ABSTRACT
La toxocarosis humana es una parasitosis larvaria crónica catalogada dentro de las cinco enfermedades subestimadas más importantes por los CDC. Las larvas pueden diseminarse por vía sistémica y migrar a distintos tejidos (larva migrans visceral) incluyendo el hígado y vesícula biliar. La colecistitis aguda acalculosa (CAA) es una enfermedad rara en niños. El diagnóstico se basa en parámetros clínicos y criterios imagenológicos. Se ha asociado a sepsis, shock, trauma, quemaduras, enfermedades sistémicas graves, anomalías congénitas e infecciones, como también en niños sanos. Presentamos el caso de una toxocarosis infantil con síntomas clínicos y criterios imagenológicos compatibles con una CAA tratado médicamente, y discutir la relación entre ambos cuadros en base a la evidencia publicada.
Human toxocarosis is a chronic larval parasitosis listed as one of the five most important neglected diseases by the CDC. The larvae can spread systemically and migrate to different tissues including liver and gallbladder. Acalculous acute cholecystitis (AAC) is a rare disease in children. The diagnosis is based on clinical parameters and imaging criteria. It has been reported in relation to sepsis, shock, trauma, burns, severe systemic diseases, congenital anomalies, infections and also in healthy children. We report a pediatric case of toxocarosis, with clinical symptoms and imaging criteria compatible with AAC treated medically, and discuss the relationship between toxocarosis and AAC based on published evidence.
Subject(s)
Humans , Male , Child , Larva Migrans, Visceral/complications , Acalculous Cholecystitis/diagnosis , Acalculous Cholecystitis/parasitology , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Albendazole/therapeutic use , Acute Disease , Anthelmintics/therapeutic useABSTRACT
Infection of humans with embryonated eggs of Toxocara canis (larva migrans) remains asymptomatic, or results in covert or common toxocarosis, visceral larva migrans syndrome, or ophthalmologic and neurologic impairment. Though neurological manifestations of Toxocara canis larvae are rare, toxocarosis remains an important differential diagnosis of various neurological disorders. Manifestations of the central nervous system are dementia, meningo-encephalitis, myelitis, cerebral vasculitis, epilepsy, or optic neuritis. Manifestations of the peripheral nervous system comprise radiculitis, affection of cranial nerves, or musculo-skeletal involvement. If toxocarosis is neglected, ignored, or refused as a differential of these abnormalities, it may be easily overlooked for years. Early recognition and treatment of the infection is, however, of paramount importance since it reduces morbidity and mortality and the risk of secondary superinfection. Like the visceral manifestations, neurological manifestations of toxocarosis are treated by benzimidazole components, most frequently albendazole, corticosteroids, or diethylcarbamazine. If detected and treated early, the prognosis of neurological manifestations of toxocarosis is favourable.
Infecção humana com ovos embrionados de Toxocara canis (larva migrans) pode permanecer assintomática ou resultar em toxocaríase acentuada ou comum, síndrome da larva migrans visceral ou manifestações neurológicas ou oftalmológicas. Embora manifestações neurológicas das larvas de Toxocara canis sejam raras, a toxocaríase permanece como importante diagnóstico diferencial de várias manifestações neurológicas. Manifestações do sistema nervoso central são demência, meningoencefalite, mielite, vasculite cerebral, epilepsia, ou neurite ótica. Manifestações do sistema nervoso periférico compreendem radiculite, agressão de nervos cranianos ou envolvimento músculo-esquelético. Se a toxocaríase é negligenciada, ignorada, ou recusada como diferencial destas anormalidades, ela pode ser facilmente desapercebida por anos. Reconhecimento precoce de tratamento da infecção é portanto de fundamental importância uma vez que reduz sua morbidade e mortalidade e o risco de superinfecção secundária. Da mesma maneira que as manifestações viscerais, as neurológicas são tratadas por benzimidazólicos, mais freqüentemente albendazole, corticosteróides ou dietilcarbamazine. Se detectado e tratado precocemente, o prognóstico das manifestações neurológicas da toxocaríase é favorável.
Subject(s)
Animals , Cats , Dogs , Humans , Central Nervous System Helminthiasis/parasitology , Peripheral Nervous System Diseases/parasitology , Toxocara canis , Toxocariasis/diagnosis , Central Nervous System Helminthiasis/diagnosis , Central Nervous System Helminthiasis/drug therapy , Diagnosis, Differential , Peripheral Nervous System Diseases/diagnosis , Peripheral Nervous System Diseases/drug therapy , Toxocariasis/complications , Toxocariasis/drug therapyABSTRACT
The diagnosis of toxocarosis is based upon the demonstration of antibodies by ELISA methods, although cross-reaction with other ascarids may occur in populations from tropical areas. For this reason, some authors proposed western blotting as a confirmatory test. The aim of this work was to develop an immunoblotting in simpler technical conditions and to compare results with the ELISA test. With this purpose sera from adults and children with sign and/or symptoms of toxocarosis and living in the metropolitan area of Resistencia city (Northeast of Argentina) were studied. ELISA test was performed and 120 positives and 60 negatives sera were selected and analyzed again by immunoblotting. Positive samples and controls showed a WB pattern with six bands of 67.6 kDa, 55.6 kDa, 43.9 kDa, 32.4 kDa, 26.6 kDa and 23.4 kDa, while negative controls from endemic and non-endemic areas of toxocarosis showed no bands. Out of the 180 samples studied, in 172 coincident results for both methods were obtained (95.6%), 6 ELISA negative samples were positive for WB (3.3%) and 2 ELISA positive samples resulted negative in the WB (1.1%). The immunoblotting technique described in this work may constitute an adequate method for the diagnosis of toxocarosis in subtropical areas, particularly useful in cases with negative or low-titers ELISA test results and with signs or symptoms of the infection.
El diagnóstico de toxocariosis se basa en la demostración de anticuerpos mediante enzimo-inmunoensayos, aunque en poblaciones de área tropicales suelen ocurrir reacciones cruzadas con otros ascáridos. Por ello algunos autores han propuesto el Western Blot como test confirmatorio. El objetivo de este trabajo fue desarrollar un método de immunoblotting con condiciones técnicas sencillas y comparar su comportamiento con la reacción de enzimoinmunoensayo. Se estudiaron 180 muestras de suero de adultos y niños con signo-sintomatología compatible con toxocariosis. Se efectuó test de ELISA con Antígenos TES, seleccionándose 120 sueros positivos y 60 negativos, los que fueron analizados nuevamente por immunobloting y se compararon los resultados de ambos métodos. Las muestras y controles positivos mostraron en el WB un patrón de seis bandas con PMs de 67,6 kDa, 55,6 kDa, 43,9 kDa, 32,4 kDa, 26,6 kDa y 23,4 kDa. Los sueros de control negativo de área endémica y no endémica de toxocarosis no mostraron banda alguna. De 180 muestras estudiadas, en 172 se obtuvieron resultados coincidentes por ambos métodos (95,6%), 6 muestras negativas por ELISA resultaron positivas por Western Blot (3,3%) y dos muestras positivas por ELISA fueron negativas por Western Blot (1,1%). El ensayo de immunoblotting acá descrito constituiría un método adecuado para el diagnóstico de toxocariosis en áreas sub-tropicales, particularmente útil en los casos en los que el test de ELISA resulte negativo o positivo con títulos bajos y en presencia de signos y/o síntomas de la infección.