Toxocariasis: symptoms

There are two main forms of toxocarosis - visceral and ocular. Some researchers propose to subdivide toxocarosis into the following forms:

• visceral toxocariasis, including damage to the respiratory system, digestive tract, urogenital system, myocardium (rarely);
• toxocarosis of the central nervous system:
• muscle toxocarosis:
• toxocarosis of the skin:
• toxocarosis of the eye;
• disseminated toxocariasis.

Symptoms of toxocarias are the main criterion for dividing this disease into: toxocarias manifest and asymptomatic, and in the course of the course - acute and chronic.

Visceral toxocariosis affects both children and adults, but in children this form is more common, especially at the age of 1.5 to 6 years. The clinical picture of toxocarias is not very specific and resembles the clinical symptoms of the acute phase of other helminthiases. The main symptoms of toxocarias in the acute stage are recurrent fever, pulmonary syndrome, increase in liver size, polyadenopathy, skin manifestations, eosinophilia of blood, hypergammaglobulinemia. In children, the disease often develops suddenly or after a short prodromal period. Body temperature is often subfebrile (in severe cases of infestation - febrile), more pronounced in the period of pulmonary manifestations. A variety of types of relapsing skin rashes (erythematous, urticaria), possibly the development of Quinck edema, Masql-Wells syndrome, etc., are noted for a variety of types. Skin syndrome can persist for a long time, sometimes it is the main clinical manifestation of the disease. Examination for children with a diagnosis of eczema, carried out in the Netherlands, showed that 13.2% of them have high titres of specific antibodies to toxocaram. Most of the infected, especially in children, have moderately increased peripheral lymph nodes.

The defeat of the respiratory system occurs in 50-65% of patients with visceral toxocariasis and can be expressed in varying degrees - from catarrhal phenomena to severe asthmoid conditions. Particularly severe lesions occur in young children. There are recurrent bronchitis, bronchopneumonia. Patients report typical symptoms of toxocariasis: dry cough, frequent attacks of night cough, sometimes ending with vomiting, in some cases severe expiratory dyspnoea accompanied by cyanosis. Auscultation is listened to by scattered dry and variegated wet rales. X-ray reveals an increase in pulmonary pattern, a picture of pneumonia; often define cloud-like infiltrates, which in combination with other clinical symptoms (fever, lymphadenopathy, hepatosplenomegaly, skin-allergic syndrome, hypereosinophilic leukocytosis) makes it possible to diagnose the Loeffler syndrome. One of the most serious problems associated with toxocarosis is its relationship with bronchial asthma. It is shown that in 20% of patients with atopic form of bronchial asthma, which proceeds with hypereosinophilia, antibodies to toxocarose antigen (immunoglobulins of G and / or E classes) are detected.

Hepatomegaly is recorded in 40-80% of patients. The palpation of the palpation is compact, smooth, often tense, while approximately 20% of patients have enlarged spleen. The predisposing role of toxocar in the development of pyogenic liver abscesses, which are both single and multiple, is found in both lobes of the liver. Abdominal syndrome is observed in 60% of cases. Characterized by abdominal pain, bloating, nausea, sometimes vomiting, diarrhea.

In the chronic stage of toxocarias there are exacerbations and remissions. After an acute period, the symptoms of toxocarosis may be absent for a long time. In the chronic stage, even during remission in children, subfebrile condition, weakness, deterioration of appetite, sometimes weight loss, polyadenopathy, enlargement of the liver, and sometimes skin-allergic syndrome remain.

In some cases, toxocarosis is accompanied by myocarditis: described the development of endocarditis Löffler (endocarditis fibroplastic parietal with eosinophilia). There are reports of eosinophilic pancreatitis, the development of nephrotic syndrome. The larvae found in the biopsy specimens of the muscle tissue confirm that muscles are affected by toxocarosis. In tropical countries, pyogenic myositis, apparently caused by toxocarosis, is detected.

One of the main and most permanent manifestations of the visceral form of toxocariasis is a persistent prolonged eosinophilia of the blood, up to the development of eosinophilic-leukemoid reactions. The relative level of eosinophils, as a rule, exceeds 30%, and in some cases can reach 90%. The total number of leukocytes also increases to 15-20x10 ⁹ / l, and in some cases - up to 80x10 ⁹ / l. Eosinophilia can persist for months and even years. Children are often noted for moderate anemia. Characterized by an increase in ESR, hypergammaglobulinemia. With liver damage, the levels of bilirubin and liver enzymes are increased.

When the larvae of toxocar migrate to the brain, signs of CNS damage are revealed (seizures of the "petit mal" type, epileptiform seizures). In severe cases, meningoencephalitis, paresis, paralysis, and mental disorders are recorded.

The cases of disseminated toxocariosis with simultaneous lesion of the liver, lungs and CNS in patients with immunodeficiency (against radiation therapy, corticosteroid treatment, HIV infection, etc.) are described.

Eye toxocariasis

Eye toxocariasis is more common in children and adolescents and rarely combines with visceral lesions. There are two types of lesions: solitary granulomas and chronic endophthalmoses with exudation. One-sided lesion of the eyes with the development of chronic endophthalmitis, chorioretinitis, iridocyclitis, keratitis, papillitis, strabismus is characteristic. Possible hemorrhages in the retina, damage to the optic nerve, eosinophilic abscesses of the ciliary body, panophthalmitis, retinal detachment. There are also lesions of larvae of paraorbital fiber, manifested by periodic edema. With a sharp edema, exophthalmos may develop. The number of eosinophils in peripheral blood in patients with toxo-coronary eye is usually normal or increased slightly.

[1], [2], [3], [4], [5], [6], [7]

Complications of toxocariasis

Possible disruption of the functions of vital organs (brain, eyes, etc.). In some cases, the development of bronchial asthma is likely. Eye toxocariasis is one of the possible causes of vision loss.

[8], [9], [10], [11], [12], [13], [14]

Mortality and causes of death

Lethal outcomes with toxocarosis are rare, observed with massive invasion and are associated with the migration of larvae into the myocardium and important parts of the central nervous system.