Pakistan Journal of Medical Sciences

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CASE REPORT

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Volume 23

October - December 2007 (Part-I)

Number  5


 

Abstract
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Human toxocariasis:
A report of 3 cases

A.H. Talaizadeh1, S. Maraghi2, A. Jelowdar3, M. Peyvasteh4

ABSTRACT

Toxocariasis is a worldwide helminthic zoonosis due to the infection of human by larvae of Toxocara canis or Toxocara cati. In this study, three cases of human visceral larva migrans are reported. The first case was a 5 year old male referred to hospital with the symptoms of abdominal pain, loosing appetite, tenderness, cashexia, fever and 9.5gr/dl haemoglobin. Abdominal sonography revealed an echohetrogeny 492054mm in. RUQ and indicated an abscess of fecalis mass. Laparatomy was carried out and 26cm of large intestine including secum, attached small intestine and appendix (5cm) in length and ilocecal lymph node measured 2.51.50.7cm were removed. Histopathological indicated toxocariasis. The second patient was a two years old girl admitted with symptoms of abdominal pain, tenderness, loosing appetite and loosing weight for two months. The patient was anemic and hypereosinophilic (46%). Physical examination indicated a solid mass in RUQ. Abdominal sonography revealed a solid hypoechoic mass with margin measured 884463mm. The solid mass was removed after laparatomy. Histopathological examination verified the serological test against toxocara toward toxocariasis. The third case was a 46 year old female admitted with the symptoms of abdominal pain in RUQ, right tenderness, leukocytosis and eosinophilia (10%). The clinical diagnosis was appendicitis. Appendectomy was carried out. The appendix was inflamed and around the colon was highly inflamed as well. Serological test on serum sample of the patient against toxocariasis was positive.

KEY WORDS: Toxocariasis, Human, Dog, Cat.

Pak J Med Sci    October - December 2007 (Part-I)    Vol. 23 No. 5    782-784


1. A.H. Talaizadeh
2. M. Peyvasteh

1-2: Department of Surgery,
Imam Khomeini Hospital,
Jundi-Shapour University of Medical Sciences,
Ahwaz Iran.
3. S. Maraghi
4. A. Jelowdar

3-4: Department of Mycoparasitology,
School of Medicine,
Jondi-Shapour University of Medical Sciences,
Ahwaz Iran.

Correspondence

Prof. S. Maraghi
E-mail: maraghis@gmail.com

* Received for Publication: March 6, 2007
* Accepted: July 3, 2007


INTRODUCTION

Toxocariasis (Visceral larva migrans) is prevalent in tropical and developing countries and is generally associated with socioeconomic level1,2 and caused by larvae of the parasitic round worms, Toxocara canis (Dog round worm) or Toxocara cati (Cat round worm), two nematode parasites of animals. The life cycle of these parasites is accomplished in dog and cat respectively. Humans acquire infection as accidental hosts. Toxocariasis occurs mainly in young children, who acquire Toxocara eggs through contact with soil contaminated by the faeces of dogs and cats that carry the parasite. Children frequently transfer the eggs from their hands to their mouth and may eat the contaminated soil.3,4 Occasionally, adults who eat clay become infected. After the eggs are swallowed, larvae hatch in the intestine wall and are spread through the blood stream. This is termed visceral larva migrans or toxocariasis. The larvae can enter the liver, the lung, brain or eye.5-7 Eventually they die and become walled off in microscopic cysts and calcify, but not before causing tissue damage. In the eye, toxocariasis may be mistaken for retinoblastoma, cancer of the eye, leading to removal of an eye. Toxocariasis may suspect the persons who have enlarged liver,8 inflammation of the lungs, fever, cough, wheezing,9 seizures, rashes, lymph node enlargement,10 and visual symptoms including decreased vision11,12 and high level of eosinophils13,14 In this study three cases of human toxocariasis are reported.

Patient-1: A five year old male was referred to Imam Khomeini Hospital in 2004 with the abdominal pain, loosing appetite, tenderness, cashexy and fever. The patient was pale (Haemoglobin was 9.5gr/dl). Abdominal sonography revealed an echohetrogeny 492054mm was in RUQ and indicated an abscess of fecalis mass. After consultation, the patient was put under general anesthetic and laparatomy was carried out, 26cm of large intestine including secum, attached small intestine (Low) and appendix (5cm) in length and ilocecal lymph node measured 2.51.50.7cm were collected and sent for histopathologic examination. The report of pathology indicated toxocariasis.

Patient-2: A two year old girl was admitted to Imam Khomeini Hospital with symptoms of abdominal pain, tenderness, loosing appetite, loosing weight for two months. The patient was pale and abdominal physical examination indicated a solid mass in RUQ. Abdominal sonography revealed a solid hypoechoic mass with margin measured 884463mm. The laboratory findings are shown in table one.

The patient was put under general anesthesia and laparatomy was carried out. The solid mass was removed and sent for histopathological examination. No malignancy was indicated and toxocariasis was verified. Serological test against toxocara IgG was positive. The patient was prescribed Prednisolen and diethylcarbamazine. The patient is well and is being followed uptil now.

Patient-3: A 46 year old female was admitted to Imam Khomeini Hospital with abdominal pain in RUQ, right tenderness, leukocytosis and eosinophilia (10%). The clinical diagnosis was appendicitis. Appendectomy was performed the appendix was inflamed and around the colon was highly inflamated as well. Samples were collected from the inflamed sites and histopathological examination indicated inflamed epidiopoli appendicitis with eosinophilic infiltration which is seen mostly in parasitic infection such as toxocariasis. Serological test on serum sample of the patient against toxocariasis was positive.

DISCUSSION

Human toxocariasis is still a poorly diagnosed disease specially in places with conditions which favours its development and it is largely unknown either to health professionals or the general population. Serological testes are of considerable importance in the detection of infection by T.canis as from clinical symptoms of toxocariasis are of limited value in the differential diagnosis.15 The medical professions is only starting to recognize visceral larva migrans as a relatively frequent syndrome in children and adults. Population surveys in many countries amongst healthy people have definitely shown that subclinical toxocariasis is common.16,17

In this study three cases of toxocariasis were referred to hospital with abdominal pain and loosing appetite. Two patient were eosinophilic and diagnosis of toxocariasis was made according to the pathology and serological examination and sonography. As the age of patients varied from 2 to 46 years. Eosinophilia could be a suitable indication for following the patients and leading to correct diagnosis.

ACKNOWLEDGEMENT

We would like to express our thanks to the staff of surgery department and operation room at of Imam Khomeini Hospital for their critical help and cooperation.

REFERENCES

1. Thompson DE, Dap B, Cooper ES, Schantz PM. Epidemiological characteristics of Toxocara canis zoonotic infection of children in a Caribbean community. Bull WHO 1986;64(2):283-90.

2. Glickman LT, Magnaval JF. Zoonotic roundworm infections. Infect Dis Clin North America 1993;7:717.

3. Coelho LMPS, Silva MV, Dini CY, Neto AEG. Human Toxocariasis: A Seroepidemiological Survey in School children of Sorocaba, Brazil. Neil F Novo, Edilene PR Silveira, Mem Inst Oswaldo Cruz, Rio de Janeiro 2004;99(6):533-57.

4. Wolfe A, Wright IP. Human toxocariasis and direct contact with dogs. Veternary Record 2003;152:419-22.

5. Dickson D. Toxocariasis: Clinical Aspects, Epidemiology, Medical Ecology, and Molecular Aspects. Clinical Microbiology Reviews 2003;16(2):265-72.

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7. Vidal JE, Sztajnbok J, Seguro AC. Eosinophilic meningoencephalitis due to Toxocara canis: case report and review of the literature. Am J Trop Med Hyg 2003;69(3):341-3.

8. Hartleb M, Januszewski K. Severe hepatic involvement in visceral larva migrans. Eur J Gastroenterol Hepatol 2001;13(10):1245-9.

9. Kuziemski K, Jassem E, Mierzejewska E, Goljan J, Slominski JM. Lung manifestation of visceral larva migration syndrome due to Toxocara canis infection. Pneumonol Alergol Pol 1999;67(11-12):554-7.

10. Szczepanski T, Sonta-Jakimczyk D, Janik-Moszant A, Olejnik I. Generalized lymphadenopathy as initial presentation of toxocariasis in a seven-year-old boy. Pediatr Infec Dis J 1996;15(8):117-8.

11. Sharghi N, Schantz PM, Hotez PJ. Toxocariasis: an occult cause of childhood asthma, seizures and neuropsychological deficit? Semin Pediatr Infect Dis 2001;32:E111-E116.

12. Lopez-Velez R, Suarez de Figueroa M, Gimeno L, Garcia-Camacho A, Fenoy S, Guillen JL, et al. Ocular toxocariasis or retinoblastoma? Enferm Infecc Microbiol Clin 1995;13(4):242-5.

13. Arango CA. Visceral larva migrans and the hypereosinophilia syndrome. Saudi Med J 1998;91:882-3.

14. Rayes AA, Lambertucci JR. Human toxocariasis as a possible cause of eosinophilic arthritis. Rheumatology 2001;40:109-10.

15. Luo ZJ, Wang GX, Yang CI, Luo CH, Cheng SW, Liao L. Detection of circulating antigens and antibodies in Toxocara canis infection among children in Chengdu, China. J Parasitol 1999;85(2):252-6.

16. Sadjjadi SM, Khosravi M, Mehrabani D, Orya A. Seroprevalence of toxocara infection in school children in Shiraz, Southern Iran. J Trop Pediatr 2000;46(6):327-30.

17. Alderete JMS, Jacob CMA, Pastorino AC, Elefant GR, Castro APM, Fomin ABF, et al. Prevalence of Toxocara Infection in Schoolchildren from the Butanta Region, Sao Paulo, Brazil. Mem Inst Oswaldo Cruz, Rio de Janeiro 2003;98(5):593-7.


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