| We described a patient with encephalopathy associated with visceral larva migrans (VLM) caused by ascaris suum. He suffered from drowsiness, quadriparesis, eosinophilia and elevated serum IgE levels. brain magnetic resonance (MR) imaging revealed multiple cerebral cortical and white matter lesions. Serological tests indicated recent infection with A. suum. pulse steroid therapy relieved the patient's central nervous system symptoms and marked improvement of lesions on brain MR images. We concluded that the encephalopathy in this patient was probably caused by VLM due to ascaris suum. ( info) |
| We report a case of tropical pyomyositis in a boy who presented with a severe febrile illness associated with diffuse erythema, and swelling in many areas of the body which revealed on operation extensive necrotic areas of various muscles that required repeated debridement. The patient gave a history of contact with dogs, and an ELISA test for toxocara canis was positive. He also presented eosinophilia and high serum IgE levels. staphylococcus aureus was the sole bacteria isolated from the muscles affected. We suggest that tropical pyomyositis may be caused by the presence of migrating larvae of this or other parasites in the muscles. The immunologic and structural alterations caused by the larvae, in the presence of concomitant bacteremia, would favour seeding of the bacteria and the development of pyomyositis. ( info) |
| We describe a case of visceral larva migrans syndrome complicated by liver abscess, pericardial effusion and ascites. To our knowledge, these findings have not been reported previously. The structural and immunological alterations caused by visceral larva migrans are thought to lead to the development of visceral abscesses. ( info) |
4/64. Radiologic-pathologic findings in raccoon roundworm (Baylisascaris procyonis) encephalitis. A 13-month-old boy developed eosinophilic meningoencephalitis, retinitis, and a protracted encephalopathy with severe residual deficits. The initial MR examination revealed diffuse periventricular white matter disease, and follow-up images showed atrophy. brain biopsy, serology, and epidemiologic studies lead to the diagnosis of Baylisascaris procyonis infection, a parasitic disease contracted through exposure to soil contaminated by the eggs of a common raccoon intestinal roundworm. The pathologic, epidemiologic, and imaging features of this disease are herein reviewed. ( info) |
| A 9-year-old child with miliary pulmonary infiltrates, eosinophilia, and hyperimmunoglobulinemia E recovered rapidly cover a four-week period. Subsequent analysis of serum samples by a solid phase radioimmunoassay technique demonstrated IgM, IgE, and IgG antibodies to ascaris suum antigen which declined following the acute phase of the illness in parallel with a decline in serum IgM, IgE, and IgG concentrations. Precipitating antibodies in serum against Ascaris antigen were demonstrated. The diagnosis is considered to be toxocariasis or ascariasis. The application of sensitive radioimmunoassay techniques of this type should provide a method of earlier diagnosis and the demonstration of rapidly changing antibody levels a method of confirming the diagnosis in parasitic diseases. ( info) |
6/64. Severe hepatic involvement in visceral larva migrans. Because of its anatomical position, the liver may be involved in many protozoan and helminthic gastrointestinal infections. Visceral larva migrans caused by toxocara canis is rarely taken into account in adult patients with cholestatic syndrome, especially when liver disease is not associated with hypereosinophilic reaction. We report on a 74-year-old immunocompetent woman who presented with fever, bronchospasm, erythema nodosum, weight loss and progressive jaundice. A liver biopsy showed caseating granulomatous hepatitis with secondary portal fibrosis and paucity of interlobular bile ducts. A step-by-step search for aetiological factors led us to a diagnosis of toxocariasis (positive enzyme-linked immunosorbent assay IgG test). An excellent clinical response to combined treatment with steroid and diethylcarbamazine, and a reduction in the antibody level against T. canis supported the diagnosis. Computed tomography and laparoscopy demonstrated multiple small mass lesions and fibrous perihepatitis. This report shows that visceral larva migrans may be a cause of prostrating chronic liver disease and should be suspected in every febrile patient with cryptogenic cholestatic hepatitis. ( info) |
7/64. Hepatic involvement of visceral larva migrans due to toxocara canis: a case report--CT and MR findings. Imaging findings of hepatic lesions of visceral larva migrans are reported. A 44-year-old man presented with chills, eruptions, marked leukocytosis (31,400/microlitter), and eosinophilia (eosinophil, 72%). Multiple liver nodules were detected as low-density lesions on computed tomography (CT). They were visualized as high signal intensity lesions on T2-weighted, and as low signal intensity lesions on T1-weighted magnetic resonance imaging (MRI). The patient was diagnosed as having visceral larva migrans due to toxocara canis, by Toxocara immnoserological test. After antihelmintic therapy, multiple liver nodules disappeared on CT. We consider that the differential diagnosis of multiple liver nodules should include visceral larva migrans. ( info) |
8/64. Visceral larva migrans due to ascaris suum which presented with eosinophilic pneumonia and multiple intra-hepatic lesions with severe eosinophil infiltration--outbreak in a Japanese area other than Kyushu. A 32-year-old man presented with the chief complaint of severe cough. Examination of peripheral blood showed a marked increase in eosinophils. Chest CT demonstrated multiple ground glass opacities in both lungs. bronchoalveolar lavage showed abundant eosinophils. Abdominal CT demonstrated multiple low attenuation areas in the liver. Liver biopsy with ultrasonography revealed severe eosinophil infiltrations around the portal veins. Serologically, a multi-dot enzyme linked immunosorbent assay (DOT-ELISA) and ELISA inhibition test using microtiter plates were positive for ascaris suum. Thus, visceral larva migrans due to ascaris suum was diagnosed. Outbreaks of this disease in japan have previously been confined to the Kyushu area. The present case which occurred outside that area, illustrates the importance of constant attention to the epidemiology of this disease. ( info) |
9/64. Chronic eosinophilic pneumonia due to visceral larva migrans. A 38-year-old woman presented with worsening cough, blood eosinophilia, and pulmonary infiltrates. bronchoalveolar lavage showed 96.4% eosinophils. The diagnosis of visceral larva migrans (VLM) was made based on the positive results in enzyme-linked immunosorbent assay for toxocara canis together with clinical symptoms and laboratory data. Pulmonary infiltrates due to VLM generally manifest as a transient form of Loffler's syndrome or simple eosinophilic pneumonia mainly in children. Here we report an adult case of VLM, with pulmonary infiltrates pathologically proven to be eosinophilic pneumonia, which persisted for 7 weeks before anthelmintic treatment with albendazole and manifested as chronic eosinophilic pneumonia. ( info) |
| A 26-year-old man who was diagnosed with myocarditis presented eosinophilia after having eaten raw meat several times before the admission. Since the antibody titer against toxocara canis was high, we diagnosed that he had visceral larva migrans due to toxocara canis associated with myocarditis and eosinophilia. He was then treated with oral albendazole and prednisolone for 4 weeks and eosinophil count and hepatic enzymes were normalized along with the decrease in the antibody titer. We consider that his myocarditis was probably caused by direct larval migration and/ or by hypersensitivity reaction, for which combined therapy with albendazole and prednisolone was effective. ( info) |