Visceral larva migrans

Infectious diseases

Clinicals - History

Fact Explanation
Cough and wheeze Following the ingestion of toxocara eggs, the larvae hatch in the small intestine, invade the mucosa, and enter the portal system. From there larvae proceed to the lungs where they induce a pulmonary inflammatory response in the form of an eosinophilic pneumonitis . Cough and wheeze
Following the ingestion of toxocara eggs, the larvae hatch in the small intestine, invade the mucosa, and enter the portal system. From there larvae proceed to the lungs where they induce a pulmonary inflammatory response in the form of an eosinophilic pneumonitis .
Fever Due to the migratory tracts of hatched larvae associated with necrosis and inflammation . Fever
Due to the migratory tracts of hatched larvae associated with necrosis and inflammation .
Abdominal pain Larvae can proceed from the intestine to the liver. The deposited larvae causes an inflammatory response in the liver which manifests as eosinophilic granulomas resulting in liver enlargement and necrosis . Abdominal pain
Larvae can proceed from the intestine to the liver. The deposited larvae causes an inflammatory response in the liver which manifests as eosinophilic granulomas resulting in liver enlargement and necrosis .
History of asthma, atopic dermatitis and other allergic conditions Several immunological mechanisms have been proposed regarding helminth mediated modulation of allergy, including: enhancing or suppressing allergic inflammation directed against the parasite; immunological cross-reactivity between helminth allergens and aeroallergens; affecting allergic inflammation directed against aeroallergens through bystander effects in the same tissues such as the lungs . History of asthma, atopic dermatitis and other allergic conditions
Several immunological mechanisms have been proposed regarding helminth mediated modulation of allergy, including: enhancing or suppressing allergic inflammation directed against the parasite; immunological cross-reactivity between helminth allergens and aeroallergens; affecting allergic inflammation directed against aeroallergens through bystander effects in the same tissues such as the lungs .
Presence of household pets Infected dogs and cats deposit toxocara eggs in the soil via feces. Poor personal hygiene as well as consumption of raw vegetables grown in contaminated kitchen gardens may lead to ingestion of such eggs . Presence of household pets
Infected dogs and cats deposit toxocara eggs in the soil via feces. Poor personal hygiene as well as consumption of raw vegetables grown in contaminated kitchen gardens may lead to ingestion of such eggs .
Consumption of raw meat Infective eggs that are ingested by chickens, rabbits, etc, leads to the depostion of larvae in their tissues which are potentially infective to predators on these animals . Consumption of raw meat
Infective eggs that are ingested by chickens, rabbits, etc, leads to the depostion of larvae in their tissues which are potentially infective to predators on these animals .
Seizure. The immune reaction which is triggered in the brain due to deposited larvae may lead to generalized seizures, while granulomas may lead to focal seizures . Seizure.
The immune reaction which is triggered in the brain due to deposited larvae may lead to generalized seizures, while granulomas may lead to focal seizures .
Blindness. In the eye, migrating larvae can damage the retina, inducing granulomatous reactions, resulting in blindness . Blindness.
In the eye, migrating larvae can damage the retina, inducing granulomatous reactions, resulting in blindness .
Malaise, psychomotor agitation, disturbance of concentration and other features of encephalitis. Encephalitis occurs due to eosinophilic granulomata and immune vasculitis in the brain as a result of deposited larvae inducing a inflammatory reaction . Malaise, psychomotor agitation, disturbance of concentration and other features of encephalitis.
Encephalitis occurs due to eosinophilic granulomata and immune vasculitis in the brain as a result of deposited larvae inducing a inflammatory reaction .
Chest discomfort. Direct larval invasion to the myocardium and hypersensitivity reactions to the parasites result in an eosinophilic myocarditis . Chest discomfort.
Direct larval invasion to the myocardium and hypersensitivity reactions to the parasites result in an eosinophilic myocarditis .

Clinicals - Examination

Fact Explanation
Hepatomegaly Larvae can proceed from the intestine to the liver. The deposited larvae causes an inflammatory response in the liver which manifests as eosinophilic granulomas resulting in liver enlargement and necrosis . Hepatomegaly
Larvae can proceed from the intestine to the liver. The deposited larvae causes an inflammatory response in the liver which manifests as eosinophilic granulomas resulting in liver enlargement and necrosis .
Rales heard on auscultation of the lung. Following the ingestion of toxocara eggs, the larvae hatch in the small intestine, invade the mucosa, and enter the portal system. From there larvae proceed to the lungs where they induce a pulmonary inflammatory response in the form of an eosinophilic pneumonitis . Rales heard on auscultation of the lung.
Following the ingestion of toxocara eggs, the larvae hatch in the small intestine, invade the mucosa, and enter the portal system. From there larvae proceed to the lungs where they induce a pulmonary inflammatory response in the form of an eosinophilic pneumonitis .
Chronic urticaria Several immunological mechanisms have been proposed regarding helminth mediated modulation of allergy, including: enhancing or suppressing allergic inflammation directed against the parasite; immunological cross-reactivity between helminth allergens and aeroallergens; affecting allergic inflammation directed against aeroallergens through bystander effects in the same tissues . Chronic urticaria
Several immunological mechanisms have been proposed regarding helminth mediated modulation of allergy, including: enhancing or suppressing allergic inflammation directed against the parasite; immunological cross-reactivity between helminth allergens and aeroallergens; affecting allergic inflammation directed against aeroallergens through bystander effects in the same tissues .

Investigations - Diagnosis

Fact Explanation
Eosinophilia in full blood count. Larvae induce an eosinophil predominant inflammatory reaction . Eosinophilia in full blood count.
Larvae induce an eosinophil predominant inflammatory reaction .
Stool examination to rule out other parasitic infections. Larvae cannot complete their lifecycle in the human and therefore do not excrete infective stages . Stool examination to rule out other parasitic infections.
Larvae cannot complete their lifecycle in the human and therefore do not excrete infective stages .
Antigen detection via ELISA. Specific antigens are secreted by second stage larvae . Antigen detection via ELISA.
Specific antigens are secreted by second stage larvae .
Elevated isohemagglutinin titres. It occurs because of the similarity between antigens of the parasites and those of human erythrocytes. . Elevated isohemagglutinin titres.
It occurs because of the similarity between antigens of the parasites and those of human erythrocytes. .
Hypergammaglobulinemia. Due to polyclonal activation as a result of chronic release of different antigens of the parasite . Hypergammaglobulinemia.
Due to polyclonal activation as a result of chronic release of different antigens of the parasite .
Abdominal ultrasound scan- hypoechoic areas in the liver. Abdominal CT scan- low-density areas in the liver. MRI scan of brain- hyper-intense areas on T2-weighted images These point towards granulomatous lesions which occur within organs in areas of larval deposition as a result of the inflammatory response . Abdominal ultrasound scan- hypoechoic areas in the liver. Abdominal CT scan- low-density areas in the liver. MRI scan of brain- hyper-intense areas on T2-weighted images
These point towards granulomatous lesions which occur within organs in areas of larval deposition as a result of the inflammatory response .
Pulmonary infiltrates on chest radiograph. Deposited larvae in the lung induce a pulmonary inflammatory response in the form of an eosinophilic pneumonitis . Pulmonary infiltrates on chest radiograph.
Deposited larvae in the lung induce a pulmonary inflammatory response in the form of an eosinophilic pneumonitis .

Management - Supportive

Fact Explanation
Treatment of infected dogs or cats in the household with appropriate antihelminthic treatment. Infected dogs and cats deposit toxocara eggs in the soil via feces. Poor personal hygiene as well as consumption of raw vegetables grown in contaminated kitchen gardens may lead to ingestion of such eggs . Treatment of infected dogs or cats in the household with appropriate antihelminthic treatment.
Infected dogs and cats deposit toxocara eggs in the soil via feces. Poor personal hygiene as well as consumption of raw vegetables grown in contaminated kitchen gardens may lead to ingestion of such eggs .

Management - Specific

Fact Explanation
Albendazole. Dose: 10 mg/kg for 5 days. It acts by binding to parasite beta tubulin,
inhibiting its polymerization and impairing glucose uptake .
Albendazole. Dose: 10 mg/kg for 5 days.
It acts by binding to parasite beta tubulin,
inhibiting its polymerization and impairing glucose uptake .
Thiabendazole. Dose: 25 mg/kg for 3 to 7 days. It acts by binding to parasite beta tubulin,
inhibiting its polymerization and impairing glucose uptake .
Thiabendazole. Dose: 25 mg/kg for 3 to 7 days.
It acts by binding to parasite beta tubulin,
inhibiting its polymerization and impairing glucose uptake .
Diethylcarbamazine. 3-4 mg/kg for 21 days. It acts on the parasite neuromuscular pathways and paralyses them . Diethylcarbamazine. 3-4 mg/kg for 21 days.
It acts on the parasite neuromuscular pathways and paralyses them .
Corticosteroids. It suppresses the intense allergic manifestations of the infection .
It should be noted that corticosteroids are needed only in severe infection.
Corticosteroids.
It suppresses the intense allergic manifestations of the infection .
It should be noted that corticosteroids are needed only in severe infection.

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