eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Visceral Larva Migrans: Differential Diagnoses & Workup

Author: Raymond D Pitetti, MD, MPH, Associate Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine; Consulting Staff, University of Pittsburgh Physicians
Contributor Information and Disclosures

Updated: May 22, 2009

Differential Diagnoses

Ancylostoma Infection
Hypereosinophilic Syndrome
Ascariasis
Hypersensitivity Pneumonitis
Asthma
Loffler Syndrome
Bancroftian Filariasis
Myocarditis, Nonviral
Crohn Disease
Paragonimiasis
Cutaneous Larva Migrans
Schistosomiasis
Cysticercosis
Strongyloidiasis
Diphyllobothrium Latum Infection
Taenia Infection
Dirofilariasis
Trichinosis
Dracunculiasis
Urticaria
Echinococcosis
Vasculitis and Thrombophlebitis
Filariasis
Whipworm
Gnathostomiasis
Hookworm Infection
Hymenolepiasis

Other Problems to Be Considered

Allergies
Eosinophilia-myalgia syndrome
Neoplasia
Other parasitic infections

Workup

Laboratory Studies

  • A CBC count often reveals leukocytosis and eosinophilia in patients with visceral larva migrans (VLM); however, eosinophilia may not always be present. Children may be anemic.
  • Obtain stool cultures to rule out other parasitic infections. 
  • Elevated titers of isohemagglutinins to the A and B blood group antigens support the diagnosis of visceral larva migrans.
  • Enzyme-linked immunosorbent assay (ELISA) is the most commonly used serologic test physicians use to diagnose visceral larva migrans, with a reported sensitivity of 78.3% and specificity of 92.3%.
  • Hypergammaglobulinemia may be present.

Imaging Studies

  • Children with visceral larva migrans may exhibit an abnormal liver parenchymal pattern on both abdominal ultrasonography and CT scanning.4  
  • MRI may reveal multiple cerebral lesions in patients with CNS visceral larva migrans.
  • Pulmonary infiltrates due to visceral larva migrans generally manifests as a transient form of Löffler syndrome or simple eosinophilic pneumonia on a chest radiograph.

Procedures

  • In unusual circumstances, liver biopsy may aid in diagnosing visceral larva migrans; however, microscopic identification of larvae from biopsy samples is infrequent.
  • Negative liver biopsy findings do not exclude visceral larva migrans.

Histologic Findings

  • Multiple eosinophilic abscesses and allergic-type granulomas are often found in affected tissues.

More on Visceral Larva Migrans

Overview: Visceral Larva Migrans
Differential Diagnoses & Workup: Visceral Larva Migrans
Treatment & Medication: Visceral Larva Migrans
Follow-up: Visceral Larva Migrans
Multimedia: Visceral Larva Migrans
References
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References

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Further Reading

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Keywords

visceral larva migrans, toxocariasis, Toxocara canis, Toxocara cati, VLM, parasitic infection, roundworm parasites, chronic eosinophilic pneumonia, myocarditis, Henoch-Schönlein purpura, eating dirt, ocular larva migrans, atopic dermatitis, asthma, hepatomegaly, splenomegaly, wheezing, rales, pruritic rash, urticaria, periorbital edema, strabismus, Löffler syndrome, seizure, abdominal pain, treatment, diagnosis

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Contributor Information and Disclosures

Author

Raymond D Pitetti, MD, MPH, Associate Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine; Consulting Staff, University of Pittsburgh Physicians
Raymond D Pitetti, MD, MPH is a member of the following medical societies: Allegheny County Medical Society, American Academy of Pediatrics, Pennsylvania Medical Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Leslie L Barton, MD, Professor, Program Director, Department of Pediatrics, University of Arizona School of Medicine
Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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