Caracterización clínico-epidemiológica de la toxocariasis ocular

Objetivo: Caracterizar clínica y epidemiológicamente la toxocariasis ocular. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal con pacientes diagnosticados de toxocariasis ocular, atendidos en el Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período de abril de 2019 a diciembre de 2022. Resultados: Predominó el sexo masculino (53,7 %) y el grupo etario de 0 a 10 años (73,1 %). El 56,1 % de los pacientes vivían en área rural. La convivencia con animales domésticos representó el 75,6 %. El síntoma más referido fue la disminución de la agudeza visual (48,8 %). La forma de presentación más frecuente fue el granuloma periférico de forma unilateral en ojo derecho (52,4 %). La complicación más observada fue el desprendimiento de retina (58,5 %). Conclusiones: La infección ocular por Toxocara spp. es una enfermedad prevenible e incapacitante que limita el desenvolvimiento educacional, laboral y de la vida en general de los pacientes afectados, particularmente la población infantil, el sexo masculino y los que residen en área rural en convivencia con animales domésticos, en especial perros.

Objective: To characterize ocular toxocariasis clinically and epidemiologically. Methods: An observational, descriptive and cross-sectional study was conducted with patients diagnosed with ocular toxocariasis, attended at the Instituto Cubano de Oftalmología Ramón Pando Ferrer in the period from April 2019 to December 2022. Results: The male sex predominated (53.7 %), together with the age group 0-10 years (73.1 %). 56.1 % of the patients lived in rural areas. Cohabitation with domestic animals accounted for 75.6 %. The most frequently reported symptom was decreased visual acuity (48.8 %). The most frequent form of presentation was peripheral granuloma in the right eye (52.4 %). The most observed complication was retinal detachment (58.5 %). Conclusions: Ocular infection by Toxocara spp. is a preventable, as well as incapacitating, disease that limits the educational, occupational and general life development of affected patients, particularly children, males and those living in rural areas cohabitating with domestic animals, especially dogs.

Clinical characteristics and treatment prognosis of ocular toxocariasis / 中华眼底病杂志

Objective:To observe the clinical characteristics and treatment prognosis of patients with ocular toxocariasis (OT).Methods:A retrospective clinical trial. From March 2018 to September 2021, 40 eyes of 40 OT patients diagnosed by ophthalmic examination in the First Affiliated Hospital of Zhengzhou University were included in the study. All patients underwent best corrected visual acuity (BCVA) and scanning laser ophthalmoscope (SLO) examination. Color Doppler ultrasound flow imaging (CDFI), fluorescein fundus angiography (FFA) and optical coherence tomography (OCT) were performed in 25, 26 and 26 eyes, respectively. Among the 40 patients, there were 23 males (57.5%, 23/40) and 17 females (42.5%, 17/40). All patients were monocular. Thirty patients (75.0%, 30/40) were younger than 18 years old, with the mean age of (9.60±0.60) years. Ten patients (25.0%, 10/40) were great than or equal to 18 years old, with the mean age of (34.60±4.52) years. Thirty-three patients (82.5%, 33/40) lived in rural areas for a long time. There were 27 patients (67.5%, 27/40) with a history of contact with dogs and cats. In 40 eyes, peripheral granuloma (peripheral type), posterior pole granuloma (posterior pole type), vitreous opacity similar to endophthalmitis (turbid type) and hybrid type were 18(45.0%, 18/40), 11(27.5%, 11/40), 6(15.0%, 6/40) ang 5(12.5%,5/40), respectively. All patients were treated with drugs and/or surgery after definite diagnosis. There were 28 eyes of peripheral type, posterior pole type and hybrid type, 17 eyes were treated with surgery and 11 eyes with drug treatment, respectively. Five eyes with turbid type were only treated with drugs. In 40 patients, 33 patients participated in follow-up. The follow-up time after treatment was (18.78±9.44) months. The improvement of BCVA was observed. The number of eyes with different BCVA before and after treatment was compared by χ2 test or Fisher's test. Results:At the first visit, the BCVA ranged from light perception to 0.6, including 20 eyes with BCVA <0.1, 13 eyes with BCVA 0.1-0.3, and 7 eyes with BCVA >0.3. The posterior vitreous anterior limiting membrane was thickened in 24 eyes (60.0%, 24/40). There were 27 eyes (67.5%, 27/40) with lamellar vitreous opacity and 22 eyes (55.0%, 22/40) with peripheral/posterior pole granulomas. Among 25 eyes examined by CDFI, 14 eyes (56.0%, 14/25) showed characteristic stratified or diffuse opacity in vitreous body. Of the 26 eyes examined by FFA, 15 eyes (57.7%, 15/26) had "fern-like" leakage of retinal capillaries, and the lesion had a patchy non-perfused area. In 26 eyes examined by OCT, epiretinal membrane, cystoid macular edema and vitreoretinal traction were 8 (30.8%, 8/26), 5 (19.2%, 5/26) and 2 (7.7%, 2/26) eyes, respectively. At the last follow-up, compared with before treatment, the BCVA of 5 eyes with turbid type increased, and the difference was statistically significant ( P<0.05). In 28 eyes with peripheral type, posterior pole type and hybrid type, 17 eyes with surgical treatment improved BCVA, and the difference was statistically significant ( χ2=6.258, P<0.05). In 11 eyes only treated with drugs, BCVA remained unchanged, and the difference was not statistically significant ( χ2=0.594, P>0.05). Conclusions:OT patients are mostly children; retinal granulomas, gray-white hyperplastic membrane behind lens or vitreous stratified opacity are specific characteristics. OT is mainly treated by glucocorticoid drugs and vitrectomy.

Toxocara canis 30-35 kDa excretory-secretory antigen is an important marker in mice challenged by inocula containing different parasite load levels

ABSTRACT The Western-blotting technique was applied to identify antigenic fractions of excretory-secretory Toxocara canis antigen recognized by IgG antibodies throughout an experimental infection in mice challenged by different inocula. Mice were inoculated with 5, 50 and 500 embryonated eggs and serum samples were collected 15, 30, 60, 90 and 120 days post-infection. Serum samples were analyzed using an excretory-secretory Toxocara antigen. Antibodies recognized antigenic fractions from 30 to 90 kDa. The protein fraction of 30-35 kDa was the most frequently recognized regardless of the size of inoculum and the stage of infection represented by the different collection times, but the antigenic recognition was more evident in groups infected with 50 and 500 eggs. This study presents an antigenic panel of the excretory-secretory antigen of T. canis and suggests that the 30-35 kDa antigenic fraction is a promising marker of the infection and should be further explored in future studies on experimental toxocariasis.

Progress in diagnosis and treatment of ocular toxocariasis / 国际眼科杂志(Guoji Yanke Zazhi)

@#Ocular toxocariasis(OT)is an ocular parasitic disease involving ocular tissue infection by the ascarid-omatidae nematode. OT is usually caused by toxocara canis or toxocara cati. Susceptible population are more likely to be affected by their own hygiene, the frequency of exposure to dogs and cats, and the consumption of food or water contaminated with toxocariasis larvae. Most cases have been reported worldwide in children, but cases in adults have also been reported in recent years, which may be due to the lack of systematic induction and summary of its diagnosis, treatment and prognosis. In this paper, the four clinical manifestations of OT, advanced noninvasive diagnostic techniques, and laboratory immunological tests were sorted out and supplemented by reviewing domestic and international literature. Meanwhile, this paper introduced the treatment progress of OT in recent years, such as the combination of anthelmintic and hormone, and the application of intravitreal injection and vitreous surgery. It is expected that clinicians should pay more attention to this disease, improve the accuracy of early diagnosis of toxocariasis and protect patients' vision.

Clinical observation of dexamethasone sustained release intraocular implantation combined with vitrectomy in pediatric ocular toxocariasis / 中华眼底病杂志

Objective:To observe the efficacy of parsplana vitrectomy (PPV) combined with 0.7 mg dexamethasone sustained-release Ozurdex intravitreal implantation in the treatment of children with ocular toxocariasis (OT).Methods:A retrospective clinical study. Fifty-three pediatric patients (53 eyes) diagnosed with OT and underwent PPV in Beijing Tongren Eye Center of Beijing Tongren hospital from March 2015 to December 2021 were included. There were 30 males and 23 females, with an average age of 7.07±3.45 (4-14) years; all were unilateral. Color Doppler imaging, fundus color photography, optical coherence tomography examinations were performed for patients who can cooperated with the examiners. Forty-three eyes were examined by best corrected visual acuity (BCVA); 47 eyes were examined by intraocular pressure; 29 eyes were examined by ultrasound biomicroscopy. According to the location of granuloma, OT was divided into posterior pole granulomatous type (posterior type), peripheral granulomatous type (peripheral type), and chronic endophthalmitis type. According to whether Ozurdex was implanted into the vitreous cavity after PPV, the children were divided into the oral glucocorticoid group after PPV (group A) and the PPV combined with vitreous cavity implantation of Ozurdex group (group B), 37 cases with 37 eyes and 16 cases with 16 eyes, respectively. There was no significant difference in age ( t=0.432), sex composition ratio ( χ2=0.117), BCVA ( χ2=0.239), and clinical type ( χ2=0.312) between the two groups ( P>0.05). The follow-up time after surgery was ≥5 months. The intraocular pressure at 1 week and 1, 3, and 6 months after surgery, the changes of BCVA and the occurrence of complications such as concurrent cataract and epimacular membrane were observed at the last follow-up, and the incidence of obesity in the children during the follow-up period was recorded. The measurement data between groups was compared by independent sample t test; the enumeration data was compared by χ2 test. Results:One month after the operation, the intraocular pressure of group A and group B were 15.17±6.21 and 25.28±10.38 mm Hg (1 mm Hg=0.133 kPa) respectively; the intraocular pressure of group B was significantly higher than that of group A, the difference was statistically significant ( t=0.141, P=0.043). At the last follow-up, there was no significant difference in the percentage of visual acuity improvement between the two groups ( χ2=0.315, P=0.053); there was no significant difference in the incidence of concurrent cataract and epimacular membrane ( χ2=0.621, P >0.05). Among the 37 cases in group A, 32 cases (86.5%, 32/37) developed obesity symptoms during the follow-up period. Conclusion:PPV combined with intravitreal implantation of Ozurdex and oral glucocorticoid after PPV can effectively improve the visual acuity of the affected eye; the incidence of complications is similar, however, the incidence of obesity after oral glucocorticoid is higher.

Manifestaciones oculares de la toxocariasis en escolares del estado Anzoátegui en Venezuela / Ocular manifestations of toxocariasis in schoolchildren from the state from the Anzoátegui state in Venezuela

RESUMEN El objetivo de este estudio fue determinar manifestaciones oculares de la toxocariasis en escolares. Se realizó un estudio en dos escuelas del estado Anzoátegui en Venezuela en el 2019. Se empleó la prueba de ELISA para determinar los anticuerpos IgG contra Toxocara spp. Las familias completaron un cuestionario y los niños fueron evaluados clínicamente por pediatras y oftalmólogos. Participaron 118 niños, el 18,6% presentó anticuerpos anti-Toxocara spp. Las manifestaciones clínicas con asociación estadísticamente significativa fueron las reacciones alérgicas, epífora y disminución de la agudeza visual. En la evaluación oftalmológica se encontró queratitis, uveítis, iritis, granuloma retiniano, endoftalmitis, amaurosis, leucocoria, desprendimiento de retina y endotropía. Los hallazgos muestran una alta frecuencia de enfermedad ocular en niños con toxocariasis de un estado de Venezuela.

ABSTRACT The objective of this study was to determine ocular manifestations of toxocariasis in schoolchildren. A study was conducted in two schools in the Anzoátegui state in Venezuela in 2019. The ELISA test was used to determine IgG antibodies against Toxocara spp. The families completed a questionnaire, and the children were clinically evaluated by pediatricians and ophthalmologists. 118 children participated, 18.6% presented anti-Toxocara spp. The clinical manifestations with a statistically significant association were allergic reactions, epiphora, and decreased visual acuity. The ophthalmological evaluation found keratitis, uveitis, iritis, retinal granuloma, endophthalmitis, amaurosis, leukocoria, retinal detachment and endotropia. The findings show a high frequency of eye disease in children with toxocariasis from a state of Venezuela.

Toxocariasis en niños: análisis de 85 casos en un hospital pediátrico de Argentina / Toxocariasis in children: analysis of 85 cases in a paediatric hospital in Argentina

INTRODUCCIÓN: La toxocariasis es una enfermedad parasitaria ampliamente distribuida. Las formas clínicas descritas son la asintomática (TA), larva migrans visceral (LMV), larva migrans ocular (LMO) y encubierta (TE). OBJETIVOS: Describir las características clínicas, de laboratorio, evolución y tratamiento de los casos y comparar las diversas formas clínicas de presentación. PACIENTES Y MÉTODOS: Análisis retrospectivo de todos los pacientes pediátricos con diagnóstico de toxocariasis atendidos en el Servicio de Infectología del Hospital General de Niños Pedro de Elizalde entre 2012 y 2019. RESULTADOS: Se incluyeron 85 pacientes. El 63,5 % fueron varones y la mediana de edad fue de 60 meses. Cuarenta y nueve pacientes presentaron TA, 14 LMV, 15 LMO y 7 TE. Los pacientes con LMV presentaron menor edad y recuento de eosinófilos más altos. Todos los casos de LMO presentaron mal pronóstico visual. Se indicó tratamiento con albendazol en todos los casos de LMV, en los casos activos de LMO, en 4 TE y en 3 TA. CONCLUSIÓN: Este estudio representa uno de los más grandes llevados a cabo en el país. Todas las formas clínicas excepto las LMO tuvieron buena evolución. Resulta fundamental enfatizar en la prevención y en el diagnóstico precoz de la enfermedad para instaurar de manera oportuna el tratamiento y evitar secuelas.

BACKGROUND: Toxocariasis is a widely spread parasitic disease. The most frequent clinical form is asymptomatic (AT) although it may present with visceral larva migrans (VLM), ocular larva migrans (OLM) or covert (TE) involvement. Aims: To describe the clinical presentation, laboratory, evolution and treatment characteristics of the cases and to compare the various clinical forms of presentation. PATIENTS AND METHODS: Retrospective analysis of all children diagnosed with toxocariasis attended at the Infectology Service of the Pedro de Elizalde Children's General Hospital between 2012-2019. RESULTS: We included 85 patients. 63.5% were males and the median age was 60 months. 49 patients presented AT, 14 VLM, 15 OLM and 7 TE. Children with LMV had lower age and higher eosinophil count. All the cases of OLM evolved with a poor visual prognosis. Treatment with albendazole was indicated in all cases of LMV, in active cases of LMO, in 4 TE and in 3 AT. CONCLUSION: This study represents one of the largest conducted in our country. The ocular forms had bad prognosis, while the visceral and covert forms had good evolution. It is essential to emphasize the prevention and early diagnosis of the disease in order to establish timely treatment and avoid sequelae.

Brain lesions associated with eosinophilia. A useful clue for neurotoxocariasis. Report of one case

ABSTRACT Neurotoxocariasis is uncommon. Its manifestations include events of meningitis, encephalitis and less frequently vasculitis, which manifest as headache, seizures, focalization, confusion, cognitive alterations and /or fever. Peripheral eosinophilia with clinical and neurological imaging elements, allow its early suspicion. We report a 48-year-old agricultural worker, admitted in our hospital for one week of gastrointestinal complaints, headache, progressive left hemiparesis and impaired consciousness. He had leukocytosis (13,530/μL) with peripheral eosinophilia (25%, absolute count 3,400 /μL). CSF analysis revealed no abnormalities and brain CT showed poorly defined hypodense lesions on subcortical areas and semioval centers. Magnetic resonance imaging showed multiple foci with increased signals predominantly in the white matter in both hemispheres, especially at frontal and occipital regions and at semioval centers. Lesions reinforced after paramagnetic contrast. Serological studies found specific IgG antibodies by ELISA against antigens of the genus Toxocara, which were confirmed by a positive IgG Western Blot. The patient was treated with albendazole (800 mg/d) for 14 days associated with parenteral and then oral corticosteroids with a favorable response and gradual complete recovery.

La neurotoxocariasis es infrecuente. Sus manifestaciones incluyen eventos de meningitis, encefalitis y con menor frecuencia vasculitis, que se manifiestan como cefalea, convulsiones, focalización, confusión, alteraciones cognitivas o fiebre. La eosinofilia periférica, junto a elementos clínicos e imágenes compatibles, permiten su sospecha. Informamos el caso de un trabajador agrícola de 48 años que ingresó por una semana de molestias gastrointestinales, cefalea, hemiparesia izquierda progresiva y deterioro de conciencia. Los exámenes revelaron leucocitosis (13.530/μL) con eosinofilia periférica (25%, recuento absoluto 3.400/μL). El análisis del LCR sin anomalías y la tomografía computada cerebral mostró lesiones hipodensas mal definidas en áreas subcorticales y centros semiovales. La resonancia magnética mostró múltiples focos con aumento de la señal predominantemente en la sustancia blanca en ambos hemisferios. Las lesiones presentaron refuerzo tras contraste paramagnético. Los estudios serológicos indicaron anticuerpos IgG específicos por ELISA contra antígenos del género Toxocara. El paciente fue tratado con albendazol (800 mg /día) durante 14 días asociado a corticoides con respuesta favorable y una recuperación gradual completa.

Presentación atípica de toxocariasis infantil: a propósito de un caso / Atypical presentation of infant toxocariasis: about a case

Resumen Se presenta el caso de una niña de 8 años, procedente de la Amazonia peruana, con una presentación atípica de una toxocariasis. El cuadro clínico, de un mes de evolución, fue caracterizado por dolor abdominal crónico, palidez y geofagia, asociado a una masa abdominal y linfoadenopatías generalizadas. No hubo sintomatología respiratoria, dérmica, ocular o neurológica. En el hemograma se encontró una anemia y eosinofilia periférica acentuada y una eosinofilia moderada en el aspirado medular. El diagnóstico fUe confirmado por serología por el método de enzimoinmunoanálisis (ELISA), que mostró la presencia de anticuerpos anti-Toxocara de tipo IgG e IgM. Se administró tratamiento con albendazol 400 mg al día, durante cinco días, con una evolución favorable.

Abstract We present the case of an 8-year-old girl with an atypical presentation of toxocariasis, from the Peruvian Amazon. A month ago, the clinical presentation was characterized by the presence of abdominal pain, paleness and geophagia, associated with an abdominal mass and generalized lymphadenopathy. There were no respiratory, dermal, ocular or neurological symptoms. Marked peripheral eosinophilia was found in the blood count, and moderate eosinophilia in the spinal cord aspírate. The diagnosis was confirmed by serology with the enzyme-linked immunosorbent assay (ELISA), which showed the presence of IgG and IgM anti- Toxocara antibodies. Treatment with albendazole 400 mg once daily was administered for five days with favorable evolution.

Larva migrans visceral como causa de síndrome febril prolongado y eosinofilia severa. Reporte de un caso

RESUMEN Toxocara canis y catis son helmintos que parasitan el intestino del perro o del gato, sus huéspedes definitivos. Las hembras eliminan huevos infectantes al medio ambiente, que, ingeridos accidentalmente por el ser humano, sólo desarrollan el estado larvario en etapa embrionaria y causan la toxocariasis. Esta es una zoonosis extendida por todo el mundo, especialmente en aquellas áreas donde prevalecen condiciones deficientes de hábitat e higiene. El cuadro clínico puede variar desde formas asintomáticas a la larva migrans visceral (LMV) o larva migrans ocular (LMO), debidas a la diseminación de larvas embrionadas en el hígado, pulmones y en menor medida el SNC. La LMV se caracteriza clínicamente por la presencia de hepatomegalia, infiltración pulmonar con tos, eosinofilia de variada intensidad, hiper Ig E y anticuerpos Ig G anti-toxocara. Por no ser la fiebre un síntoma clínico destacado, se presenta el siguiente caso clínico.

ABSTRACT Toxocara canis and catis are helminths that parasitize the intestine of dogs or cats, their definitive hosts. Females shed infective eggs into the environment, which, when accidentally ingested by humans, only develop the embryonic larval stage and cause toxocariasis. This is a zoonosis that is widespread throughout the world, especially in those areas where poor habitat and hygienic conditions prevail. The clinical picture can vary from asymptomatic forms to visceral larva migrans (VLM) or ocular larva migrans (OLM), due to the dissemination of embryonic larvae in the liver, lungs and to a lesser extent the CNS. VLM is clinically characterized by the presence ofhepatomegaly, pulmonary infiltration with cough, eosinophilia of varying intensity, hyper Ig E and Ig G anti-toxocara antibodies. Since fever is not a prominent clinical symptom, the following clinical case is presented.

Unnoticed metallic foreign body in the camerular angle inducing chronic uveitis / Corpo estranho metálico não notado em ângulo camerular induzindo uveíte crônica

ABSTRACT We report the case of an eight-year-old male patient with a four-month history of unilateral anterior chronic uveitis, associated with a pigmented lesion surrounded by fibrinoid material in the inferior camerular angle and with a fibrotic lesion in the extreme periphery of the inferior retina. The patient had no history of trauma or any other clinical symptoms. Although the patient was suspected of having toxocariasis, serological tests were negative. Partial symptomatic improvement was achieved using both orally and topically administered corticosteroids. In addition, a decrease in fibrinoid material around the pigmented camerular lesion revealed it to be regular and cylindric. Computed tomography of the orbits revealed a metallic foreign body in the topography of the inferior camerular angle. The patient underwent removal of the foreign body through a corneal incision and photocoagulation around the inferior retinal traction. Excellent visual and anatomical results were obtained.(AU)

RESUMO Os autores relatam o caso de paciente do sexo masculino, 8 anos de idade, com história de uveíte crônica anterior unilateral há quatro meses, associada a lesão pigmentada envolvida por material fibrinóide em ângulo camerular inferior e a lesão fibrótica em extrema periferia de retina inferior. Não havia histórico de trauma ou outros sintomas clínicos. A hipótese de toxocaríase foi afastada diante de testes sorológicos negativos. Melhoria sintomática parcial foi alcançada com administração de corticosteróide vias oral e tópica. Ademais, redução na quantidade de material fibrinóide ao redor da lesão camerular a revelou regular e cilíndrica. Foi realizada tomografia computadorizada de órbitas, permitindo a detecção de corpo estranho metálico na topografia de ângulo camerular inferior. O paciente foi submetido a remoção do corpo estranho através de incisão corneana e a fotocoagulação ao redor da tração retiniana inferior. Excelentes resultados visual e anatômico foram obtidos.(AU)

Toxocariosis / Toxocariosis

RESUMEN La toxocariosis humana es una helmintozoonosis por invasión de las larvas de la especie Toxocara al organismo humano. Se adquiere al ingerir los huevos de larvas por falta de higiene de las manos, consumo de vegetales y carnes crudas, geofagía y aguas no tratadas. El serodiagnóstico se realiza por Elisa o Western Blot. Es una enfermedad altamente prevalente, en especial en países tropicales, en vía de desarrollo y sobre todo en áreas rurales. Hay diferentes formas de presentación clínica y entre ellas la del compromiso del sistema nervioso central. Su tratamiento es con antihelminticos.

SUMMARY Human toxocariasis is a helminthic zoonosis caused by the invasion of the larvae of the species Toxocara to the human organism. It is acquired by ingesting the eggs of larvae due to lack of hand hygiene, consumption of vegetables and raw meats, geophagy, and untreated water. The serodiagnosis is performed by ELISA or western blot. It is a highly prevalent disease especially in countries tropical, developing and especially in rural areas. There are different ways to clinical presentation and among them that of central nervous system involvement. Its treatment is with anthelmintics.

Toxocariasis en edad pediátrica. Presentación de un caso / Toxocariasis in pediatric age. A case presentation

RESUMEN La toxocariasis humana es una importante zoonosis parasitaria causada por formas larvarias del toxocara, un parásito nematodo de perros y gatos. La migración de la larva por los diferentes tejidos blandos en el ser humano genera una serie de entidades clínicas, tales como: toxocariasis encubierta, el síndrome de larva migrans visceral, la toxocariasis ocular y la neurotoxocariasis. Se presenta un caso clínico de un paciente de seis años de edad, hospitalizado a consecuencia de un síndrome febril agudo asociado a dolor abdominal; cuyo examen físico, reveló signos meníngeos, fotofobia, alteraciones en el fondo de ojo y eosinofilia moderada. Teniendo en cuenta la epidemiología, el cuadro clínico y los resultados de estudios serológicos, se concluyó el diagnóstico de larva migrans ocular, para lo cual se utilizó tratamiento específico con una evolución satisfactoria. Esta entidad nosológica requiere de una adecuada valoración socio-epidemiológica de los pacientes, así como de un minucioso examen físico que, unido a las pruebas específicas permitirán el diagnóstico precoz y el tratamiento oportuno.

ABSTRACT Human toxocariasis is an important parasitic zoonosis caused by larval forms of toxocara, a nematode parasite of dogs and cats. The migration of the larva through the different soft tissues in humans generates a series of clinical entities, such as: covert toxocariasis, visceral larva migrans syndrome, ocular toxocariasis and neurotoxocariasis. The clinical case of a six-year-old patient is presented, hospitalized as a result of an acute febrile syndrome associated with abdominal pain; whose physical examination revealed meningeal signs, photophobia, fundus alterations and moderate eosinophilia. Taking into account the epidemiology, the clinical picture and the results of serological studies, the diagnosis of ocular larva migrans was concluded, for which specific treatment was used with a satisfactory evolution. This nosological entity requires an adequate socio-epidemiological assessment of the patients, as well as a thorough physical examination that, together with the specific tests, will allow early diagnosis and timely treatment.

Seropositividad a Toxocara spp. en estudiantes atópicos de la Universidad de los Llanos / Seropositivity to Toxocara spp. in atopic students from Universidad de los Llanos / Soro positividade à Toxocara spp. em alunos atópicos da Universidade dos Llanos

Introducción: Las exposiciones frecuentes o estacionales a helmintos que no provocan infecciones crónicas se asocian a un aumento de la inflamación alérgica, situación que podría extrapolarse a la toxocariasis humana. El objetivo de esta investigación fue determinar la frecuencia de seropositivos a Toxocara spp. entre estudiantes atópicos y la relación entre atopia y seropositividad a Toxocara spp. Materiales y métodos: Estudio observacional transversal donde por conveniencia se seleccionaron 90 estudiantes de los programas de Enfermería, Regencia en Farmacia y MVZ de la Universidad de los Llanos que según diligenciamiento del cuestionario ISAAC fase III se presume sufren de enfermedad atópica; para desarrollar en ellos la prueba de hipersensibilización alérgica cutánea (PHAC), utilizando extractos de Blomia tropicalis y Dermatophagoides pteronyssius. En los estudiantes positivos a esta prueba, se tomaron muestras sanguíneas para el recuento de eosinófilos e inmunoensayo in-house para IgG anti-Toxocara spp. Resultados: De los 90 estudiantes con antecedentes de enfermedad atópica, solo el 33,3% fueron positivos para uno o ambos ácaros del polvo en la PHAC y su recuento de eosinófilos en sangre fue normal 66,6%, medio 26,7% y moderado 6,7%. La frecuencia de seropositividad a Toxocara spp. fue del 73,3% (DO 1,009 cut-off). La OR entre atopia y seropositividad a Toxocara spp. fue 1,18 (IC95% 0,24-5,7). Discusión: Colombia es uno de los países con alta endemicidad de toxocariasis con prevalencias entre 40.4­54.4%, dato confirmado según la frecuencia de seropositivos a Toxocara spp. encontrada en personas atópicas en estudio. Conclusiones: No se encontró relación entre atopia y seropositividad a Toxocara spp.

Introduction: The frequent or seasonal expositions to parasitic worms that do not provoke chronic infections are associated to an increase of allergic inflammation, situation that could be extrapolated to human toxocariasis. The objective of this research was to determine the frequency of Toxocara spp seropositivity among atopic students and the relationship be-tween atopy and seropositivity to Toxocara spp. Materials and methods: Observational and cross-sectional study using 90 students by convenience from the Nursing, Farmacy, Veter-inary, and Animal Science programs at the Universidad de los Llanos that according to the completion of the ISSAC phase III questionnaire are presumed to suffer from an atopic dis-ease. In order to perform an allergy skin test in them, extracts from Blomia tropicalis and Dermatophagoides pteronyssius were used. The students that tested positive got a blood test to count the eosinophils and the in-house enzyme immunoassay for IgG anti-Toxocara spp. Results: From the 90 students with records of atopic diseases, only 33,3% were positive to one or the two dust mites in the allergy skin test. Their eosinophils count in the blood test were normal 66.6%, medium 26.7% and moderate 6.7%. The frequency of seropositivity to Toxocara spp. was 73.3% (DO 1,009 cut-off). The OR between atopy and seropositivity to Toxocara spp. corresponded to 1.18 (CI 95% 0,24-5,7). Discussion: Colombia is one of the countries with high endemicity of toxocariasis with prevalences between 40.4­54.4%, a fact that is confirmed according to the frequency of seropositives to Toxocara spp. found in atopic people in the study. Conclusions: No relationship between atopy and seropositivity to Toxocara spp. was found

Introdução: as exposições frequentes ou estacionais a helmintos que não desenvolvem in-feções crônicas associam-se com o incremento de inflamação alérgica, situação que poderia evoluir a toxocaríase humana. O objetivo dessa pesquisa foi determinar a frequência de soro positividade à Toxocara spp. entre alunos atópicos e a relação entre atopia e soro positividade à Toxocara spp. Materiais e métodos: Estudo observacional transversal onde por conveniên-cia estudaram-se 90 alunos dos programas de enfermagem, regência em farmácia e medicina veterinária da Universidade dos Llanos que segundo o preenchimento do questionário ISAAC fase III presumiam padecer doença atópica. Para desenvolver a prova de hiper sensibilidade alérgica cutânea (PHAC), usaram-se extratos de Blomia tropicalis e Dermatophagoides pter-onyssius. Os alunos com teste positivo, foram analisados por meio de amostra sanguínea para contagem de eosinófilos e imunoensaio in-house para IgG anti-Toxocara spp. Resultados: dos 90 alunos analisados, só 33,3% foram positivos para um ou ambos ácaros no PHAC. A contagem de eosinófilos em sangue foi normal (66,6%), média (26,7%) e moderada (6,7%). A frequência de soro positividade para à Toxocara spp. foi de 73,3% (DO 1,009 cut-off). O OR relacionando atopia e soro positividade à Toxocara spp. foi de 1,18 (IC95% 0,24-5,7). Discussão: Colômbia é um dos países endêmicos para toxocaríase com prevalências entre 40.4 e 54,4%, informação confirmada com os achados desse estudo. Conclusões: Não foi encontrada relação estadística entre atopia e soro positividade à Toxocara spp

Difference of clinical characteristics in ocular toxocariasis between adults and children and characteristics of anti-toxocaria antibody in intraocular fluids / 中华眼底病杂志

Objective:To compare the clinical manifestations of ocular toxoplasmosis (OT) in adult and children, and to preliminarily explore the role of intraocular fluid detection in the early diagnosis of OT.Methods:A retrospective study. From January 2018 to October 2019, 60 cases of OT patients with 60 eyes diagnosed in the Department of Ophthalmology of Beijing Chaoyang Hospital Affiliated of Capital Medical University were included in the study. The medical history information of patients was collected in parallel with slit-lamp microscopy, indirect ophthalmoscope examination, and canine toxoplasma antibody detection in aqueous or vitreous fluid. Fifty-eight cases underwent visual inspection; 2 cases did not underwent visual inspection, who were children. The visual acuity examination was carried out using the new version of the standard logarithmic visual acuity chart, which was converted into the logarithmic minimum angle of resolution(logMAR) visual acuity during statistics. According to age, the patients were divided into adult group and child group, with 12 eyes in 12 cases and 48 eyes in 48 cases, respectively. The clinical characteristics and main points of diagnosis and treatment of the two groups of patients were compared and observed. The comparison among the measurement data groups conforming and the normal distribution was performed by the independent t test. The comparison between the measurement data groups of the skewed distribution was performed by the Kruskal- Wallis test. The qualitative data were compared with χ 2 test. Results:Among the adult group and the child group, 7 (58.3%, 7/12) and 34 (70.8%, 34/48) patients with a clear history of contact with dogs and cats were in the adult group and the child group, respectively. The adult group was significantly lower than the child group, however, there was no different statistical significance ( χ 2=0.236, P=0.627). At the first visit, the self-reported blurred vision of the adult group and the child group was 10 (83.3%, 10/12) and 22 (45.8%, 22/48) cases, respectively. In the adult group and the child group, 3 (25.0%, 3/12) and 20 (43.5%, 20/46) eyes with logMAR visual acuity greater than 1.85, 8 (66.7%, 8/12) and 22 (45.8%, 22/46) eyes with logMAR visual acuity less than 0.3. The visual acuity of the adult group was better than that of the child group, and the difference was statistically significant ( Z=2.162, P=0.031). There was no statistically significant difference in the composition ratio of different clinical types of the two groups of eyes ( χ 2=1.908, P=0.385). The incidence of inflammation in the anterior segment of the eye in the adult group and the child group were 25.0% (3/12) and 56.3% (27/48), respectively; there was no statistically significant difference between the two groups ( χ 2=3.750, P=0.053). The concentration of antibodies in the vitreous humor of the affected eye in the adult group and the child group was greater than that of aqueous humor. The antibody concentrations of vitreous humor and aqueous humor were 36.51 (22.58) and 19.94 (21.78) U/ml in the children group; 45.95 (56.44) and 32.20 (38.64) U/ml in the adult group. Comparison of antibody concentrations in the vitreous humor and aqueous humor of the affected eyes in the child group showed statistically significant differences ( Z=-1.984, P=0.047). Conclusions:Compared with children with OT, adult patients with OT have better vision and mild inflammation or hyperplasia of the vitreous cavity. The detection of antibodies related to toxoplasma in the intraocular fluid is helpful for early diagnosis.

Toxocariasis and Toxocara vaccine: a review / Toxocariasis y vacunación para Toxocara: una revisión sistemática / Toxocaríase e vacina para controle de Toxocara: uma revisão

Abstract Based on prevalence and impact on public health, toxocariasis is an underestimated zoonosis in developing and developed countries. The transmission of Toxocara spp. involves pets, stray dogs and cats (Canis familiaris and Felis catus, respectively), which spread the parasite's eggs in their feces to the environment. One of the main risk factors for the infection and development of human toxocariasis, is to cohabit with puppies and kittens. For a long time, the preventive strategy for this parasitic infection has been the regular use of antiparasitic drugs to reduce parasite burden in the short term. A long lasting immunological protection can be achieved with vaccination, however, a vaccine is not yet available. Therefore, it is fundamental to know and to understand the state of the art of vaccine development for effective control of this zoonosis. This paper reviews the experimental studies focused on vaccine development for toxocariasis control, and special attention is given to relevant epidemiological studies on the importance of dogs in human toxocariasis.

Resumen Según la prevalencia y el impacto en la salud pública, la toxocariasis es una zoonosis subestimada en los países en desarrollo y desarrollados. La transmisión de Toxocara spp. involucra animales de compañía caninos y felinos, como también perros y gatos sin hogar (Canis familiaris y Felis catus, respectivamente), que diseminan los huevos del parásito en sus heces al medio ambiente. Uno de los principales factores de riesgo para la infección y el desarrollo de la toxocariasis humana es convivir con cachorros felinos y caninos. Durante mucho tiempo, la estrategia preventiva para esta infección parasitaria ha sido el uso regular de medicamentos antiparasitarios para reducir la carga parasitaria a corto plazo. Se puede lograr una protección inmunológica duradera con la vacunación, sin embargo, todavía no se dispone de una vacuna. Por lo tanto, es fundamental conocer y comprender el estado del arte del desarrollo de vacunas para el control efectivo de esta zoonosis. Este artículo revisa los estudios experimentales centrados en el desarrollo de vacunas para el control de la toxocariasis, y se presta especial atención a los estudios epidemiológicos relevantes sobre la importancia de los caninos domésticos en la toxocariasis humana.

Resumo Com base na prevalência e no impacto na saúde pública, a toxocaríase é uma zoonose subestimada nos países em desenvolvimento e desenvolvidos. A transmissão de Toxocara spp. envolve animais cães e gatos de estimação e vadios (Canis familiaris e Felis catus, respectivamente), que espalham os ovos do parasita nas fezes para o meio ambiente. Um dos principais fatores de risco para a infecção e desenvolvimento da toxocaríase humana é coabitar com filhotes de cachorros e gatos. Por um longo tempo, a estratégia preventiva para essa infecção parasitária tem sido o uso regular de medicamentos antiparasitários para reduzir a carga parasitária a curto prazo. Uma proteção imunológica duradoura pode ser alcançada com a vacinação, no entanto, uma vacina ainda não está disponível. Portanto, é fundamental conhecer e entender o estado da arte do desenvolvimento de vacinas para o controle efetivo dessa zoonose. Este artigo revisa os estudos experimentais focados no desenvolvimento de vacinas para o controle da toxocaríase, e atenção especial é dada a estudos epidemiológicos relevantes sobre a importância dos cães na toxocaríase humana.

Frequency of enteroparasitic infections and serum positivity for Toxocara spp. in children from a public day care center in Southern Brazil / Frequência de enteroparasitos e de soropositividade para Toxocara spp. em crianças de uma creche pública do Sul do Brasil

Abstract Introduction Day care centers play an important social role in children's early education and development. The objective of this study was to investigate the frequency of intestinal parasitic infections and infection with Toxocara spp. in children from a day care center in the city of Rio Grande, Rio Grande do Sul, Brazil. Methods: The study was conducted using fecal samples from 50 children, ages three to six years, using Ritchie, Faust, Rugai, and Kinyoun's techniques. A closed and structured epidemiological questionnaire was used to collect data from the parents/guardians of the children. Serological studies for detection of antibodies to Toxocara spp. by immunoenzymatic assays using Toxocara excretion and secretion antigen (TES) were conducted on sera collected from 41 children. Results: The frequency of enteroparasites was 18%, with 43.9% of the children testing seropositive for Toxocara spp. Low family income and low literacy levels of parents/guardians were common factors between the families of the parasite-positive children. For the children who tested positive for Toxocara spp., most of the parents/guardians reported using only water for sanitizing raw vegetables and fruits. Conclusions: The high seropositivity rates for Toxocara spp. indicate that children were exposed to this parasite, and it is important to reduce the risk of infection. In addition, the seropositivity for enteroparasites and the interviews with the parents/guardians indicate the need to educate the studied population regarding the modes of intestinal parasite transmission and the prophylactic measures needed to prevent their dissemination.

Resumo Introdução As creches desempenham um importante papel social na educação e desenvolvimento inicial das crianças. O objetivo deste estudo foi investigar a frequência de infecções parasitárias intestinais, além de infecção por Toxocara spp. em crianças de uma creche na cidade do Rio Grande, Rio Grande do Sul, Brasil. Métodos: Para o estudo, foram coletadas amostras fecais de 50 crianças de três a seis anos, analisadas pelas técnicas de Ritchie, Faust, Rugai e Kinyoun, sendo aplicado um questionário epidemiológico fechado e estruturado aos pais/responsáveis ​​das crianças. Também foi realizada uma pesquisa sorológica de anticorpos para Toxocara spp. em 41 crianças, pelo ensaio imunoenzimático, associado ao antígeno de excreção e secreção (ES), com soros pré-adsorvidos com antígeno somático de Ascaris lumbricoides. Resultados: A frequência de enteroparasitos foi de 18%, enquanto que 43.9% das crianças foram soropositivas para Toxocara spp.. Baixa renda familiar e baixo nível de alfabetização dos pais/responsáveis ​​foram fatores comuns entre as famílias das crianças parasitadas. A maioria dos pais ou responsáveis das crianças, com diagnóstico positivo para enteroparasitos ou para Toxocara spp., relatou utilizar apenas água para a higienização de verduras e frutas. Conclusões: As altas taxas de soropositividade para Toxocara spp. indicam que as crianças foram expostas a esse parasito, sendo importante minimizar o risco de infecção. Além disso, a positividade de 18% para enteroparasitos e os dados obtidos com as entrevistas realizadas com os pais ou responsáveis demonstram a necessidade da realização de trabalhos com a população estudada que visem a divulgação sobre as parasitoses intestinais, especialmente sobre medidas profiláticas especificas.

Toxocariasis: manifestaciones clínicas y de laboratorio en niños asistidos en un prestador integral de salud privado de Montevideo, Uruguay (2014-2018) / Toxocariasis: clinical and laboratory manifestations in children assisted in a private comprehensive healthcare provider of Montevideo, Uruguay. 2014-2018 / Toxocaríase: manifestações clínicas e de laboratório em crianças atendidas em uma instituição privada de assistência integral de saúde em Montevidéu, Uruguai. 2014-2018

Resumen: Introducción: la toxocariasis humana es una parasitosis de amplia distribución en el mundo cuyos agentes etiológicos son Toxocara canis y, en menor medida, Toxocara cati. Objetivo: describir las características clínicas y paraclínicas de toxocariasis en menores de 15 años asistidos en un prestador integral privado de Montevideo entre 2014 y 2018. Material y método: estudio descriptivo, retrospectivo, de los menores de 15 años derivados a la policlínica de infectología entre el 1 de enero de 2014 y el 31 de diciembre de 2018 con diagnóstico de toxocariasis confirmada por ELISA. Variables: edad, sexo, motivo de consulta, manifestaciones clínicas, recuento leucocitario y de eosinófilos, parasitosis asociadas, tratamiento y evolución. Resultados: fueron asistidos 20 niños de los cuales 11 eran asintomáticos, cinco presentaron síndrome de larva migrans visceral (LMV) y cuatro síndrome de larva migrans ocular (LO). Veinte niños recibieron albendazol y uno, además, mebendazol. Aquellos con compromiso ocular recibieron también corticoides vía oral. Se constató pérdida de agudeza visual en dos pacientes. Discusión y conclusiones: la mayorías de los niños eran asintomáticos, la cuarta parte consultaron por alteraciones visuales cuyas secuelas representan un grave problema de salud potencialmente prevenible. Debería realizarse la búsqueda de la infección mediante serología en niños que presenten eosinofilia con y sin síntomas respiratorios o disminución de la agudeza visual causada por lesión intraocular y en niños con factores de riesgo para esta parasitosis.

Summary: Introduction: human toxocariasis is a widely distributed parasitosis around the world. Its etiological agents are Toxocara canis and Toxocara cati in a smaller proportion. Objective: to describe the clinical and paraclinical manifestations of toxocariasis in children younger than 15 years old who were assisted in a private comprehensive healthcare provider in Montevideo between 2014 and 2018. Method: descriptive, retrospective study of children under 15 years old who were referred to the infectology service between January 1, 2014 and December 31, 2018 with a diagnosis of toxocariasis confirmed by ELISA. Variables were age, sex, reason of consultation, clinical manifestations, leukocyte and eosinophils count and associated parasitosis, treatment and evolution. Results: 20 children were assisted, 11 of them were asymptomatic, 5 evidenced visceral larva migrans (VLM) syndrome and 4 of them presented larva migrans ocular (LMO). 20 patients received albendazon and one of them also received mebendazol. Those whose eyes were compromised also received oral corticoids. Two patients presented loss of visual acuity. Discussion and conclusions: Most children were asymptomatic, 25% of them consulted for visual alterations whose sequelae represented a potentially preventable severe health problem. We need to make a greater effort to insist on eye control for children since alterations may be detected, avoiding sequelae with an early diagnosis and the right treatment.

Resumo: Introdução: a toxocaríase humana é uma parasitose com ampla distribuição em todo o mundo; seus agentes etiológicos são o Toxocara canis e menos frequentemente Toxocara cati. Objetivo: descrever as características clínicas e de laboratório de toxocaríase em menores de 15 anos atendidos em uma instituição privada de assistência integral de saúde em Montevidéu no período 2014-2018. Materiais e métodos: estudo descritivo, retrospectivo, dos menores de 15 anos referidos ao ambulatório de infectologia no período 1 de janeiro de 2014 - 31 de dezembro de 2018 com diagnóstico de toxocaríase confirmado por ELISA. Variáveis: idade, sexo, motivo de consulta, manifestações clínicas, contagem de leucócitos e de eosinófilos, parasitoses associadas, tratamento e evolução. Resultados: vinte crianças foram atendidas sendo: 11 assintomáticos, 5 com síndrome de larva migrans visceral (LMV) e 4 síndrome de síndrome de larva migrans ocular (LO). Todas foram medicadas com albendazol e uma recebeu também mebendazol. Aquelas com compromisso ocular tomaram também corticoides por via oral. Dois pacientes apresentaram perda da acuidade visual. Discussão e conclusões: a maioria das crianças eram assintomáticas, sendo que um quarto consultou por alterações visuais cujas sequelas representam um problema grave de saúde potencialmente previnivel. Devemos melhorar os esforços para insistir na realização de controle oftalmológico das crianças nos controles de saúde, pois com um diagnóstico precoce e tratamento adequado é possível detectar alterações e evitar sequelas.

Evaluation of Toxocara canis Glycosylated TES Produced in Pichia pastoris for Immunodiagnosis of Human Toxocariasis

Abstract Recombinant proteins are a suggested alternative for the diagnosis of toxocariasis. The current Escherichia coli recombinant protein overexpression system usually produces insoluble products. As an alternative, yeast such as Pichia pastoris have secretory mechanisms, which could diminish the cost and time for production. This study aimed to produce recombinant proteins in Pichia pastoris and verify their sensibility and specificity in an indirect ELISA assay. Two sequences (rTES-30 and rTES-120) of Toxocara canis excretory-secretory antigens were cloned in a pPICZαB vector and expressed in P. pastoris KM71H. Sera samples collected from human adults infected by Toxocara spp. were tested by indirect ELISA using rTES-30 and rTES-120 as antigens. Recombinant proteins were detected at 72 hours after induction, in the supernatant, as pure bands between 60~70 kDa with hyperglycosylation. Regarding diagnosis potential, recombinant antigens had high specificity (95.6%); however, sensitivity was 55.6% for rTES-30 and 68.9% for rTES-120. Further deglycosylation of the P. pastoris antigens did not seem to affect ELISA performance (p>0.05). The low sensitivity in the serodiagnosis diminished any advantage that P. pastoris expression could have. Therefore, we do not recommend P. pastoris recombinant TES production as an alternative for the diagnosis of toxocariasis.

Trastornos inmunitarios en dos pacientes pediátricos con Toxocariasis / Immune disorders in two pediatric patients with Toxocariasis

RESUMEN Introducción: La Toxocariasis es una zoonosis causada por nemátodos del género Toxocara. Accidentalmente el ser humano ingiere los huevos larvados y ocurren reacciones inflamatorias. En pacientes con afecciones inmunológicas, la infección se manifiesta de forma más grave. Objetivo: Evaluar los trastornos inmunológicos de dos pacientes con Toxocariasis en el Hospital Pediátrico "William Soler". Presentación de casos: Se presentan dos pacientes; una, de 5 años, con infecciones recurrentes respiratorias, y pérdida de visión del ojo izquierdo, y otro paciente de 14 años con neumonías recurrentes, diarreas frecuentes y disminución de la agudeza visual en ambos ojos. En la paciente, en el fondo de ojo encontramos leucocoria y granuloma y presentó disminución marcada de la agudeza visual. Se realizó cuantificación de inmunoglobulinas séricas G, A, M por turbidimetría, y E por ELISA, subpoblaciones linfocitarias B, T y de células asesinas naturales por citometría de flujo y Test de ELISA para Toxocara canis, positivo en ambos casos, en la paciente IgA 0 g/l (ausente), e IgE 720 UI/mL (elevada). Subpoblaciones linfocitarias TCD3+/CD8+ (5.57%), y B CD19 (11,06%) disminuidas. En el segundo caso, IgE 810 UI/mL (elevada) y resto normales. Subpoblaciones linfocitarias TCD3+/CD8+ (4.86 %), y NKCD 56 (5,04%) disminuidas. Conclusiones: Se diagnosticó inmunodeficiencia combinada T-B en un paciente e inmunodeficiencia celular en el otro. Después del tratamiento con Hebertrans mejoraron las infecciones y se detuvo la pérdida de agudeza visual. La evolución tórpida y complicaciones se correspondieron con el deterioro inmunológico de estos pacientes.

ABSTRACT Introduction: Toxocariasisis is a zoonosis caused by nematodes of the genus Toxocara. Accidentally, the human being ingests larvae eggs which causes inflammatory reactions. In patients with immunological conditions, the infection is expressed in the most severe form. Objective: To evaluate the immunological disorders of two patients with Toxocariasis in William Soler Pediatric Hospital. Case presentation: We present two patients: a 5 years old girl with recurrent respiratory infections and loss of vision on the left eye and a 14 years old boy with recurrent pneumonia, frequent diarrhea and decreased visual acuity in both eyes. After performing a fundus examination to the first patient, leukocoria, granuloma and a marked decrease in visual acuity were found. Quantification of serum immunoglobulins G, A, M were determined by a turbidimetric method, and E was determined by ELISA; B-lymphocyte subpopulations and T lymphocytes and natural killer cells were also determined by flow cytometry and Elisa test, which were positive for Toxocara canis in both cases. In the first patient IgA was 0 g / l (absent), and IgE was 720 IU / mL (elevated). TCD3 + / CD8 + lymphocyte subpopulations (5.57%), and decreased B CD19 (11.06%) were also found. In the second case, IgE was 810 IU / mL (elevated) and the others were normal. TCD3 + / CD8 + lymphocyte subpopulations (4.86%), and NKCD56 (5.04%) were decreased. Conclusions: Combined T-B immunodeficiency was diagnosed in a patient, and cellular immunodeficiency was diagnosed in the other one. Infections improved in both patients and the loss of visual acuity stopped after treatment with Hebertrans. The torpid evolution and complications corresponded with the immunological deterioration of these patients.