Ecchymoses: an unusual manifestation of toxocariasis in children.

OBJECTIVE: To investigate the aetiology of multiple ecchymoses associated with eosinophilia. SETTING: Professorial Paediatric Unit (PPU) at Lady Ridgeway Hospital (LRH) for children, Colombo. DESIGN: Prospective study from July 1998 to April 2000. MATERIALS AND METHODS: Patients admitted to the PPU with multiple ecchymoses associated with an absolute eosinophilia (> 1 x 10(9)/1) were investigated further to determine the possible aetiology; bleeding time, clotting time, platelet count, platelet function tests, stools examination and toxocara antibody tests were performed. Patients who were positive for toxocara were treated either with thiabendazole or albendazole. Patients who had geohelminth infestations were treated with mebendazole. RESULTS: 14 children (11 boys) were studied. 7 were between 1 and 5 years, and 7 were above 5 years of age. The mean eosinophil count was 4.3 x 10(9)/1. All patients had a prolonged bleeding time, but clotting time and platelet counts (mean value 220 x 10(9)/1) were normal. Platelet function tests were done in 5 patients. Twelve patients were positive for toxocariasis and the other 2 were positive for ascariasis. All children who were positive for toxocariasis had contact with pet cats or dogs. Six patients were treated with thiabendazole and 6 with albendazole. The two patients who had ascariasis were treated with mebendazole. Post-treatment mean eosinophil count was 0.63 x 10(9)/1, and the bleeding time was 4 minutes. CONCLUSION: Toxocariasis could present with ecchymoses due to an acquired bleeding disorder. Awareness of this would help to investigate, diagnose and treat early, and lessen parental anxiety.

Histopathological diagnosis of subcutaneous Dirofilaria repens infection in humans.

The host tissue response in humans, based on a study of biopsies of 14 subcutaneous nodules caused by Dirofilaria repens is described. The response was characterized by accumulation of eosinophilic material or eosinophilic pus adjacent to the parasite with surrounding granulomatous inflammation associated with extensive eosinophil infiltration of the surrounding tissue. Unlike with fungal lesions, fat necrosis was conspicuously absent. Nodules were all less than 3 cm in size. Fifteen percent of the smaller nodules (less than 1 cm) and 30% of the larger nodules required extensive examination of tissue to visualize the parasite. It is concluded that when typical tissue reactions are seen, extended histological processing is indicated for accurate diagnosis of dirofilariasis, by demonstrating the parasite.

First reports of subcutaneous sparganosis in Sri Lanka.

OBJECTIVE: To report and create awareness of sparganosis, a parasitic zoonosis caused by a larval stage of Spirometra sp. SETTING: Two patients with non-tender subcutaneous lumps. DIAGNOSIS CRITERIA: Morphology of solid cestode larva in excision biopsies. CONCLUSIONS: Although these two instances were innocuous, infection is potentially dangerous as larvae are long lived and could invade vital organs. The most likely source of infection in Sri Lanka is ingestion of the infected first intermediate host, Cyclops, in water.