Visceral larva migrans in French adults: a new disease syndrome?

Visceral larva migrans is apparently an endemic disease among adults in southwest France. Thirty-seven adults living in the Midi-Pyrenees region of France were confirmed as having visceral larva migrans based on an increased specific antibody titer to Toxocara canis as detected by enzyme-linked immunosorbent assay (ELISA) and by the Western blot method. The disease was characterized clinically by weakness, pruritis, rash, difficulty breathing, abdominal pain, and pathologically by allergic manifestations including eosinophilia and increased serum immunoglobulin (Ig) E levels. Conditional logistic regression analysis using a control group of 37 hospital patients with other conditions who were individually matched to patients with visceral larva migrans by age and sex revealed an increased risk for visceral larva migrans associated with hunting or living in a household with a hunter (odds ratio (OR) = 9.0, p = 0.02) and with living in a village of less than 500 persons (OR = 5.7, p = 0.04). Owning two or more dogs compared with owning one or no dogs increased the risk of visceral larva migrans for hunting or living in a household with a hunter (OR = 9.6 vs. OR = 4.5) and for persons living in nonhunting households (OR = 2.1 vs. OR = 1.0). These findings, however, could not be duplicated when 60 age- and sex-matched neighbors were used as a second control group.     

Toxocariasis: under-estimated disease. Report of 9 cases

Toxocariasis or visceral larva migrans is a parasitosis due to the migration in the human organism of animal ascarid larvae. Its importance is under-estimated and the reported tunisian cases are rare. We report nine cases of toxocariasis, noted between January of 2000 to March of 2002, in the laboratory of parasitology-mycology in La Rabta Hospital. They were six children and three adults. The clinical forms are varied: ophthalmologic form (5 cases), general syndrome (1 case), oedema (1 case) and hypereosinophilia (2 cases), and confirmed serologically by the presence of anti Toxocara canis antibody using ELISA test. Visceral larva migrans should be kept in mind to avoid severe forms such as ophthalmologic forms.     

Dirofilariasis as a cause of eosinophilic meningitis in man diagnosed by immunofluorescence and Arthus hypersensitivity

Sera from patients with eosinophilia of unknown aetiology or having symptoms suggesting helminth involvement were surveyed for antibodies against Dirofilaria immitis, Toxocara canis, Ascaris suum, Angiostrongylus cantonensis and A. mackerrasae using a fluorescent antibody test and a passive reversed Arthus test in guinea-pigs. Positive reactions were obtained against D. immitis and T. canis but not against the other parasites. 6 out of 9 patients with anti-D. immitis antibodies showed symptoms of cranial involvement with the parasite. It was concluded that D. immitis is an aetiological agent of eosinophilic meningitis. The most common clinical symptom associated with T. canis visceral larva migrans was persistent eosinophilia.     

Detection of Neisseria meningitidis cell envelope antigen by enzyme-linked immunosorbent assay in patients with meningococcal disease

Sera from various populations and cerebrospinal fluid (CSF) from meningitis patients were tested for Neisseria meningitidis cell envelope antigen by an enzyme-linked immunosorbent assay (ELISA) sandwich system. The minimum optical density (OD) for antigen detection in CSF was defined as the mean value obtained with specimens from a group of tuberculous meningitis patients plus two standard deviations. By this criterion, antigen was detected by ELISA in four of five CSF specimens from group A meningococcal meningitis patients. Very high ELISA values were obtained with sera from fulminating cases but control sera and sera obtained from meningococcal meningitis non-fulminating cases could not be clearly differentiated by this technique. The possible reasons for this are discussed. The results of this study show that as little as 15 ng/ml (protein) of cell envelope antigen can be detected by the ELISA sandwich test and suggest that the technique may be of value in clinical diagnosis of meningococcal disease.     

Toxocaral larva migrans: the use of larval secretory antigens in haemagglutination and soluble antigen fluorescent antibody tests.

Toxocara larval excretions and secretions collected from in vitro culture were used as antigen in passive haemagglutination and soluble antigen fluorescent antibody tests for the diagnosis of visceral larva migrans in experimental animals and man. Antibody to toxocaral secretions was detected in rabbits within 13 days of light Toxocara infection (ten larvae per kg) and within four days of heavy infection (10(4) larvae). Antibody was not detected following infection with 10(4) Ascaris suum larvae. In human sera, antibody was detected at low titre in 1% of 100 healthy adults and in 2% of 50 children. High titres were observed in one third of 170 patients with suspected visceral larva migrans and in 23 of 27 such patients presenting with an eosinophilia greater than 20%. In 25 patients with ocular lesions of an undiagnosed nature, four showed significant levels of anti-Toxocara antibody.     

Seroprevalence of toxocariasis in children and a case of VLM

An epidemiological study on toxocariasis in children was carried out at our hospital (Madrid, Spain) in relation with a case of toxocariasis in a child with chronic hypereosinophilia. The study was based on a positive result of the ELISA test, using excretory-secretory antigen fromToxocara canis. The seroprevalence in children was 1%.Abbreviations ES excretory-secretory - VLM visceral larva migrans     

Imported skin diseases

In two Dutch subjects who had been on holiday in the tropics, a woman aged 32 and a man of Surinam descent aged 52 years, and in two men aged 21 and 38 years who had arrived from the tropics in the Netherlands, one recently and one 15 years previously, import skin diseases were diagnosed: larva migrans cutanea, cutaneous leishmaniasis, mycetoma and lobomycosis. The diagnosis was based on the anamnesis, the clinical picture and histopathological findings. The patients were cured by administration of antimicrobial agents and (or) excision. When travellers or immigrants from the tropics present with skin lesions, an imported skin disease should be considered.     

Toxocariasis: a serological survey of blood donors in the Australian Capital Territory together with observations on the risks of infection

The sera from 660 healthy blood donors from Canberra were tested for antibodies to Toxocara canis by the ELISA test. The results were compared with those from patients with suspected or confirmed visceral larva migrans or ocular toxocariasis. Over 7% of Canberra sera showed elevated levels of antibody reacting with T. canis antigen. Sera from patients resident in Australia with other helminth parasites did not cross-react with T. canis antigen in our tests. However, studies of sera collected in several tropical countries with other parasitic infection, show that cross-reactions with other parasites are possible. The use of purified glycoprotein antigen does not alter the possibility of cross-reaction. Observations and experiments show that people in Canberra may be exposed to the infective eggs of T. canis.     

In Vivo Observation of Cutaneous Larva Migrans by Fluorescence-Advanced Videodermatoscopy

Fluorescence-advanced videodermatoscopy is not a widespread diagnostic technique. Its application in dermatology can facilitate the diagnosis of diseases such as cutaneous larva migrans by enabling us to recognize the precise position of larva in vivo on the skin. Using this noninvasive technique, we detected a case of cutaneous larva migrans in a patient.     

Visceral Larva Migrans in Immigrants from Latin America

To determine whether increased migration is associated with an increase in incidence of toxocariasis (visceral larva migrans), we analyzed clinical data obtained from immigrants from Latin America. Although infection with Toxocara sp. roundworm larvae is distributed worldwide, seroprevalence is highest in tropical and subtropical areas.     

Lyme borreliosis and other tick-borne diseases. Guidelines from the French scientific societies (II). Biological diagnosis,treatment, persistent symptoms after documented or suspected Lyme borreliosis

The serodiagnosis of Lyme borreliosis is based on a two-tier strategy: a screening test using an immunoenzymatic technique (ELISA), followed if positive by a confirmatory test with a western blot technique for its better specificity. Lyme serology has poor sensitivity (30–40%) for erythema migrans and should not be performed. The seroconversion occurs after approximately 6 weeks, with IgG detection (sensitivity and specificity both > 90%). Serological follow-up is not recommended as therapeutic success is defined by clinical criteria only. For neuroborreliosis, it is recommended to simultaneously perform ELISA tests in samples of blood and cerebrospinal fluid to test for intrathecal synthesis of Lyme antibodies. Given the continuum between early localized and disseminated borreliosis, and the efficacy of doxycycline for the treatment of neuroborreliosis, doxycycline is preferred as the first-line regimen of erythema migrans (duration, 14 days; alternative: amoxicillin) and neuroborreliosis (duration, 14 days if early, 21 days if late; alternative: ceftriaxone). Treatment of articular manifestations of Lyme borreliosis is based on doxycycline, ceftriaxone, or amoxicillin for 28 days. Patients with persistent symptoms after appropriate treatment of Lyme borreliosis should not be prescribed repeated or prolonged antibacterial treatment. Some patients present with persistent and pleomorphic symptoms after documented or suspected Lyme borreliosis. Another condition is eventually diagnosed in 80% of them.     

Presence of Visceral Larva Migrans in the Urinary Bladder of a Woman in Khorramabad,Iran

The presence of Visceral Larva Migrans (VLM) in a patient is reported. A 57-year- old woman suffering from right upper abdominal and suprapubic pain referred into a clinic in Khorramabad, Lorestan Province, Iran. A cystoscopy was performed and biopsy was taken. The light microscopic study showed a couple of larvae as well as mononuclear inflammatory cell- infiltration. Because occurrence of VLM is potentially problem in rural areas, it is recommended that an educational program to be initiated to prevent and control VLM infection in both rural and urban people. Clinicians also should consider the clinical features of visceral larva migrans.     

In vitro studies on cervical contraception: use of urea as a spermicidal agent.

Examination of the tails of Dalkon Shields removed from patients showed that approximately 34% of the tails had breaks or holes in the nylon sheath immediately below the double knot at the base of the Shield. The location of these holes is such that most of them would have been within the endometrial cavity. For control purposes, unused sterile Shields were removed from their pouches, and the tails were inspected for breaks in the sheath. Breaks were found in approximately 9% of these. Most of the holes were in the same location as those seen in tails removed from patients.The internal contents of the short terminal segments of Dalkon tails located beyond the double knot, from Shields removed from patients, were studied. Thirty-five (35) segments were evaluated by phase contrast microscopy and 10 were studied subsequently by transmission electron microscopy. Bacteria were found within the interfilamental spaces inside the sheath of 8 of the 10 tails. These observations suggest that bacteria which have ascended through the tail from the vagina could exit through these breaks in the sheath or from the terminal end of the tail directly into the endometrial cavity. The potential clinical implications of the data presented in this paper must be taken into consideration in the management of the non-pregnant asymptomatic wearer of a Dalkon Shield.     

Cutaneous larva migrans in children in a school of center-western Brazil

This paper reports an outbreak of cutaneous larva migrans in children of a school located in Campo Grande, MS. Six out of the 16 students (37.5%) acquired this parasitic dermatitis in two playgrounds contaminated by cat feces, in which ancylostomid larvae were found. The serpiginous lesions and/or papules were located in the hands, feet, buttocks, thighs, vulva and scrotum. Control measures of this parasitosis are discussed.     

Cutaneous larva migrans in Hospital Kuala Lumpur, Malaysia: rate of correct diagnosis made by the referring primary care doctors

A retrospective study was undertaken to determine the clinical features of cutaneous larva migrans (CLM) seen in the Department of Dermatology, Hospital Kuala Lumpur (Kuala Lumpur, Malaysia) and to assess the rate of correct diagnosis made by the referring primary care doctors. Clinical records of all 31 patients with CLM seen between January 2006 and June 2010 were retrieved. The majority of patients were male. The mean age was 32.2 years. Pruritus was reported in 83.9% of cases and serpiginous tracts in 100%. The mean lesion count was 4.4 and the mean duration of disease before presentation was 3.1 weeks. The majority of skin lesions were on the buttock and lower extremities. Only 45.2% of patients had the correct diagnosis made by the referring primary care doctors. Older age of patients and lower number of lesions were associated with a higher rate of correct diagnosis. The low rate of correct diagnosis made by the referring primary care doctors to the dermatologists in this study warrants the need for education of not only primary care doctors but also future primary care providers, consisting of medical students, house officers and junior medical officers.     

Advances in molecular identification, taxonomy, genetic variation and diagnosis of Toxocara spp

The genus Toxocara contains parasitic nematodes of human and animal health significance, such as Toxocara canis, Toxocara cati and Toxocara vitulorum. T. canis and T. cati are among the most prevalent parasites of dogs and cats with a worldwide distribution. Human infection with T. canis and T. cati, which can cause a number of clinical manifestations such as visceral larva migrans (VLMs), ocular larva migrans (OLMs), eosinophilic meningoencephalitis (EME), covert toxocariasis (CT) and neurotoxocariasis, is considered the most prevalent neglected helminthiasis in industrialized countries. The accurate identification Toxocara spp. and their unequivocal differentiation from each other and from other ascaridoid nematodes causing VLMs and OLMs has important implications for studying their taxonomy, epidemiology, population genetics, diagnosis and control. Due to the limitations of traditional (morphological) approaches for identification and diagnosis of Toxocara spp., PCR-based techniques utilizing a range of genetic markers in the nuclear and mitochondrial genomes have been developed as useful alternative approaches because of their high sensitivity, specificity, rapidity and utility. In this article, we summarize the current state of knowledge and advances in molecular identification, taxonomy, genetic variation and diagnosis of Toxocara spp. with prospects for further studies.     

Risk factors for toxocaral ocular larva migrans: a case-control study.

Twenty-four patients with serologically confirmed toxocaral ocular larva migrans (OLM) and 24 age- and sex-matched controls were the subjects of an epidemiologic study. Information on the exposure to dogs and other factors possibly associated with transmission of toxocariasis was obtained by contacting the parents of the subjects. The odds of having had a dog present in the household within the year previous to onset of illness were 3 to 1 for cases vs controls. An association of pups (< 3 months) in the households of OLM patients within one year of onset was statistically significant (P < .05). Twenty-three of 24 OLM patients had had dogs in their homes some time before their illness, and the twenty-fourth patient had a history of geophagia, a behavioral pattern previously identified as a risk factor for toxocariasis. Exposure to cats and other animals in or outside the home did not differ for patients and controls. Infected dogs, especially pups, in the patients' homes were the most probably sources of infection for this group of OLM patients.     

The prevalence of Toxocara species ova in backyards and gardens of Baltimore, Maryland.

Toxocara species ova were found in 16 of 146 (11 per cent) soil samples collected from backyards and gardens of private residences within Baltimore City. The recovery rate of parasite ova was similar for households regardless of their grouping by pet ownership characteristics or the presence of visible animal feces. The findings demonstrate the common occurrence of these eggs in locations likely to be important in the transmission of visceral larva migrans.     

Endometrial morphology with copper-bearing intrauterine devices

Copper-containing intrauterine devices such as the endouterine Copper T (CuT) first developed by Zipper and Tatum appear to offer great promise. The clinical effectiveness of these devices and their low rate of associated side effects such as expulsion, bleeding, and cramping compare favorably with other devices.The antifertility effect of the CuT is believed to be related to the metallic copper covering. Experimental data suggest that a local, rather than a systemic, contraceptive mechanism is operative due either to direct spermatocidal action, the inhibition of implantation, or a combination of these.The present study was undertaken to extend the electron microscopic studies of CuT-IUCD-bearing endometria using both scanning and transmission electron microscopy and to examine copper distribution utilizing an energy dispersive X-ray analyzer.     

Toxocariasis in Poznan region,Poland, in years 1990-2000

The results of multidisciplinary studies on toxocariasis in Poznan region, Poland carried out in 1990-2000 in co-operation with CDC, Atlanta GA, USA are summarised as follows. In Poznan region toxocariasis in dogs, cats and foxes is common. Environmental contamination with Toxocara spp. eggs was higher in courtyards between apartment houses in the centres of cities than in sandboxes and in rural or recreational areas. High percentage of the T. cati eggs found raises the yet unanswered question how frequent is T. cati toxocariasis in humans? Seroepidemiological studies demonstrated a rather high percentage of positive results in urban population as well as in adults. The majority of toxocariasis cases in humans is asymptomatic even in the foci with a high soil contamination. Optic density OD405 = 1.200 in a commercial ELISA test was accepted as a border line between the toxocariasis cases usually asymptomatic and the cases, which might have symptoms. In toxocariasis a high correlation was found between the value of OD, eosinophilia and the clinical expression. A new classification of clinical toxocariasis was proposed, including incomplete larva migrans syndrome and neurotoxocariasis and an up-dated definition of covert toxocariasis. It was found that 5 days treatment with albendazole is equally effective as 3-weeks treatment with diethylcarbamazine. Considering the risk of ocular toxocariasis in non-intensive invasions one course of treatment with albendazole is suggested in every case of infection, even asymptomatic.