1/76. Pars plana vitrectomy and subretinal surgery for ocular toxocariasis. The clinical course of ocular toxocariasis and the chronological development of peripheral retinal and macular granulomas are reported. Removing the epiretinal as well as subretinal component of the granuloma via pars plana vitrectomy and retinotomy techniques yielded an excellent clinical result. Clinicopathologic correlation of the specimen confirmed the diagnosis with histological evidence of degenerated larval structures in granulomatous inflammation. ( info) |
2/76. Ocular toxocariasis: a rare presentation of a posterior pole granuloma with an associated choroidal neovascular membrane. BACKGROUND: Ocular toxocariasis is a rare infection caused by the nematode larvae of toxocara canis, which is commonly found in dogs. Human transmission is usually via geophagia, the ingestion of food contaminated with the toxocara eggs, or contact with infected puppies, often resulting in devastating ocular and/or systemic effects. Distribution is worldwide; however, a higher incidence is demonstrated in the united states. methods: A 17-year-old black woman sought treatment at a neighborhood health center with a report of gradual decrease in vision from her left eye over a 3-month period. Her ocular and systemic histories were unremarkable. Anterior segment evaluation revealed no signs of anterior uveitis. The posterior pole showed a 1.5 DD, round, raised, white, subretinal lesion adjacent to the fovea with an overlying serous retinal detachment and retinal hemorrhage. RESULTS: She was referred to a retinologist who performed both fluorescein and indocyanine green (ICG) angiographies. A serum toxocara ELISA test was also ordered. fluorescein angiography revealed hyperfluorescence consistent with the granuloma. The ICG demonstrated an occult choroidal neovascular membrane (CNV) underlying the area of hemorrhage inferotemporal to the granuloma. CONCLUSION: This paper illustrates the case presentation and includes an extensive review of the ocular and systemic manifestations of toxocariases. A description of ICG videoangiography, therapeutic approaches, and management will also be discussed. ( info) |
| PURPOSE: To study the results of modern vitrectomy in traction and combined traction-rhegmatogenous retinal detachment involving the macula in cases of ocular toxocariasis. methods: This was a cohort study of patients seen in different institutions in the united states. Ten eyes of 10 patients were studied. vitrectomy was performed in all eyes, combined with membrane removal, scleral buckle, fluid-gas exchange, silicone oil, or lensectomy in certain cases. The anatomic and visual results of surgery were reviewed. RESULTS: Ten eyes from 10 patients ranging in age from 2 to 33 years (median, 6 years) were reviewed. Follow-up ranged from 3 months to 8 years (median, 2 years). All eyes achieved macular attachment following surgery; vision improved in 5 (50%) eyes, and was unchanged in 5 (50%). Histologic specimens from six eyes were reviewed, and revealed combinations of fibrous tissue, eosinophils, plasma cells, lymphocytes, and giant cells. One specimen revealed an encysted toxocara canis organism. CONCLUSION: inflammation created in response to Toxocara larvae may lead to traction retinal detachment of the macula. vitreoretinal surgery has a good chance of reattaching the macula and improving vision. ( info) |
| This case report describes nephrotic syndrome in a 7-year-old boy coincident with toxocara canis infection. This rare association was confirmed by elevated Toxocara-specific IgM titres. Treatment with corticosteroids resulted in remission of renal symptoms as well as abatement of the T. canis infection. The relationship between T. canis infection and glomerular disease is still unclear; nephrotic syndrome may be another manifestation of T. canis infection. ( info) |
5/76. A case of presumed ocular toxocariasis in a 28-year old woman. This is a case of presumed ocular toxocariasis in a 28-year old woman complaining of a sudden onset of nasal side field defect of the right eye. The patient had been suffering from uveitis for ten months. Fundoscopic examination of the right eye showed a rhegmatogenous retinal detachment. Furthermore, a retinochoroidal granulomatous lesion was observed nearby the tear site. scleral buckling, cryotherapy, and gas injection(SF6, pure gas, 0.7 cc) were conducted. mebendazole was prescribed for one month at 25 mg/kg per body weight daily. Even though the interventions resulted in the recovery of the field defect, anti-Toxocara IgG and IgE titer levels did not decrease when checked three months after the treatment ended. This is the first confirmed serological ocular toxocariasis case in korea. uveitis may be a clinical presentation prior to retinal detachment of a person with toxocariasis. ( info) |
6/76. Eosinophilic pleocytosis and myelitis related to toxocara canis infection. toxocara canis causes the visceral larva migrans syndrome in which central nervous involvement is rare. We report the case of a 40-year-old woman presenting with a subacute weakness of the right leg and dysaesthesiae in the right Th8-Th10 dermatomas. Spinal magnetic resonance imaging examination showed abnormal hyperintensity within the spinal cord. cerebrospinal fluid analysis revealed eosinophilic pleocytosis. Antibody titres to toxocara canis were higher in the cerebrospinal fluid than in the serum. Treatment using mebendazole led to a complete clinical recovery, normalization of cerebrospinal fluid parameters and improvement in spinal magnetic resonance imaging abnormalities. ( info) |
| parasitic diseases which during their course in the host switch the immune system from a T helper 1 to a T helper 2 response may be detrimental to the host, contributing to granuloma formation, eosinophilia, hyper-IgE, and increased susceptibility to bacterial and fungal infections. patients and animals with acute schistosomiasis and hyper-IgE in their serum develop pyogenic liver abscess in the presence of bacteremia caused by staphylococcus aureus. The salmonella-S. mansoni association has also been well documented. The association of tropical pyomyositis (pyogenic muscle abscess) and pyogenic liver abscess with Toxocara infection has recently been described in the same context. In tropical countries that may be an interesting explanation for the great morbidity of bacterial diseases. If the association of parasitic infections and pyogenic abscesses and/or fungal diseases are confirmed, there will be a strong case in favor of universal treatment for parasitic diseases to prevent or decrease the morbidity of superinfection with bacteria and fungi. ( info) |
| A girl with myelodysplastic syndrome (RAEB-T) received HLA-identical bone marrow from her younger brother after myeloablative treatment with busulfan and cyclophosphamide. After bone marrow transplantation, fever, exanthema, pruritis, and a pulmonary infiltrate were treated symptomatically. Bacterial cultures remained negative. Leukocyte engraftment began on day 10, and all blood cell populations proved to be of donor origin on FISH analysis. Increasing IgE levels (21 000 U/ml) on day 14 after BMT, positive RAST, specific IgG-antibodies, and missing Toxocara (T.) canis antigens in the recipient indicated donor-derived seroconversion. Before BMT, the recipient had been negative for T. canis in routine parasitological screening, and the donor proved to be positive for T. canis antibody by ELISA. This report suggests that the transfer of IgE immunity in the absence of detectable antigens may be responsible for IgE-mediated symptoms consistent with toxocara infection and confirms the need for parasite screening in donor medical examinations. ( info) |
9/76. eosinophil cationic protein as a possible marker of active human Toxocara infection. BACKGROUND: Human toxocariasis is a common, worldwide helminthozoonosis that may elicit syndromes including various allergy symptoms. The diagnosis relies upon specific serology. However, this parasitosis is often self-limiting, and many subjects have residual antibodies, thus making differential diagnosis quite difficult when blood eosinophilia, a commonly accepted criterion of active helminthiasis due to tissue-dwelling parasites, is lacking. methods AND RESULTS: We present a patient with chronic irritant cough displaying negative allergologic screening, normal blood eosinophilia, but positive toxocariasis immunodiagnosis. Therefore, this case presented the fortuitous association of an unexplained allergic picture with residual anti-Toxocara antibodies. In an attempt to distinguish between active and past toxocaral infection, the subject's level of eosinophil cationic protein (ECP) was assessed and then compared to those of four control groups, namely, healthy volunteers, subjects presenting anti-Toxocara residual antibodies, patients with various helminthiases, and patients with active toxocaral disease. Since the patient's ECP level was found to be sharply elevated, we hypothesized that viable Toxocara larvae were still present in the tissues, and the patient was given anthelmintic therapy. At the control checkup, the cough had waned and the ECP level had decreased to below the mean value observed in both healthy subjects and in subjects with past toxocaral infections. CONCLUSIONS: These data suggest, first, that patients presenting unexplained allergic syndromes should be checked for helminthiases, even if blood eosinophilia is lacking, and, second, in such subjects displaying positive toxocariasis immunodiagnosis, ECP assessment would be a useful marker to distinguish between active and past toxocaral disease. ( info) |
| Vasculitis associated with helminthic infection is rare. We report a case of systemic negative antineutrophil cytoplasmic antibodies vasculitis associated with toxocara canis infection documented by enzyme-linked immunosorbent assay and Western blot analysis. This case report is unusual because of lymphocytic temporal arteritis and renal involvement. The spontaneous remission of systemic vasculitis without use of steroids or immunosuppressive agents favors a close relationship between vasculitis and the parasite that is more than a coincidental association. To our knowledge, this is the first observation of temporal vasculitis associated with helminthic infection, extending the clinical spectrum of visceral larva migrans. ( info) |