Larva migrans visceral. Presentación de un caso / Visceral larva migrans. Report of a case

RESUMEN La larva migrans visceral es una enfermedad que se produce al ingerir huevos infectantes de nematodos parásitos de gatos y perros (Toxocaracanis y Toxocaracati); los cuales eclosionan en el intestino del hombre y las larvas se distribuyen en todo el organismo, principalmente hígado, pulmón, corazón y cerebro. Las larvas en su migración dejan trazos de hemorragias, necrosis y células inflamatorias; algunas son destruidas por la respuesta inmune del huésped y otras forman granulomas eosinofílicos. Los síntomas dependen del tejido u órgano afectado, de la intensidad de la infección y del grado de la respuesta inmunológica inducida. Se presenta un caso del sexo masculino de 72 años que ingresa en el Servicio de Medicina del Hospital Militar Docente “Dr. Mario Muñoz Monroy”, de Matanzas, por cuadro de fiebre, diarreas, tos seca, astenia, anorexia y pérdida de peso al que se le diagnosticó larva migrans visceral. Por lo atípico de la edad del paciente y la complejidad del diagnóstico decidimos presentar este caso (AU).

ABSTRACT Visceral larva migrans is a disease produced after the ingestion of infectant eggs of cat´s and dog´s nematode parasites (Toxocara canis and Toxocara cati). These parasites harch in the men´s intestines and the larvas are distributed around the organism, mainly in the following organs: liver, lungs, hearth and brain. In their migration, the larvas leave traces of hemorrhage, necrosis and inflammatory cells; several of them are destroyed by the host´s immune answer and others form eosinophilic granulomas. The symptoms depend on the affected tissue or organ, on the infection intensity and on the level of induced immunologic answer. The case of a male patient, aged 72 years-old is presented. He entered the Medicine Service of the Teaching Military Hospital “Dr. Mario Muñoz Monroy”, of Matanzas with fever, diarrhea, dry cought, asthenia, anorexia and weight loss.Visceral larva migrans was diagnosed. The presentation of the case was decided because of the atypical patient´s age and the complexity of the diagnosis (AU).

Toxocaríase visceral / Visceral toxocariasis

Larva migrans visceral é uma infecção universal que ocorre mais frequentemente em crianças menores de 10 anos de idade, caracterizada por febre, hepatomegalia, doença pulmonar e eosinofilia. O agente é o ascaris intestinal de cães e gatos. O benefício das drogas anti-helmínticas não está definido. O tratamento com tiabendazol, albendazol ou mebendazol está indicado nas complicações da doença. A transmissão da infecção pode ser prevenida estimulando as crianças a lavarem suas mãos após brincarem em áreas onde há cães

[The association between human toxocariasis and pyogenic abscesses]. / A associação entre a toxocaríase humana e os abscessos piogênicos.

The association between hepatic abscesses and schistosomiasis mansoni was confirmed by clinical and experimental studies. Other parasites may cause systemic immunologic changes and local structural alterations in the affected organs that can facilitate the seeding of these areas by bacteria. Tropical pyomyositis, pyogenic liver and renal abscesses are frequent diseases in tropical areas. The visceral larva migrans syndrome is caused by the presence, in the human body, of larvae of worms that have other animals as their definitive host, most commonly being caused by Toxocara canis. The larvae migrate to various body organs leading to many inflammatory reactions in the form of granuloma and tissue necrosis. In this review we discuss the possible host-parasite-bacteria interactions that would favour the formation of abscesses in the organs involved by the larva of T. canis and present preliminary results of a clinical and experimental study undertaken during the last four years to define the role of this parasite in the pathogenesis of the abscesses.

Larva migrante visceral (toxocariasis humana) causa de hipereosinofilia y granulomas viscerales en el adulto / Visceral larva migrans (human toxocariasis) cause of hypereosinophilia and visceral granulomas in the adults

A 24-year -old woman 2-3 months after a normal parturation presented geophagy. Due to hypermenorrhea she consulted a gynecologist and in a hemogram a 57 percent (6, 893 x mm3) hypereosinophilia was detected. A chest TAC showed bilateral pulmonary nodules. The following tests resulted positive: ELISA IgG for toxocariasis 1: 1000, isohemagglutinins anti A 1:2048 and anti B 1:512. The patient was treated with albendazole and prednisone during 10 days. One month after treatment eosinophilia decreased to 2.590 x mm3 and ELISA IgG for toxocariasis descended to 1:128. Different aspect of human toxocariasis are commented. When hypereosinophia is observed in adult patients, toxocariasis must be checked

Toxocariasis: a propósito de un caso; revisión de la literatura / Toxocariasis: apropos of a case; review of the literature

La toxocariasis humana es una enfermedad producida por la infestación de huésped por larvas de Toxocara canis. Las formas clínicas son variadas y dependen del órgano afectado. Se han descrito la forma de larva migrans visceral, toxocariasis ocular, toxocariasis oculta y una forma asintomática. El diagnóstico se basa en las pruebas serológicas, siendo el Elisa la más confiable. El tratamiento es controversial y se indica dependiendo de la severidad del cuadro ya que no existe una droga totalmente efectiva. El objetivo es presentar la evolución de un caso clínico de larva migrans visceral durante un año quien mantiene eosinofilia persistente con exacerbaciones clínicas a pesar del tratamiento con albendazol, probablemente causadas por reinfección ya que se mantiene en el mismo medio ambiente. Se enfatizan las medidas de prevención para evitar la infección y reinfección

Larva migrans visceral. Primer reporte en el Perú / Visceral larva migrans in Peru. Report of the first three cases

El presente trabajo tiene como propósito presentar 3 casos clínicos pediátricos, diagnosticados de toxocariasis, vistos en Lima-Perú, entre los años 1987 y 1989. Los tres pacientes son menores de 5 años de edad, con antecedentes de comer tierra, que presentaron leucocitosis leve o severa con hipereosinofilia (1500 eosinofilos por mm3). el primer paciente tuvo además hipergammaglobulinemia y gran compromiso del estado general, requiriendo el uso de tiabendazol. El segundo paciente presentó dolor abdominal crónico y la biopsia hepática reveló granulomas con abundantes eosinófilos. el tercer paciente tuvo dolor articular crónico de rodilla derecha con sinovitis en los dedos de la manos y pies. Los tres pacientes tuvieron títulos en sangre para toxocariasis en la prueba de ELISA a 1/4096, (CDC de Atlanta). Se trata del primer reporte clínico de larva migrans visceral en el Perú.

Toxocariasis--an unlikely cause of Palm Island mystery disease.

After the suggestion was made that the "Palm Island mystery disease" might have been an epidemic of visceral larva migrans that was caused by the flying fox parasite, Toxocara pteropodis, work was undertaken to elucidate this nematode's life-cycle and pathogenicity. Studies of infections in various laboratory animals have shown unexpectedly variable susceptibility patterns, with mice harbouring most larvae for the longest time period. However, in all susceptible animals (which include mice, guinea-pigs and suckling rats), the larvae demonstrated marked hepatotropism. Experimental infections in monkeys demonstrated that primates are susceptible to this infection, but large doses of 20,000 infective eggs produced blood eosinophilia and focal granulomatous hepatitis without clinical disease or biochemical abnormalities in the blood. It is concluded that humans are susceptible to larval infections with this nematode, but that clinical manifestations would be unlikely to develop.

[Viscera larva migrans syndrome in children: description of a case]. / Sindrome da "visceral larva migrans' in età pediatrica: descrizione di un caso.

The AA describe a case of Larva Migrans Visceral syndrome in a two year-old boy in systemic form with negative outcome. The autoptic examination showed a "granulomatous hepatitis with marked component of eosinophil cells'. The presence of "eosinophil granuloma' in liver has led to the diagnosis of Visceral Larva Migrans Syndrome; other possible causes of Ipereosinophilous Syndrome have been excluded on the basis of anamnestic, clinic and laboratory data. The discovery in the medical history of frequent contacts with a dog which was affected by a serious toxocara canis infections, has led to the diagnosis of Larva Migrans Syndrome from Toxocara canis.

Visceral larva migrans-like syndrome caused by Angiostrongylus costaricensis.

In two cases of ectopic localization of Angiostrongylus costaricensis adult worms and eggs were seen in the liver, causing a granulomatous inflammatory reaction with dense eosinophilic infiltration and necrosis. In the first case, although antibodies for A. costaricensis had been demonstrated, a clinical diagnosis of visceral larva migrans was recorded; however, further examination of a liver biopsy revealed eggs of A. costaricensis. In the second case, severity of the intestinal pathology masked the presence of lesions and an adult A. costaricensis that were discovered in a retrospective study of the liver 13 years later. A close similarity between the visceral larva migrans syndrome and ectopic localization (liver) of A. costaricensis is established.

Visceral larva migrans caused by Trichuris vulpis.

Two brothers with visceral larva migrans caused by Trichuris vulpis were diagnosed after they had been investigated for an eosinophilia. Both patients were almost asymptomatic. The diagnosis of visceral larva migrans was based on the results of immunoelectrophoretic studies and no liver biopsy was performed. After administration of thiabendazole, the number of eosinophils and serum total IgE levels gradually decreased, and the patients have remained well.