Visceral larva migrans syndrome: analysis of serum cytokine levels in children with hepatic lesions confirmed in radiological findings.

Abstract

Human toxocariasis is a helminth zoonosis resulting from accidental infection of humans by the roundworms Toxocara canis (T. canis) and cati (T. cati). The infection occurs in five forms: systemic (VLM), ocular, neurological, covert and asymptomatic. The aim of this study was to characterize the radiological and immunological findings in hepatic inflammation during the course of systemic infection by Toxocara sp. in children. Fifteen children, 2 to 17 years of age, with serological diagnosis of T. canis infection underwent abdominal ultrasonography and computer tomography (CT). Eosinophil counts, immunoglobulin E titres, interleukins IL-1α, IL-4, Il-6, IL-10 and interferon gamma were measured for all patients. Abdominal ultrasound revealed multiple hypoechoic areas in the livers of all patients. On the CT images, the hepatic lesions were seen as multiple, ill-defined, oval low-attenuating nodules that measured 6 to 9 millimetres in diameter. The nodules were usually best seen in the portal venous phase and were not seen on arterial-phase images. Significant intergroup differences were observed in the concentrations of IL-1α, IL-4, IL-6 and IL-10. The level of IFN-γ was not significantly elevated in patient sera relative to controls. The analysis shows that the production of anti-inflammatory cytokines is insufficient for granuloma formation in children presenting liver lesions in the course of VLM.