Abstract
Although infection with Toxocara canis or T. catis (commonly referred as toxocariasis) appears to be highly prevalent in (sub)tropical countries, information on its frequency and presentation in returning travelers and migrants is scarce. In this study, we reviewed all cases of asymptomatic and symptomatic toxocariasis diagnosed during post-travel consultations at the reference travel clinic of the Institute of Tropical Medicine, Antwerp, Belgium. Toxocariasis was considered as highly probable if serum Toxocara-antibodies were detected in combination with symptoms of visceral larva migrans if present, elevated eosinophil count in blood or other relevant fluid and reasonable exclusion of alternative diagnosis, or definitive in case of documented seroconversion. From 2000 to 2013, 190 travelers showed Toxocara-antibodies, of a total of 3436 for whom the test was requested (5.5%). Toxocariasis was diagnosed in 28 cases (23 symptomatic and 5 asymptomatic) including 21 highly probable and 7 definitive. All but one patients were adults. Africa and Asia were the place of acquisition for 10 and 9 cases, respectively. Twelve patients (43%) were short-term travelers (< 1 month). Symptoms, when present, developed during travel or within 8 weeks maximum after return, and included abdominal complaints (11/23 symptomatic patients, 48%), respiratory symptoms and skin abnormalities (10 each, 43%) and fever (9, 39%), often in combination. Two patients were diagnosed with transverse myelitis. At presentation, the median blood eosinophil count was 1720/μL [range: 510–14160] in the 21 symptomatic cases without neurological complication and 2080/μL [range: 1100–2970] in the 5 asymptomatic individuals. All patients recovered either spontaneously or with an anti-helminthic treatment (mostly a 5-day course of albendazole), except both neurological cases who kept sequelae despite repeated treatments and prolonged corticotherapy. Toxocariasis has to be considered in travelers returning from a (sub)tropical stay with varying clinical manifestations or eosinophilia. Prognosis appears favorable with adequate treatment except in case of neurological involvement.
Highlights
Toxocariasis, caused by intestinal roundworm of dogs (Toxocara canis) or cats (Toxocara catis), is a zoonotic infection with a worldwide distribution [1,2]
Toxocariasis is a zoonosis of worldwide distribution caused by dog (Toxocara canis) or cat (T. catis) roundworm that can be fully asymptomatic or may cause significant disease such as a the systemic syndrome called visceral larva migrans as well as neurological or eye manifestations
We describe in detail a case series of 28 international travelers, mostly adults, diagnosed with toxocariasis from 2000 to 2013 at the reference travel clinic of the Institute of Tropical Medicine of Antwerp, Belgium
Summary
Toxocariasis, caused by intestinal roundworm of dogs (Toxocara canis) or cats (Toxocara catis), is a zoonotic infection with a worldwide distribution [1,2]. Humans can get infected by ingestion of embryonated eggs present on the soil, plants or soil-dwelling invertebrates contaminated by dog or cat feces, and less frequently by ingestion of encapsulated larvae from undercooked paratenic hosts such as chickens, cattle and sheep. Presentation may be acute or sub-acute, with systemic, abdominal or respiratory manifestations, classically described as the syndrome of visceral larva migrans (VLM) sometimes associated with dermatological symptoms as well. A distinct clinical presentation called “covert” (in children) or “common” (in adults) toxocariasis has been described more recently, with more subtle and chronic symptoms such as cough, abdominal pain or pruritus, associated with mild eosinophilia and Toxocara spp. seropositivity [4,5,6]. It is assumed that most cases of human toxocariasis go unrecognized
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