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Infectious disease
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Spread by faeces or infected food. Causes larva migrans: visceral (migration to liver and lungs with fever, wheeze, lymphadenopathy and hepatosplenomegaly) or ocular (migration to eye with pain and decreased acuity).
Unexplained Fever In Patients Returning From The Tropics Including U.F. Associated With Hypereosinophilia
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Such a host-parasite reaction could be the expression of the antigenic incompatibility of coexistence of larvae and host, and diminishes when larvae become adults. As this is never the case with visceral larva migrans, such reaction persists.
Signs and symptoms of skin disease
Published in Ronald Marks, Richard Motley, Common Skin Diseases, 2019
The shape of skin lesions can also help in diagnosis. Some skin disorders start off as macular lesions that are clear in the centre, making ring-like or annular lesions. Ringworm, granuloma annulare and erythema multiforme are three conditions in which the developed lesions tend to be annular (Figs 2.8–2.10). Some skin disorders often produce oval lesions, pityriasis rosea being the best example of this tendency. Skin lesions may assume a linear shape – scratch marks are a good example (excoriations). Lesions may also appear serpiginous – cutaneous larva migrans is an example of this appearance. Occasionally, lesions assume bizarre patterns on the skin surface that almost seem to be representing a particular pattern or symbol. This is termed figurate, and many disorders, including psoriasis, may produce such lesions. For the most part, skin lesions are not usually angular and do not form squares or triangles. However, one condition, lichen planus, does produce small lesions that often seem to have a roughly polygonal outline (Fig. 2.11).
Trichinella spiralis-associated myocarditis mimicking acute myocardial infarction
Published in Acta Clinica Belgica, 2022
Othmane Mohib, Philippe Clevenbergh, Carine Truyens, Marielle Morissens, José Castro Rodriguez
The suspicion of trichinellosis is based on the clinical presentation, eosinophilia (during the muscular phase), and favorable epidemiology. The disease is definitively diagnosed by revealing the encysted larvae by muscular biopsy. While this invasive and painful method is not generally required, it can be helpful in the setting of diagnostic uncertainty [25]. Thus, the diagnosis is usually made based on clinical symptoms and is confirmed by serologic assays, mainly ELISA. The sensitivity and specificity of ELISA depend on the Trichinella spiralis antigens tested. An absolute sensitivity (100%) has been obtained in humans infected with Trichinella spiralis by ELISA (measuring IgG) using both an excretory-secretory (ES) antigens and crude larval extracts [26,27]. This high sensitivity rate observed 50 days after infection declined to about 80% after 2 years. Contrariwise, specific IgM can be found up to 15 years after infection [28]. The specificity of ELISA when using ES antigens appears to be approximately 91–96% [29]. In industrialized countries, the risk of cross-reactions using ES antigens is low, but cross-reactions do occur with human larva migrans syndromes of unknown species.
A Rare Case of Congenitally Acquired Ocular Toxocariasis in A Five-Week-Old Infant
Published in Ocular Immunology and Inflammation, 2021
Chris Or, James A. David, Munraj Singh, H. Sprague Eustis, D. Anthony Mazzulla, Stephen Hypes, Joseph Benevento
OT is usually diagnosed clinically and supported by serologic testing with an indirect enzyme-linked immunosorbent assay (ELISA) based on anti-Toxocara antibodies, although in ocular variants the ELISA may return negative depending on infectious load.1 Although visceral larva migrans (VLM) warrants anti-helminthic therapy, treatment for ocular toxocariasis is controversial. As humans are intermediate hosts and the larvae cannot multiply, steroids may be initiated without anti-helminthic therapy, but some question this monotherapy due to concern of immunosuppression and risk of larvae migration. For populations in endemic areas, primary prevention includes avoidance of disposal of pet litter by pregnant individuals, avoidance of ingestion of undercooked meats, and proper handwashing techniques.1 The range of infectivity of toxocariasis depends on the host’s inflammatory response to infection, the parasite load, and the migration of larvae.1
Pediatric Ocular Toxocariasis in Costa Rica: 1998-2018 Experience
Published in Ocular Immunology and Inflammation, 2021
Joaquin Martinez, Gabriela Ivankovich-Escoto, Lihteh Wu
Currently, there are no treatment guidelines for the treatment of ocular toxocariasis. Our treatment decisions have evolved over the experience gained in the past two decades. In general, if the patient presented acutely and there was a chance that the Toxocara larva was still alive, thiabendazole was prescribed either alone or in combination with corticosteroids to decrease the inflammatory reaction. The role of anti-helminthic drugs remains unclear.19,20 Combination therapy of anti-helminthic and corticosteroids may be of use in specific cases.21 In a very small comparative trial, albendazole appeared to be more effective than thiabendazole in the treatment of patients with visceral or ocular larva migrans secondary to toxocariasis.20 In a slightly larger trial, mebendazole and diethylcarbamazine had similar therapeutic efficacy but mebendazole had a lower rate of adverse events. Despite these reports, it is unclear if these anti-helminthic drugs kill intraocular Toxocara larvae. A case report looked at the thiabendazole concentration in ocular fluids following oral administration of the drug. According to Maguire and collegues,22 anti-parasitic levels of the medication can be achieved intraocularly after oral ingestion. Our impression is that anti-helminthic drugs could have some use only in very acute cases, because once the granuloma is formed, or even before, the larva is already dead.