Diagnosis Of Toxocariasis Research Articles

Diagnosis and correction of immunological reactivity disorders in tuberculosis and toxocariasis infection

The article is a systematic review of the literature on toxocariasis and tuberculosis. Human toxocariasis is a neglected tropical disease that has a global distribution and a significant impact on global public health. The infection can lead to a number of serious conditions in humans, including in cases associated with other infections. Invasion with Toxocara canis represents a strong endogenous factor in the formation of the regulatory imbalance of the immune system, which is manifested by the decrease in phagocytosis indices, the increase in the content of circulating immune complexes, and total IgE. The integral evaluation of these indices serves as an important criterion in the diagnosis of toxocariasis and the effectiveness of the applied therapy. Immunosuppression caused by parasites inhibits metabolic processes in the human body, and enzyme activity, making it difficult to absorb antiparasitic, antibacterial, and other chemotherapeutic drugs. Therefore, the treatment of tissue helminthiasis is difficult, because the larvae are in the tissues, while antiparasitic drugs do not have a high absorption capacity. Decreased eosinophils and IL-10 indicate that asymptomatic helminth infection significantly suppresses immunity in tuberculosis patients. The association of pulmonary tuberculosis wit toxocariasis is a combination of two diseases with severe endogenous intoxication, which is insufficiently elucidated.

Deglycosylation of Excretory-Secretory Antigens of the Second-Stage Larvae of Toxocara cati Improves Its Efficacy in the Diagnosis of Human Toxocariasis.

Toxocariasis is an important zoonotic infection, especially in tropical areas. One of the significant challenges in the serodiagnosis of human toxocariasis is the cross-reaction of Toxocara antigens with other parasites due to their relatively similar glycan structures. Removing the glycan structure from Toxocara excretory-secretory (TES) antigens may increase the efficacy of these antigens in the diagnosis of toxocariasis. The current study aimed to assess the efficacy of deglycosylated Toxocara cati excretory-secretory (dTES) antigens for the serodiagnosis of human toxocariasis. Toxocara ES antigens were prepared from T. cati second-stage larvae and deglycosylated using sodium hydroxide (NaOH). The TES antigens, along with the dTES antigens, were used in an ELISA as well as a western blotting system for the detection of anti-Toxocara antibodies. Sera samples collected from 30 confirmed cases of toxocariasis, 30 patients with other diseases, and 30 healthy subjects were evaluated by both systems. The sensitivity of TES and dTES ELISA for the diagnosis of human toxocariasis was 96.67% (95% CI = 82.78-99.92) and 93.33% (95% CI = 77.93-99.18), respectively, while the specificity of dTES (88.33%; 95% CI = 77.43-95.18) increased significantly compared to the TES (80.00%; 95% CI = 67.67-89.22). The sensitivity of both antigens was 100% (95% CI = 88.43-100) by the western blotting system. Moreover, the specificity of TES and dTES antigens was 95% (95% CI = 86.08-98.96) and 98.33% (95% CI = 91.06-99.96), respectively, when using the western blotting system. Results of the current study indicate that the chemical removal of the glycan epitopes of T. cati ES antigens significantly reduces cross-reactivity rates with other parasitic infections. Considering the findings of the present study, the dTES antigens seem to be suitable antigens for the serodiagnosis of human toxocariasis.

#37 Human Toxocariasis: eleven-year experience in a tertiary-care level pediatric hospital in Mexico City

Abstract Background In Mexico, human toxocariasis is not subject to continuous epidemiological surveillance. However, some studies that report seroprevalence show a significant association between larva migrans (LM) and pediatric cases (OR 3.2; IC95 2.541-4.279). Data is scarce about infection in animal reservoirs, more specifically dogs, in which there are reports of a 12-18% positivity rate. As for the role of the environment there is evidence to support high contamination levels. Most symptomatic pediatric patients develop ocular presentations that can lead to permanent vision loss, and diagnosis becomes a challenge because serological markers and peripheral eosinophilia can be absent. Method A retrospective, transverse, descriptive study including 17 patients with diagnosis of toxocariasis according to electronic medical records. For categoric variables, frequencies and percentages were analyzed and for discrete variables median and ranges were calculated. Results Nine patients (52.9%) presented with ocular LM of which, 55.6% were female with a median age of 5 years at diagnosis (IQR=9). 44.4% came from the coastal state of Veracruz and 88.9% had close contact with either dogs or cats. Two patients presented with eosinophilia and only one had positive anti-Toxocara antibodies at 2.12 OD. Under suspicion of retinoblastoma, two patients underwent enucleation and diagnosis was made with pathology findings. Eight patients (47.1%) presented with visceral LM of which, 62.5% were female with a median age of 7.5 years at diagnosis (IQR=12). 62.5% of them had close contact with either dogs or cats. In this case, all patients had history of peripheral eosinophilia but it was only in 75% that it was corroborated during initial workup at our institution ranging between 500-9400 cells/mm3 and all of them had positive antibodies that ranged between 1.02-3.2 OD. Five patients received oral treatment with albendazole for 3-7 days. Conclusion Human toxocariasis is a neglected parasitic disease with scarce published data. Pediatric patients are an important vulnerable group specially for ocular presentations. The differential diagnosis of leukochoria should always include retinoblastoma, but as shown in this study, also ocular LM. As new approaches to global health move towards prevention, our study can set a precedent in order to standardize patient care and resource allocation.

Changes in the expression of miR-103a and miR-21: a functional diagnosis of toxocariasis in rats.

Introduction. Toxocariasis is a zoonotic parasitic disease caused by migrating nematode worms, Toxocara species larvae, within tissues. MicroRNAs (miRNAs) are small RNA molecules that regulate gene expression at a post-transcriptional level.Hypothesis/Gap Statement. miRNA-based diagnostic biomarkers for toxocariasis are emerging, but there is limited information about the role of many miRNAs and a more detailed diagnostic evaluation of miRNA expression patterns is needed to understand their immunobiological function.Aim. We investigated the expression levels of circulating miRNA 21 and miRNA 103a as potential biomarkers for the prediction and diagnosis of toxocariasis in Wistar rats infected with Toxocara canis.Methodology. Thirty Wistar rats were inoculated orally with 2500 T. canis embryonated eggs via gavage. Serum samples were collected from infected animals and were tested against T. canis antigens for 60 days post-infection. The plasma samples were isolated for quantitative real-time PCR (qPCR) assays and qPCR was used to assess transcription levels of miRNA 21 and miRNA 103a.Results. The prevalence of anti-Toxocara IgG was detected in 7/30 (23.3 %) infected rats. Molecular analysis of miRNAs 21 and 103a showed that expression levels of miRNAs in both groups of Toxocara-positive and negative samples were the same without significant association. The ratio of housekeeping gene expression (U6) to gene expression of miRNAs 21 and 103a indicated the rate of change (1/1.38 ≈ 0.75 and 1/0.751 ≈ 1.3, respectively).Conclusion. Our study revealed that miRNAs 21 and 103a might play fundamental roles as biomarkers and diagnostic tools for toxocariasis. However, the changes in expression of these miRNAs were not adequate to be used as biomarkers in diagnosis.

Neglected parasitic infection: Ocular toxocariasis case report

Ocular toxocariasis is an uncommon worldwide parasitic infection that affects mostly children and is found in both rural and metropolitan areas. In many parts of the world, parasitic infections of the eye are a major cause of blindness. The diagnosis of toxocariasis is essentially clinical, based on the lesion morphology and supportive laboratory data such as serum enzyme-linked immunosorbent assay (ELISA) titers and ELISA Toxocara titers on aqueous humor; other diagnostic methods are imaging studies including optical coherence tomography, fluorescein angiography, computed tomography, and ocular ultrasound. Treatment is directed at complications arising from intraocular inflammation and vitreous membrane traction. Early vitrectomy may be of value both diagnostically and therapeutically.

Clinic and diagnosis of toxocariasis in children

Toxocariasis is a zoonotic invasion with a long relapsing course (from several months to several years) and polymorphic clinical manifestations of an immunological nature. The causative agents of toxocariasis belong to the class of roundworms of the genus Toxocara. Two species of this genus are known: T. canis is a helminth of the canine family and T.cati is a helminth of the cat family. The role of T. canis in human pathology has been firmly established, and T. cati is still under discussion. These nematodes are widespread in cats and dogs. Affected animals excrete a huge number of eggs with feces, causing a high contamination of the soil. Up to 50% of samples from children's sandboxes contain invasive toxocara eggs, which are very resistant and persist in the soil for several years. Children under 5 years of age are most commonly infected. The main source of infestation for children are dogs, especially puppies. Infection occurs through direct contact with an infested animal whose coat is infected with infective eggs. Children with geophagy are most at risk of infection, especially when playing in the sand or with a dog.

Epidemiological aspects of toxocariasis in the astrakhan region in 2000–2019

The clinical and epidemiological situations of toxocariasis were analyzed following the International Classification of Diseases X revision (B83.0 Visceral form of diseases caused by the migration of helminth larvae [visceral Larva migrans]. Toxocariasis) in the Astrakhan region from 2000 to 2019. During this period, 76 (0.096%) cases of toxocarous infestation in humans were reported. Clinically, typical toxocariasis was found in 53 (69.7%) cases, and atypical (erased or asymptomatic) was noted in 23 (30.3%) cases. A typical toxocariasis presented as a gastrointestinal lesion in 32 (60.4%) patients, pain in the epigastric region in 31 (96.9%), complaints in the right hand in 12 (37.5%), bloating in 4 (12.5%), decreased and/or lack of appetite and nausea in 7 (21.9%), coughing in 30 (93.8%), and feeling of asphyxiation at night in 6 (18.8%). In addition, toxocariasis was accompanied by muscle damage, manifested in the form of complaints of joint pain, in 13 (24.5%) cases and rapid fatigue in 12 (92.3%) cases. A mixed form of toxocariasis was observed, manifesting as complaints of general weakness in 8 (15.1%) cases, subphebrilitis in 7 (87.5%), allergic runny nose and urticaria in 6 (75%), and reduced body weight and stratification of nails correspondences in 3 (37.5%). Albendazole was used for treatment. Sanitary and parasitological analysis of soil samples from playgrounds in Astrakhan and Astrakhan region for the presence of eggs and larvae of helminths, as well as cysts of pathogenic intestinal protozoa, showed fairly high contamination of toxocar eggs in environmental objects. Thus, toxocariasis was registered in individuals of different ages (children and adults). The main causes of infection were close contact with domestic and stray animals, noncompliance with personal hygiene rules, as well as a tendency to geophagia. The criteria for the diagnosis of toxocariasis were the clinical manifestations of invasion and presence of antibodies of 1:800 and higher in the formulation of the immunoassay method.

Investigation of the Toxocariasis diagnosis in children attended in the pediatric care hospital

OBJECTIVE: This study aims to associate parasitological and hematological tests with the possible diagnosis of toxocariasis in children from Hospital Escola Wladimir Arruda's pediatric care, São Paulo, SP, Brazil. METHODS: Observational, retrospective cross-sectional study, carried out from an active search on medical records of children assisted from Hospital Escola Wladimir Arruda's pediatric care. Data collection was conducted in the first semester of 2021. Medical records of children aged 0-15 years seen at HEWA were reviewed and information was collected regarding signs and symptoms of parasitic infections, data on blood tests, request for parasitological examination and serology for toxocariasis. RESULTS: The research rated 101 medical records of children aged 0 to 15 years. Only 6 (5.4%) presented as diagnostic hypothesis about some type of parasitosis, however none of these had specific diagnosis request for human toxocariasis, as well as request stool examination or other specific examination for other parasitosis. Four (66.6%) of them had blood count data, among these 2 (33.3%) of them show data about eosinophil and leukocyte, which were with no alteration. Half of the suspected cases had dogs at home. CONCLUSION: The lack of protocol or even a specific script to be followed in parasitosis suspected case and especially toxocariasis reflects absence of research on this parasitosis.

Measurement of the IgG Avidity Index in the Diagnosis of Clinical Toxocariasis Patients

Toxocara spp. are parasitic nematodes responsible for human toxocariasis, a common zoonotic helminth infection. The five main features of human toxocariasis are the classical ocular toxocariasis and visceral larva migrans syndrome, followed by covert toxocariasis, common toxocariasis and neurotoxocariasis. The diagnosis of toxocariasis is feasible by considering clinical symptoms, anamnestic history and serology laboratory results; however, serological criteria cannot be used to distinguish active Toxocara infection from past exposure, which is an area of much discussion in clinical practice. In this context, we developed avidity tests (ELISA and immunoblotting) and evaluated their clinical usefulness in distinguishing past from active toxocariasis. Our study involved 46 patients divided into two groups: “active toxocariasis” (n = 14) and “chronic toxocariasis” (n = 32). According to the avidity indices obtained for both the chronic and active toxocariasis groups, we proposed two thresholds: first, an AI lower than 32% supports an active infection; secondly, a threshold above 42% can exclude an active infection. In order to use this assay in routine clinical practice, however, is still requires standardisation with regards to the method and threshold values, which can be established through studies involving larger populations.

The kinetic profile of clinical and laboratory findings and treatment outcome of patients with toxocariasis.

Human toxocariasis is a widespread zoonosis for which a chemotherapy decision and therapy effectiveness are difficult to determine. We aimed to investigate the kinetic profile of clinical and laboratory findings and treatment outcome of patients with toxocariasis in Vietnam. The prospective study was conducted between October 2017 and June 2019. The diagnosis of toxocariasis was established based on clinical, laboratory (eosinophilia, raised IgE concentration) and serological (positive Toxocara IgG ELISA) evaluation as well as the exclusion of another helminthic co-infection. The patients were followed up after seven days, then one, three and six months after chemotherapy by thiabendazole. The study involved 80 patients with a mean age of 41.6±15.2years of whom 58.8% were female. At three and six months after chemotherapy, most patients demonstrated resolution of clinical signs and symptoms, eosinophil count and IgE concentration but not in the proportion of IgG seropositivity. Skin lesions and eosinophilia resolved earlier than the other symptoms (one month after treatment). About four-fifths of the patients were "cured" after three and six months of follow-up; 33.8% showed side effects to thiabendazole therapy but no severe events were reported. The most common adverse reaction was neurologic symptoms followed by gastrointestinal or skin manifestations which lasted as long as 4days. In toxocariasis patients, cutaneous manifestations and eosinophilia resolve more rapidly than other clinical and laboratory findings while IgG titre has a very slow kinetic after therapy. Thiabendazole seems to be a potential alternative for the treatment of human toxocariasis.

Toxocarosis in the guise of tuberculosis

The variety of clinical manifestations and the absence of strictly specific features make tuberculosis and toxocariasis difficult to diagnose and treat. Doctors of various specialties are engaged in the diagnosis of toxocariasis, depending on which organ system is affected in a person and with whatsymptoms he turned to a medical institution.Purpose: to describe the case of detecting toxocariasis in a child who was treated in a tuberculosis hospital from a bacillary family contact with pronounced indicators of immunological tests and revealed changes during CT scan of the chest organs.A complex differential diagnostic path and constant medical supervision made it possible to establish a rather rare disease - toxocariasis in a child from family contact with a patient with tuberculosis.Conclusion. In the differential diagnostic series in patients withtuberculosis, the presence of parasitic diseases with a similar clinical and radiological picture cannot be excluded.

Clinical and Laboratory Findings among Patients with Toxocariasis in Medic Medical Center, Ho Chi Minh City, Vietnam in 2017-2019.

Background:Human toxocariasis is prevalent in many countries but this disease has been rarely reported from Vietnam. We aimed to investigate the clinical and laboratory findings and assess possible association between these findings in patients with toxocariasis in Vietnam.Methods:A prospectively study, between October 2017 and June 2019 was performed involving 120 toxocariasis patients at Medic Medical Center, Ho Chi Minh City, Vietnam. The diagnosis of toxocariasis was established based on clinical, laboratory (eosinophilia, raised IgE concentration) and serological (positive Toxocara IgG ELISA test) evaluation as well as the exclusion of other helminthic coinfection.Results:The most frequently reported manifestation was of skin (n = 93, 77.5%), including urticarial (n= 69, 57.5%) followed by neurologic, gastrointestinal and pulmonary signs/symptoms. Hepatic involvement occurred in 8.3% of the patients. No significant relationship between clinical findings and laboratory parameters was found except the higher values of eosinophil count and IgE concentration among patients with liver involvement. There was a significant relationship between eosinophil count and IgE concentration (r=0.389, P<0.001). Serological findings did not show a correlation with clinical and other laboratory findings.Conclusion:Our data revealed a wide range of clinical symptoms/signs and a high incidence of skin manifestations in patients with toxocariasis. Eosinophil count and IgE concentration are valuable markers for the evaluation of the disease.

Токсокароз у детей: эпидемиологические, клинические и лабораторные аспекты

Aim: to optimize the diagnosis of toxocariasis based on the analysis of epidemiological, clinical and laboratory data in children with the infestation. Patients and Methods: the analysis of official statistical data for the period of 2014–2018, literature sources, a retrospective analysis of 57 medical records of patients (40 children and 17 adults) who received treatment and diagnostic in the clinic of the Rostov Research Institute of Microbiology and Parasitology of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing in 2015–2018 was conducted. Results: a decrease in the incidence of newly diagnosed infestation cases was revealed (registered in the clinic of the Rostov Research Institute of Microbiology and Parasitology of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing). It correlated with official statistics (r=0.9, p=0.05). Based on clinical and laboratory examination, the diagnosis was established in 26 patients (45.6%). Among patients with a verified diagnosis of toxocariasis, the proportion of children aged 1 years and 1 months to 10 years old, was 96%. An analysis of epidemiological data showed that 76% of children had close contact with the soil. The infestation occurred in the form of latent toxocariasis in 36% of patients. In more than half of the cases, the disease was clinically manifested by geophagy (56.0%). A permanent laboratory parameter was the eosinophilic leukemoid reaction in patients with toxocariasis. Peripheral blood eosinophilia ranged from 15.66.2±9.31% in latent toxocariasis to 25.5±15.0 % in visceral toxocariasis. The positive rate in ELISA with Toxocara antigen was higher than that in the group of patients with visceral toxocariasis. However, there was no correlation between the eosinophilia level and positive rate (r=0.1, p=0.05). Conclusion: in areas where the incidence of toxocariasis and environmental contamination with invasive helminth eggs are high, it is advisable to perform tests of the peripheral blood in children at least one time per year in the autumn for timely diagnosis of infestation. The use of ELISA with Toxocara antigen is reasonable in the cases of peripheral blood eosinophilia. KEYWORDS: toxocariasis, statistics, incidence, eosinophilia, enzyme-linked immunosorbent assay, Toxocara antigen. FOR CITATION: Andreeva A.O., Golovchenko N.V., Zhuravlev A.S. Toxocariasis in children: epidemiological, clinical and laboratory aspects. Russian Medical Inquiry. 2020;4(11):670–675. DOI: 10.32364/2587-6821-2020-4-11-670-675.

TOXOCARIASIS - WHAT DO WE KNOW?

Toxocariasis is a helminthic zoonosis caused by the presence and migration of animal nematode larvae in human tissue – mostly Toxocara canis and Toxocara cati. The term visceral larva migrans syndrome was used for the first time in 1952 by Beaver et al. who described the typical clinical presentation. There are difficulties in the diagnosis of toxocariasis because of the variety of symptoms depending on the larva localisation in different tissues and organs. Currently, the most commonly used serological methods are ELISA and Western blot. The disease is characterised by diverse clinical picture and thus toxocariasis is very rarely identified and most patients remain undiagnosed, which requires in-depth study of this widespread but still problematic zoonosis.

The serodiagnostic potential of recombinant proteins TES-30 and TES-120 in an indirect ELISA in the diagnosis of toxocariasis in cattle, horses, and sheep.

Toxocariasis is a zoonotic disease that affects humans and animals alike. Although recombinant proteins are widely used for its diagnosis in humans, their performance in companion and production animals remains unknown. This study aimed to investigate the serodiagnostic potential of the recombinant proteins rTES–30 and rTES–120 from Toxocara canis in an indirect ELISA for cattle, horses, and sheep. Serum samples collected from the animals were tested with indirect ELISA and Western Blotting using T. canis TES–30 and TES–120 recombinant proteins produced in Escherichia coli, as well as native-TES. In the ELISA, rTES–30 showed high serodiagnostic potential in sheep and horses (92.6% and 85.2%, respectively), while the sensitivity of rTES–120 was higher in cattle and horses (97.2% and 92.6%, respectively). Furthermore, a highly positive association was observed between native and recombinant proteins in seropositive samples, while a moderately positive association was observed in seronegative samples, probably due to the lower specificity of native TES. In conclusion, our study indicates that the use of recombinant proteins in an indirect ELISA is an effective tool for the serodiagnosis of toxocariasis in animals, with the choice of protein being species-dependent.

Neglected parasitic infection: toxocariasis

A healthy 34-year-old Japanese man presented with a 10-day history of epigastralgia. He had eaten seared chicken sashimi several times. Physical examination findings were not remarkable. Laboratory findings revealed marked...

CLINICAL-EPIDEMIOLOGICAL FEATURES OF TOXOCAROSIS IN CHILDREN

Aim. The aim of the study was to study the clinical and epidemiological features of visceral forms of toxocariasis in children. Materials and methods. The study involved 34 children (17 boys and 17 girls from 1 to 17 years old) with a diagnosis of toxocariasis. The diagnosis was confirmed by the method of immunoenzymatic analysis (ELISA) of blood, which allows to determine the level of specific antibodies of JgG to antigens of toxocar in children. In all patients, antibodies to toxocaram were found in a titer of 1: 800 and above, which was considered a diagnostic criterion. To exclude mixed infections, antibodies to lamblia antigens, ascarids, trichinelles and opistarchs were determined using the ELISA method of blood. Feces were studied for eggs of helminths threefold in all children. Results. Toxocarosis in children is characterized by a polymorphism of clinical manifestations. In 85.3% of patients the gastrobiliary system was damaged, dyspepsia, unstable stool, hepatosplenomegaly, which was confirmed by instrumental research methods (ultrasound examination of the abdominal cavity organs, esophagogastroduodenoscopy). In addition to lesions of the gastrointestinal tract, 44.1% of patients showed lung damage, and 63.3% of patients had skin manifestations. Eye damage was noted in 10.2% of sick children, a kind of strabismus and reduced vision. Conclusion. Analysis of clinical and epidemiological data of children with toxocarosis showed that all observed had signs of impairment from the gastrointestinal tract, bronchopulmonary system and skin. In the epidemic process, preschool children are primarily involved. The decisive role in the prevention of toxocarias is played by public health education and early education of children with health skills.

Cardiac Manifestations of Toxocariasis: A Case Report of Loffler Endocarditis and Literature Review

This paper reports a case of toxocariasis with cardiac manifestations. The patient was a 48-year-old man suffering from a Loffler endocarditis with hypereosinophilia. ELISA and Western blot tests confirmed the diagnosis of toxocariasis. The disease was successfully managed by a combination of albendazole and corticosteroids. A few cases of cardiac toxocariasis have been described previously in the literature focusing on this unusual location. Eosinophils may have a key role in the pathogenesis of the disease. Therefore, clinicians should always investigate toxocariasis in case of hypereosinophilia with cardiac involvement.

Characterization of excretory-secretory antigens of adult Toxocara canis by western blotting

Toxocara canis is one of the most common helminth worm of dogs which continues to stimulate both public health concern alongside the higher scientific interest. It may cause visceral and ocular damage in humans especially in children. The identification of specific antigens of T. canis is important so as to develop better diagnostic techniques. Excretory-secretory (ES) antigens were prepared by culturing the adult T. canis worms in RPMI 1640 medium without serum supplementation followed by ammonium sulphate precipitation. These antigens were separated using sodium dodecyl sulphate-electrophoresis (SDS-PAGE). Recovered proteins ranged from 30 to 384kDa. The specific reactivity of the T. canis excretory-secretory (TC-ES) proteins was checked by western blotting. The immuno-reactivity of the naturally infected dog sera with the TC-ES antigens showed five bands at 43, 57,105, 139 and 175kDa. The immuno-reactivity of the hyper immune serum raised in rabbits against TC-ES antigens was observed with ten polypeptides of 21, 25, 30, 37, 45, 50, 57, 69, 77 and 105kDa. Common antigens band were observed at 57 and 105KDa. These antigens merit further evaluation as candidate for use in diagnosis of toxocariasis in humans and adult dogs.

Ocular Toxocariasis

Ocular toxocariasis is an uncommon worldwide parasitic infection that affects mostly children and is found in both rural and metropolitan areas. In many parts of the world, parasitic infections of the eye are a major cause of blindness. The diagnosis of toxocariasis is essentially clinical, based on the lesion morphology and supportive laboratory data such as serum enzyme-linked immunosorbent assay (ELISA) titers and ELISA Toxocara titers on aqueous humor; other diagnostic methods are imaging studies including optical coherence tomography, fluorescein angiography, computed tomography, and ocular ultrasound. Treatment is directed at complications arising from intraocular inflammation and vitreous membrane traction. Early vitrectomy may be of value both diagnostically and therapeutically.