology, eosinophilia and increased levels of IgE. Amongst the available drugs albendazole is the most commonly used, although other benzimidazole compounds have a similar efficacy. The recommended dose of albendazole is 15 mg kg-1 body weight daily for 5 days and in some cases with VLM syndrome the treatment needs to be repeated. An evaluation of treatment efficacy can be made by observing a rise in eosinophilia within a week followed by any improvement in clinical symptoms and signs, lower eosinophilia and serological tests taken over a period of at least 4 weeks. In addition to clinical rationales for the specific treatment of VLM and OLM, preventive treatment needs to be considered bearing in mind the increasing risk of larvae localizing in the brain during the course of an infection. To reduce migration of Toxocara larvae a single course of albendazole is suggested in cases where eosinophilia and serology are at least moderately positive.
- Type
- Research Article
- Information
- Copyright
- Copyright © Cambridge University Press 2001
References
Abo-Shehada, M. & Herbert, I.V. (1984) Anthelmintic effect of levamisole, ivermectin, albendazole and fendenbazole on larval Toxocara canis infection in mice. Research in Veterinary Science 36, 87–91.CrossRefGoogle ScholarPubMed
Aur, R.J.A., Pratt, C.B. & Johnson, W.W. (1971) Thiabendazole in visceral larva migrans. American Journal of Diseases of Children 121, 226–229.Google ScholarPubMed
Bass, J.L., Mehta, K.A., Glickman, L.T. & Eppes, B.M. (1983) Clinically inapparent Toxocara infection in children. New England Journal of Medicine 308, 723–724.Google ScholarPubMed
Bass, J.L., Mehta, K.A., Glickman, L.T., Blocker, R. & Eppes, B.M. (1987) Asymptomatic toxocariasis in children. Clinical Pediatrics 26, 441–446.CrossRefGoogle ScholarPubMed
Beaver, P.C., Snyder, C.H., Carrera, G.M., Dent, J.H. & Lafferty, J.W. (1952) Chronic eosinophilia due to visceral larva migrans. Report of three cases. Pediatrics 9, 7–19.CrossRefGoogle ScholarPubMed
Benenson, A.S. (Ed.) (1995) Control of communicable diseases manual. 466. pp. 16th edn. American Public Health Association, Washington DC.Google Scholar
Buijs, J., Egbers, M.W.E.C., Lokhorst, W.H., Savelkoul, H.F.J. & Nijkamp, F.P. (1995)
Toxocara-induced eosinophilic inflammation. American Journal of Respiratory and Critical Care Medicine 151, 873–878.CrossRefGoogle ScholarPubMed
Buijs, J., Borsboom, G., Renting, M., Hilgersom, W.H.H., Wieringen, J.C., van., Jansen, G. & Neijens, J. (1997) Relationship between allergic manifestations and Toxocara seropositivity: a cross-sectional study among elementary school children. European Respiratory Journal 10, 1467–1475.CrossRefGoogle ScholarPubMed
Cox, D.M. & Holland, C.V. (1998) The relationship between numbers of larvae recovered from the brain of Toxocara canis-infected mice and social behaviour and anxiety in the host. Parasitology 116, 579–594.CrossRefGoogle ScholarPubMed
Cuellar, C., Fenoy, S., Aguila, C. & Guillen, J.L. (1990) Evaluation of chemotherapy in experimental toxocarosis by determination of specific immune complexes. Journal of Parasitology 64, 279–289.Google ScholarPubMed
Dao, A.H. & Virmani, R. (1986) Visceral larva migrans involving the myocardium: Report of two cases and review of literature. Pediatric Pathology 6, 449–456.CrossRefGoogle ScholarPubMed
Delgado, O., Botto, C., Mattei, R. & Escalante, A. (1989) Effect of albendazole in experimental toxocariasis of mice. Annals of Tropical Medicine and Parasitology 83, 621–624.CrossRefGoogle ScholarPubMed
Dubinsky, P. (1999) New approaches to control larval toxocarosis. Helminthologia 36, 159–165.Google Scholar
Dunsmore, J.D., Thompson, R.C.A. & Bates, I.A. (1983) The accumulation of Toxocara canis larvae in the brains of mice. International Journal for Parasitology 13, 517–521.CrossRefGoogle ScholarPubMed
Feldman, G.J. & Parker, H.W. (1992) Visceral larva migrans associated with the hypereosinophilic syndrome and the onset of severe asthma. Annals of Internal Medicine 116, 838–840.CrossRefGoogle ScholarPubMed
Fok, E. & Rozgonyi, F. (1999) Epidemiology and public health consequences of human toxocariasis as a frequently occuring urban zoonosis. Orvosi Hetilap 140, 1513–1518.Google Scholar
Friedman, S. & Hervada, A.R. (1960) Severe myocarditis with recovery in a child with visceral larva migrans. Journal of Pediatrics 56, 91–96.10.1016/S0022-3476(60)80292-2CrossRefGoogle Scholar
Gillespie, S.H., Lewis, J.W. & Maizels, R.M. (1993) The clinical spectrum of human toxocariasis. pp. 55–61. in Lewis, J.W. & Maizels, R.M. (Eds) Toxocara and toxocariasis. London, Institute of Biology and the British Society for Parasitology.Google ScholarPubMed
Glickman, L.T. & Schantz, P.M. (1981) Epidemiology and pathogenesis of zoonotic toxocariasis. Epidemiologic Reviews 3, 230–250.CrossRefGoogle ScholarPubMed
Glickman, L.T., Magnaval, J.F., Domanski, L.M., Shofer, F.S., Lauria, S.S., Gottstein, B. & Brochier, B. (1987) Visceral larva migrans in French adults. American Journal of Epidemiology 125, 1019–1034.CrossRefGoogle ScholarPubMed
Helwigh, A.B., Lind, P. & Nansen, P. (1999) Visceral larva migrans: migratory pattern of Toxocara canis in pigs. International Journal for Parasitology 29, 559–565.CrossRefGoogle ScholarPubMed
Hill, I.R., Denham, D.A. & Scholtz, C.L. (1985)
Toxocara canis larvae in the brain of a British child. Transactions of the Royal Society of Tropical Medicine and Hygiene 79, 351–354.CrossRefGoogle ScholarPubMed
Hokibara, S., Takamoto, M., Isobe, M. & Sugane, K. (1998) Effects of monoclonal antibodies to adhesion molecules on eosinophilic myocarditis in Toxocara canis-infected CBA/J mice. Clinical and Experimental Immunology 114, 236–244.CrossRefGoogle ScholarPubMed
Hotez, P.J. (1993) Visceral and ocular larva migrans. Seminars in Neurology 13, 175–179.CrossRefGoogle ScholarPubMed
Jacquier, P., Gottstein, B., Singelin, Y. & Eckert, J. (1991) Immunodiagnosis of toxocarosis in humans. Evaluation of a new enzyme-linked immunosorbent assay kit. Journal of Clinical Microbiology 29, 1831–1835.CrossRefGoogle ScholarPubMed
Jones, R.E., Finkelman, F.D., Hester, R.B. & Kayes, S.G. (1994) Failure to find IgE receptors (FcR) on eosinophils from infected mice suggests that murine eosinophils do not kill helminth larvae by an IgE-dependent mechanism. Experimental Parasitology 78, 64–75.CrossRefGoogle Scholar
Kazura, J.W. & Mahmoud, A.A. (1997) Visceral larva migrans and other tissue nematodes. pp. 125–133. in Mahmoud, A.A. (Ed.) Parasitic lung diseases. New York, Marcel Dekker Inc.Google Scholar
Kayes, S.G. & Freedman, D.O. (1997) Human toxocariasis and the visceral larva migrans syndrome: correlative immunopathology. pp. 99–124. in Freedman, D.O. (Ed.) Immunopathogenic aspects of disease induced by helminth parasites. Chemical immunology. Basel, Karger.Google Scholar
Kendell, K.R., Day, J.D., Hruban, R.H., Olson, J.L., Rosenblum, W.D., Kasper, E.K., Baughman, K.L. & Hutchins, G.M. (1995) Intimate association of eosinophils to collagen bundles in eosinophilic myocarditis and ranitine-induced hypersensitivity myocarditis. Archives of Pathology and Laboratory Medicine 119, 1154–1160.Google ScholarPubMed
Kincekova, J., Reiterova, K. & Dubinsky, P. (1999) Larval toxocariasis and its clinical manifestation in childhood in the Slovak Republic. Journal of Helminthology 73, 323–328.CrossRefGoogle ScholarPubMed
Kraus, A., Valencia, X., Cabral, A.R. and de la, Vega, G. (1995) Visceral larva migrans mimicking rheumatic diseases. Journal of Rheumatology 22, 497–500.Google ScholarPubMed
Le Lauyer, B., Menager, V., Andebert, C., Le, Ropux, P., Briguet, M.T. & Boulloche, J. (1990) Inflamatory joint disease as a manifestation of Toxocara canis larva migrans. Annales de Pediatrie 37, 445–448.Google Scholar
Ŀużna-Lyskov, A. (2000) Toxocarosis in children living in a highly contaminated area. An epidemiological and clinical study. Acta Parasitologica 45, 40–42.Google Scholar
Ŀużna-Lyskov, A., Andrzejewska, I., Lesicka, U., Szewczyk-Kramska, B., Luty, T. & Pawlowski, Z. (2000) Clinical interpretation of eosinophilia and ELISA values (OD) in toxocarosis. Acta Parasitologica 45, 35–39.Google Scholar
Magnaval, J.F. (1987) Elements nouveaux dans la sémiologie des larva migrans viscérales. Presse Médicale 16, 151–154.Google Scholar
Magnaval, J.F. (1995) Comparative efficacy of diethylcarbamazine and mebendazole for the treatment of human toxocariasis. Parasitology 110, 529–533.CrossRefGoogle ScholarPubMed
Magnaval, J.F., Baixench, M.T., Lewis, J.W. & Maizels, R.M. (1993) Toxocariasis in the Midi-Pyrénées region. pp. 63–69. in Lewis, J.W. & Maizels, R.M. (Eds) Toxocara and toxocariasis. London, Institute of Biology and the British Society for Parasitology.Google Scholar
Magnaval, J.F., Charlet, J.P. and de, Larrard, B. (1992) Etude double aveugle de l'efficacité du mebendazole dans les formes mineures de la toxocarose humaine. Therapie 47, 145–148.Google Scholar
Magnaval, J.F., Fabre, R., Mauriéres, P., Charlet, J.P. and de, Larrard, B. (1992) Evaluation of an immunoenzymatic assay detecting specific anti-Toxocara immunoglobulin E for diagnosis and post-treatment follow-up of human toxocariasis. Journal of Clinical Microbiology 30, 2269–2274.CrossRefGoogle Scholar
Magnaval, J.F., Glickman, L.T. & Dorchies, P. (1994) La toxocarose, une zoonose helminthique majeure. Revue de Médecine Véterinaire 145, 611–627.Google Scholar
Magnaval, J.F., Galindo, V., Glickman, L.T. & Clanet, M. (1997) Human Toxocara infection of the central nervous system and neurological disorders: a case-control study. Parasitology 115, 537–543.CrossRefGoogle ScholarPubMed
Magnaval, J.F., Dorchies, P. & Morassin, B. (2000) Actualités de la toxocarose humaine. Pyrexie 4, 111–115.Google Scholar
Meeusen, E.N.T. & Balic, A. (2000) Do eosinophils have a role in the killing of helminth parasites?. Parasitology Today 16, 95–101.CrossRefGoogle ScholarPubMed
Mikulecky, M. & Mikulecky, M. (1994) A biometrical view on chemotherapy of toxocariasis. Acta Pediatrica 83, 1232.CrossRefGoogle ScholarPubMed
Obwaller, A., Auer, H., Jensen-Jarolim, E., Leitner, A., Kraft, D. & Aspoeck, H. (1996) Die diagnostische Bedeutung des Nachweises specifischer IgE- Antikoerper bei Toxocara-Infestationen. Mitteilungen der Oesterreichischen Gesellschaft für Tropenmedizin und Parasitologie 18, 201–206.Google Scholar
Obwaller, A., Jensen-Jarolim, E., Auer, H., Huber, A., Kraft, D. & Aspoeck, H. (1998)
Toxocara infestations in humans: symptomatic course of toxocarosis correlates significantly with levels of IgE/anti-IgE immune complexes. Parasite Immunology 20, 311–317.CrossRefGoogle ScholarPubMed
Petithory, J.C., Beddok, A. & Quedoc, M. (1994) Zoonoses d'origine ascaridienne: les syndromes de larva migrans visceral. Bulletin de l'Academie Nationale de Medicine 178, 635–647.Google Scholar
Phan, S.H. & Kunkel, S.L. (1992) Lung cytokine production in bleomycin-induced pulmonary fibrosis. Experimental Lung Research 18, 29–43.CrossRefGoogle ScholarPubMed
Skerrett, H. & Holland, C.V. (1997) Variations in the larval recovery of Toxocara canis from the murine brain: implications for behavioural studies. Journal of Helminthology 71, 253–255.CrossRefGoogle ScholarPubMed
Stürchler, D., Schubarth, P., Gualzata, M., Gottstein, B. & Oettli, A. (1989) Thiabendazole vs. albendazole in treatment of toxocariasis: a clinical trial. Annals of Tropical Medicine and Parasitology 83, 473–478.CrossRefGoogle ScholarPubMed
Taylor, M.R., Keane, C.T., O'Connor, P., Girdwood, A. & Smith, H. (1987) Clinical features of covert toxocariasis. Scandinavian Journal of Infectious Diseases 19, 693–696.CrossRefGoogle ScholarPubMed
Taylor, M.R.H., Keane, C.T., O'Connor, P., Mulvihill, E. & Holland, C. (1988) The expanded spectrum of toxocaral disease. Lancet 1, 692–694.CrossRefGoogle ScholarPubMed
Thompson, D.E., Bundy, D.A.P., Cooper, E.S. & Schantz, P.M. (1986) Epidemiological characteristics of Toxocara canis zoonotic infection of children in a Caribbean community. Bulletin of the World Health Organization 21, 283–290.Google Scholar
Vegh, M. & Danka, J. (1987) Das Krankheitsbild und die Behandlung der Toxocara-canis-Uveitis im Kindesalter. Klinische Monatsblatter für Augenheilkunde 191, 395–396.Google Scholar
Wade, S.E. & Georgi, J.R. (1987) Radiolabeling and autoradiographic tracing of Toxocara canis larvae in male mice. Journal of Parasitology 73, 116–120.CrossRefGoogle ScholarPubMed
Wiseman, R.A., Woodruff, A.W. & Pettitt, L.E. (1971) The treatment of toxocaral infection: some experimental and clinical observations. Transactions of the Royal Society of Tropical Medicine and Hygiene 65, 591–598.CrossRefGoogle ScholarPubMed
Wolfrom, E., Chene, G., Boisseau, H., Beylot, C., Geniaux, M. & Taieb, A. (1995) Chronic urticaria and Toxocara canis
. Lancet i(345), 196.CrossRefGoogle Scholar
World Health Organization (1995) WHO model prescribing information. Drugs used in parasitic diseases. 2nd edn. Geneva, WHO.Google Scholar
Żdotarnowska, H., Basiak, W. & Dziubek, Z. (1995) Specific and total serum IgE in ocular and visceral forms of human toxocarosis. Acta Parasitologica 40, 62–65.Google Scholar