Abstract
Human toxocariasis is one of the most prevalent helminthiases worldwide. Toxocara canis larvae can cross the blood–brain barrier leading to the neurotoxocariasis. The clinical presentation consists of a wide spectrum of neurological manifestations, but asymptomatic infection is probably common. Neurotoxocariasis is not a frequent diagnosis probably due to the non-specific nature of its symptoms as well as the lack of confirmatory diagnostic tests. Diagnosis of neurotoxocariasis is based on the presence of a high titer of anti-Toxocara antibody in the cerebrospinal fluid or in the serum, presence of eosinophilia in the serum or cerebrospinal fluid, and clinical and radiological improvement after anthelmintic therapy; however, universally accepted diagnostic criteria are lacking. Magnetic resonance imaging (MRI) findings include single or multiple, subcortical, cortical or white matter hyperintense lesions, best visualized on FLAIR and T2-weighted imaging, and usually isointense or hypointense on T1. These imaging findings are suggestive but not specific to neurotoxocariasis. Definitive diagnosis is made by histological confirmation, but it is rarely followed. This review provides an overview of the clinical manifestations, management options, and MRI findings of neurotoxocariasis.
Highlights
Human toxocariasis is a parasitic zoonosis caused by the larval stages of the ascarids Toxocara canis, the common roundworm of dogs, and probably by the roundworm of cats (Toxocara cati) as well
Since the first reported case of neurotoxocariasis who underwent a brain Magnetic resonance imaging (MRI), published in 1991, we identified 48 articles [21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68] including three case series [25, 27, 28] involving a total of 104 patients with neurological manifestations in the Central Nervous System (CNS) [either myelitis (n = 70, 67.3%) or cerebral toxocariasis (n = 34, 32.7%)]
Toxocariasis is highly prevalent; neurotoxocariasis is rarely taken into account as a differential diagnosis in clinical settings
Summary
Human toxocariasis is a parasitic zoonosis caused by the larval stages of the ascarids Toxocara canis, the common roundworm of dogs, and probably by the roundworm of cats (Toxocara cati) as well. Toxocariasis is one of the most prevalent worldwide, especially in settings where human–soil–dog contact is common. Toxocara is a nematode that usually inhabits the small intestine of the host; dogs can become infected by transplacental spread or by contact with contaminated feces. Humans can become infected by direct contact with dogs or by the ingestion of contaminated food or soil. Ingested eggs develop into juvenile larvae that cross the small intestine and migrate to any organ through the circulatory system, resulting in a multisystemic inflammatory tissue reaction. Two different syndromes have been described: covert toxocariasis, which is more common in children and common toxocariasis, reported in adults, both characterized by mild Toxocara infection and less-severe systemic manifestations [4]
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