Diagnosis of toxocariasis is most often made in the spring-summer period, when parasitic infections are activated. This disease is caused by the migration of ascaris larvae of animals – most often dogs - is characterized by a long relapsing course and multiple organ lesions of an immunological nature. Toxocariasis often has external manifestations resembling a cold or an allergy, but this infection is dangerous for the development of severe pulmonary syndrome and other unpleasant complications, and therefore requires a doctor to carefully collect anamnesis and prescribe timely treatment.
Biology of the pathogen and epidemiology of toxocariasis
The main source of infection for humans are dogs, especially puppies. Infection occurs by direct contact with the hair of an infested animal, by getting into the mouth of the earth in which the eggs of Toxocara were. Infection is also possible when eating raw or poorly thermally processed meat. The possibility of transplacental and transmammary transmission of invasion in humans is not excluded.
Clinical picture of toxocariasis: main symptoms
The disease usually develops suddenly and acutely, or after a short prodrome, it manifests itself as a slight malaise. The temperature appears — subfebrile in mild cases and high up to 39 ° C and above, sometimes with chills, — in severe cases of invasion. In the cutaneous form of toxocariasis, skin rashes are observed in the form of urticaria or a polymorphic rash, sometimes Quincke-type edema. In the acute period, there is a pulmonary syndrome of varying severity: from mild catarrhal phenomena to acute bronchitis, pneumonia, severe asthma attacks. X-ray reveals an increase in the pulmonary pattern, a picture of pneumonia. Along with this, in some patients there is an increase in the liver, sometimes the spleen. Sometimes there is an abdominal syndrome in the form of bouts of abdominal pain, symptoms of dyspepsia. May develop myocarditis pancreatitis. There are known cases of thyroid lesions, manifested by symptoms of a tumor. Possible damage to muscle tissue with the development of painful infiltrates along the muscles. When larvae migrate to the brain, symptoms of CNS damage develop: persistent headaches, epileptiform seizures, paresis, paralysis. In children, the disease is accompanied by weakness, mild excitability, and sleep disturbance.
In the chronic stage of the disease, acute clinical and laboratory signs subside. Peripheral blood hypereosinophilia remains the most stable laboratory indicator.
There are subclinical, mild, moderate and severe course of toxocariasis. The so-called asymptomatic blood eosinophilia is possible, when there are no obvious clinical manifestations of invasion, but along with hypereosinophilia, antibodies to T.canis antigens are detected.
One of the most serious problems associated with toxocariasis is its relationship with bronchial asthma. There are clinical observations indicating an improvement in the course of bronchial asthma or recovery after the elimination of toxocariasis invasion.
Diagnosis of toxocariasis and differential diagnosis of invasion
Usually, the diagnosis of toxocariasis is established on the basis of epidemiological history, clinical symptoms and hematological manifestations. Immunological reactions are also used to detect antibodies to toxocar antigens.
When making a diagnosis and determining indications for specific therapy, it should be taken into account that toxocariasis proceeds cyclically with relapses and remissions, and therefore significant fluctuations in clinical, hematological and immunological parameters in the same patient are possible.
Differential diagnosis is carried out with the migratory stage of other helminthiases (ascariasis, opisthorchiasis), strongyloidiasis, eosinophilic granuloma, lymphogranulomatosis, eosinophilic vasculitis, metastasizing pancreatic adenoma, hypernephroma and multiple organ lesions of an immunological nature. It should be borne in mind that in patients with systemic lymphoproliferative diseases and serious disorders in the immune system, immunological reactions may be false positive. In these cases, a thorough analysis of the clinical picture of the disease is necessary.
Treatment of toxocariasis: schemes and criteria for effectiveness
Treatment not well developed. Apply antinematodosis drugs — thiabendazole (mintezol), mebendazole (vermox), medamin, diethylcarbamazine. These drugs are effective against migrating larvae and are not effective enough against tissue forms found in granulomas of internal organs.
Mintezol (thiabendazole) is prescribed in doses of 25-50 mg/kg of body weight per day in three divided doses for 5-10 days. Side effects occur frequently and are manifested by nausea, headache, abdominal pain, and a feeling of disgust for the drug. Adverse reactions are usually not observed.
Diethylcarbamazine is prescribed in doses of 2 — 6 mg/kg body weight per day for 2 — 4 weeks.
Albendazole is prescribed at a dose of 10 mg/kg of body weight per day in two divided doses (morning — evening) for 7 — 14 days. In the process of treatment, it is necessary to control the blood test (the possibility of developing agranulocytosis) and the level of aminotransferases (hepatotoxic effect of the drug). A slight increase in the level of aminotransferases is not an indication for discontinuation of the drug. In case of increasing hyperfermentemia and the threat of developing toxic hepatitis, drug withdrawal is required.
Criteria for the effectiveness of treatment: improvement in general condition, gradual regression of clinical symptoms, reduction in the level of eosinophilia and specific antibody titers. It should be noted that the clinical effect of treatment is ahead of the positive dynamics of hematological and immunological changes. With recurrence of clinical symptoms, persistent eosinophilia and positive immunological reactions, repeated courses of treatment are carried out.
The prognosis for life is favorable, however, with massive invasion and severe multiple organ lesions, especially in people with impaired immunity, death is possible.
According to the materials of the journal "Attending Doctor"
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