eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Visceral Larva Migrans: Treatment & Medication

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

Treatment

Medical Care

  • Therapy in patients with visceral larva migrans (VLM) is aimed at relieving symptoms and is intended to diminish the host inflammatory response to the parasite. Corticosteroids and antihistamines are often used for this purpose. Patients with myocarditis or CNS disease should always be treated with corticosteroids.
  • Antiparasite agents, such as mebendazole, may help reduce symptoms; however, systemic treatment with anthelminthics can result in hypersensitivity reactions. Clinical trials have raised questions about their efficacy.
  • Attempt to identify the source of infection. Infected puppies and kittens should be treated with appropriate anthelminthic agents.

Consultations

  • Consider infectious diseases consultation in unusual or difficult cases.
  • Consider other consultations depending on the organ system involved.

Diet

  • No special diet is necessary for acute treatment.
  • If children have a history of pica (eg, eating dirt, paint chips), attempts should be made to alter the behavior.

Activity

  • No activity restrictions are required beyond that required for the treatment of the acute infection or its sequelae.

Medication

Children can be treated with an anthelmintic agent. Severe infections should be treated with systemic corticosteroids.

Anthelmintics

Historically, the treatment of visceral larva migrans (VLM) in adults and children was primarily symptomatic. However, the identification of anthelmintics (eg, thiabendazole, diethylcarbamazine) in the 1960s offered an effective therapeutic choice. Anthelmintics act against the migrating larvae.

Parasite biochemical pathways are different from the human host; thus, toxicity is directed to the parasite, egg, or larvae. The mechanism of action varies within the drug class. Antiparasitic actions may include the following:

  • Inhibition of microtubules causes irreversible block of glucose uptake
  • Tubulin polymerization inhibition
  • Depolarizing neuromuscular blockade
  • Cholinesterase inhibition
  • Increased cell membrane permeability, resulting in intracellular calcium loss
  • Vacuolization of the schistosome tegument
  • Increased cell membrane permeability to chloride ions via chloride channels alteration


Mebendazole (Vermox)

Selectively and irreversibly blocks the uptake of glucose and other nutrients in susceptible intestine-dwelling helminths.

Adult

100-200 mg PO bid pc for 5 d

Pediatric

<2 years: Not established
>2 years: 100 mg PO bid pc for 3 d

Carbamazepine and phenytoin may decrease effects of mebendazole; cimetidine may increase mebendazole levels; increased absorption with food

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Adjust dose in hepatic impairment


Thiabendazole (Mintezol)

Inhibits mitochondrial formate reductase, which is specific for helminth.

Adult

0.25-1.5 g PO bid pc for 7 d

Pediatric

50 mg/kg/d PO divided bid pc for 7 d

May elevate serum levels of theophylline increasing toxicity (monitor serum levels and reduce dose prn)

Documented hypersensitivity; caution in children weighing <30 lb

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Closely monitor in hepatic or renal dysfunction; before initiating therapy, supportive therapy is necessary for anemic, dehydrated, or malnourished patients; use in confirmed worm infestation (not prophylactically); may cause nausea, vomiting, and mild CNS depression


Albendazole (Albenza)

Acts primarily by inhibiting tubulin polymerization, resulting in the loss of cytoplasmic microtubules. Tends to be most effective against larval forms.

Adult

400 mg PO bid pc for 3-5 d

Pediatric

<2 years: 200 mg PO bid pc for 3-5 d
>2 years: Administer as in adults

Coadministration with carbamazepine may decrease efficacy; dexamethasone, cimetidine, and praziquantel may increase toxicity

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Discontinue use if LFT results increase significantly (resume when levels decrease to pretest values); abdominal pain, nausea, vomiting, diarrhea, dizziness, vertigo, fever, increased intracranial pressure, and alopecia may occur; caution in patients receiving drugs with a narrow therapeutic index (monitor carefully)

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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