Clinical characteristics of ocular toxocariasis in adults in north China

AIM: To investigate the clinical features of adult patients with ocular toxocariasis(OT) in north China and to diagnose adults OT patients in early stage.METHODS: Clinical data of 24 adults with OT were retrospectively analyzed.Slit lamp photographs and fundus photographs and other imaging examinations of all the patients were reviewed.A questionnaire concerning the pet ownership and place of residence was completed to investigate the possible infection origin.Descriptive statistical analyses were performed on the demographic data, clinical features, funduscopic findings and ELISA results.RESULTS: Among the 24 patients diagnosed with OT by Toxocara IgG antibody in intraocular fluid, 16(66.7%) eyes were right eye.The onset age of 12 eyes(50.0%) was between 30 and 40 years old, and 21(87.5%) eyes were of peripheral granuloma type.The most common sign was vitreous opacity.Granulomas were detected in all the eyes, and 20(83.3%) patients resided in rural area.In 4 patients, the concentration of anti-Toxocara antibody both in anterior humor and in vitreous humor were detected, and the results showed the concentration in vitreous humor was much higher than aqueous humor.CONCLUSION: Our study analyzes the clinical manifestation of OT in adults, which may have been underrecognized before.Eye side, residence, and detection of granuloma may help us in diagnosis of OT in patients with monocular vitreous opacity.For adult patients with presumed OT, negative results of anti-Toxocara antibody in anterior humor cannot rule out the possibility of OT, further detection of vitreous humor is suggested for final diagnosis.

Toxocara optic neuropathy: clinical features and ocular findings

We evaluated thirteen eyes of twelve patients diagnosed clinically and serologically with Toxocara optic neuropathy. Eleven patients had unilateral involvement and one patient had bilateral optic neuropathy. Eight patients （66.7%） had a possible infection source to Toxocara. Six patients （50%） had painless acute optic neuropathy. Ten eyes had asymmetric, sectorial optic disc edema with peripapillary infiltration and three eyes had diffuse optic disc edema. Eosinophilia was noted in five patients （41.7%） and optic nerve enhancement was observed in eight of eleven eyes （72.7%） with available orbit magnetic resonance imaging （MRI）. Mean visual acuity significantly improved following treatment [mean logarithmic of the minimum angle of resolution （IogMAR） 0.94±0.56 at baseline and 0.47±0.59 at the final （P=0.02）]. Asymmetric optic disc edema with a peripapillary lesion and a history of raw meat ingestion were important clues for diagnosing Toxocara optic neuropathy. Additionally, Toxocara IgG enzymelinked immunosorbent assay （ELISA） test and evaluating eosinophil may be helpful for diagnosis.

Two case reports of toxocariasis mimicking endophthalmitis in immunosuppresed adults

This a case of 2 immunocompromised patients with a surprising ocular toxocariasis infestation.The first is a 23-year-old girl who is a known case of systemic lupus erythematosus,presenting with both eyes progressive blurring of vision for the past 3 months.Examinations showed bilateral panuveitis with posterior pole granuloma.She was treated as endogenous endophthalmitis as per protocol,but with limited improvement.To our surprise and with high index of clinical suspicion,Toxocara serology was positive.She was then started on oral albendazole for 4 weeks.The second case is a 51-year-old lady with end stage renal failure undergoing regular dialysis and on immunosuppressive therapy.She was warded for long duration for sepsis secondary to candidal fungal infection.Examinations revealed right peripheral and posterior pole granulomas almost exactly similar to the first patient.She was treated for endogenous endophthalmitis and again in close succession a positive serology was confirmed.Both cases since then showed gradual clinical improvement.