Toxocariasis in Argentinian children

Abstract

Background: Toxocariasis is one of the most widely distributed zoonoses in the world. Clinical forms of presentation are:asymptomatic, ocular larva migrans(OLM) and visceral larva migrans(VLM). Methods & Materials: We retrospectively studied children with toxocariasis assisted in a pediatric hospital in Buenos Aires from January 2012 to June 2017.Data were drawn from medical charts and analyzed using Epi.Info7.2. Results: In 73 patients toxocariasis was diagnosed, 71.2% (n = 52)had asymptomatic infection. Mean age was 76 months(SD:40.44) and the mean eosinophil count, 2402/mm (SD:1602). VLM was found in 9 children(12%) and 12 had OLM(16%). Among children with VLM, the mean age was 43 months(SD:22.44) and the mean eosinophil count: 13,429/mm (SD:13.398), significantly higher than the 2 other clinical forms.Four children with VLM were asymptomatic, 2 had diarrhea and abdominal pain, 2 polyadenopathies, 1 prolonged febrile syndrome, and 1 asthenia and lost weight. Liver involvement was found by ultrasound in 8 patients and 1 had pneumonitis with pericarditis. Among children with OLM, the mean age was 93 months (SD:46.56)and mean eosinophil count 537/mm (DS:373).Six had decreased visual acuity, 5 strabismus, 2 leukocoria, and 1 red eye. One patient presented ocular and central nervous system involvement (hemorrhagic stroke) and was admitted with faciobrachiocrural hemiparesis.Diagnosis of asymptomatic and visceral forms was made by reactive serology by ELISA and confirmed with Western Blott in 81%.OLM were diagnosed by the ophthalmological examination. They presented eosinophilia in 58% and reactive serology in 75%.VLM and active OLM received treatment with albendazole at 15 mg/kg/day.All the OLM cases presented sequelae,50% with retinal detachment and loss of vision of the affected eye. Asyntomatic and VLM forms had good evolution. Conclusion: In line with other settings the most frequent form of toxocariasis in this study was asymptomatic. Children with VLM were younger and had higher counts of eosinophils than asymptomatic and ocular forms. Patients with LMO had sequelae in 100% of children and vision loss in 50%.Due to the lack of diagnostic studies that allow predicting which subjects will evolve with visual or nervous system compromise, controversies arise in the management of this frequent disease.