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.

A case report of ocular toxocariasis

Ocular toxocariasis is prevalent among children.The symptoms and signs may mimic other ocular pathologies such as malignancies and other infectious diseases(such as toxoplasmosis and syphilis). We presented a case of progressive blurring of vision in a single eye of a 9-year-old boy.The presence of anti-toxocara antibody in serum samples helps to confirmation the diagnosis in our patient.Despite of treatment,the boy had lost his vision on the affected eye.

Disseminated toxocariasis in an immunocompetent host

Toxocariasis is a zoonotic infection caused by Toxocara canis,or less commonly,Toxocara cati,which is one of the most common zoonotic infections worldwide.It commonly affects the pediatric and immunocompromised population;however,it has rarely been reported in the immunocompetent adults.Two of the well-recognized syndromes in children are visceral larva migrans and ocular larva migrans.Infection in adults usually ranges from asymptomatic to nonspecific symptoms which makes the diagnosis challenging.A case of 36 year-old male was presented with disseminated toxocariasis with pulmonary and hepatic involvement and striking peripheral eosinophilia.

Human Toxocariasis Presenting with Fever and Colestatic Hepatitis: An Underestimated but Current Zoonosis

Human toxocariasis is a widespread parasitic disease caused by ingestion of Toxocara canis or catis larvae or eggs. Parasitic diseases are uncommon in industrialized countries, yet this problem has not disappeared. Parasitic diseases can cause different syndrome (visceral larva migrans, ocular larva migrans) and the clinical features can be confusing. Severe organ involvement affecting the liver, lungs, nervous central system and eyes can lead to serious damage. We present a case of toxocariasis presenting with fever, desaturation and cholestatic hepatitis. Only the subsequent appearance of eosinophilia helped us to arrive at the correct diagnosis. Prompt diagnosis allowed specific therapy avoiding permanent complications.

Toxocariasis:a silent threat with a progressive public health impact

Background:Toxocariasis is a neglected parasitic zoonosis that afflicts millions of the pediatric and adolescent populations worldwide,especially in impoverished communities.This disease is caused by infection with the larvae of Toxocara canis and T.cati,the most ubiquitous intestinal nematode parasite in dogs and cats,respectively.In this article,recent advances in the epidemiology,clinical presentation,diagnosis and pharmacotherapies that have been used in the treatment of toxocariasis are reviewed.Main text:Over the past two decades,we have come far in our understanding of the biology and epidemiology of toxocariasis.However,lack of laboratory infrastructure in some countries,lack of uniform case definitions and limited surveillance infrastructure are some of the challenges that hindered the estimation of global disease burden.Toxocariasis encompasses four clinical forms:visceral,ocular,covert and neural.Incorrect or misdiagnosis of any of these disabling conditions can result in severe health consequences and considerable medical care spending.Fortunately,multiple diagnostic modalities are available,which if effectively used together with the administration of appropriate pharmacologic therapies,can minimize any unnecessary patient morbidity.Conclusions:Although progress has been made in the management of toxocariasis patients,there remains much work to be done.Implementation of new technologies and better understanding of the pathogenesis of toxocariasis can identify new diagnostic biomarkers,which may help in increasing diagnostic accuracy.Also,further clinical research breakthroughs are needed to develop better ways to effectively control and prevent this serious disease.

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.

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.

Anti-Toxocara spp.antibodies in an adult healthy population:serosurvey and risk factors in Southeast Brazil

Objective:To evaluate the frequency of anti-Toxocara spp.antibodies in an adult healthy population.Methods:The study was performed by interviewing 253 blood donors,from 19 to65 years of age,in a hematological centre in Presidente Prudente,S(?)o Paulo,southeast Brazil.A survey was applied to blood donors in order to evaluate the possible factors associated to the presence of antibodies,including individual(gender and age),socioeconomic(scholarship,familial income and sanitary facilities)and habit information(contact with soil,geophagy,onycophagy and intake of raw/undercooked meat)as well as the presence of dogs or cats in the household.ELISA test was run for detection of the anti-Toxocara spp.IgG antibodies.Bivariate analysis followed by logistic regression was performed to evaluate the potential risk factors associated to seropositivity.Results:The overall prevalence observed in this study was 8.7%(22/253).Contact with soil was the unique risk factor associated with the presence of antibodies(P=0.0178;0R=3.52;95%CI=1.244-9.995).Conclusions:The results of this study reinforce the necessity in promoting preventive public health measures,even for healthy adult individual,particularly those related to the deworming of pets to avoid the soil contamination,and hygiene education of the population.

Clinical characteristics and progression of liver abscess caused by toxocara

AIM: To evaluate the clinical characteristics and progression of liver abscess caused by toxocara.METHODS: We retrospectively reviewed the medical records of patients with serum Ig G antibody to Toxocara canis and liver abscess diagnosed using abdominal computed tomography between February 2010 and February 2015. Among 84 patients exhibiting serum Ig G antibody to Toxocara canis, 34 patients were diagnosed with liver asbscess and treated with albendazole. A follow-up period of 1 year was conducted. RESULTS: Mean patient age was 53(34-79) years, with 26(76.5%) patients being male. Twenty-one(61.7%) patients were moderate or heavy drinkers, 23(67.6%) patients had a history of eating raw meat or liver and 6(17.6%) patients owned pet dogs or cats. Main patient symptoms consisted of right upper quadrant pain, fever, and fatigue; 18(52.9%) patients, however, presented with no symptoms. Lung involvement was detected in 444(11.7%) patients. The eosinophil count increased in 29(85.3%) patients at initial diagnosis, and decreased in most patients after albendazole treatment. The initial serum Ig E level increased in 25(73.5%) patients, but exhibited various response levels after albendazole treatment. Liver abscess formation improved in all patients.CONCLUSION: The liver abscess was improved with albendazole treatment.