Toxocariasis Follow-up

  • Author: Sun Huh, MD, PhD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Apr 18, 2012
 

Further Inpatient Care

  • In a patient with acute symptoms of toxocariasis (ie, dyspnea, chest tightness) due to lung involvement, hospitalization may be necessary.
  • In a patient with liver or ocular involvement, hospitalization may be needed for diagnostic and/or therapeutic procedures such as biopsy or laser surgery.
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Further Outpatient Care

  • Perform a follow-up examination of the lesion and a serum titer for TES-Ag using IgG, IgE with ELISA, or immunoblotting.
  • For significant lung involvement, obtain follow-up chest radiography to confirm the resolution of any acute infiltrate.
  • Serum transaminases and alkaline phosphatase can be used to monitor the degree of liver involvement.
  • For ocular involvement, monthly or bimonthly funduscopic examinations are recommended, according to the patient's state of remission.
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Inpatient & Outpatient Medications

  • Continue anthelmintic therapy for 1 month after completing a course of steroids. If symptoms persist after a full course of anthelmintic therapy, extend steroid administration and taper according to lung symptoms.
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Deterrence/Prevention

  • The eggs of Toxocara species are widespread in parks, playgrounds, yards, and in homes and apartments where the occupants have dogs or cats. Elimination of eggs from the environment is not possible; therefore, prevention depends on proper hygiene, including handwashing after contact with pets.
  • Dogs and cats can be de-wormed. However, this does not eliminate eggs from the larger environment.
  • Public policies that have attempted to eradicate Toxocara infection in dogs and cats have had limited success.
  • Puppies and kittens acquire Toxocara infection transplacentally and should be de-wormed at 2, 4, 6, and 8 weeks.
  • Sandboxes should be covered when not in use.
  • Dog and cat feces should be disposed of properly.
  • After playing in public parks and in sandboxes, children should wash their hands before eating.
  • For more information, visit CDC’s Guidelines for Veterinarians.[5]
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Complications

  • Decreased visual acuity may occur if ocular toxocariasis is not identified and treated.
  • Retinal detachment due to ocular involvement may cause unilateral visual loss.
  • Seizures may result from cerebral involvement.
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Prognosis

  • Toxocariasis is generally a self-limited disease. The prognosis is good when adequately treated, except in some patients with ocular or cerebral involvement.
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Patient Education

  • Properly de-worm kittens and puppies.
  • Pets should undergo periodic stool examinations by a veterinarian, and they should be treated if examination findings are positive for Toxocara eggs.
  • Do not bring stray dogs or cats home. If such animals are brought home, they should be examined by a veterinarian for toxocariasis.
  • Focus on personal hygiene. If dogs or cats have been in the yard, consider it contaminated. Wash hands after lawn work or gardening.
  • For patient education resources, see the Brain and Nervous System Center, as well as Brain Infection.
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Contributor Information and Disclosures
Author

Sun Huh, MD, PhD  Chairman, Professor, Department of Parasitology, College of Medicine, Hallym University, Korea

Disclosure: Nothing to disclose.

Coauthor(s)

Sooung Lee, PhD  Team Manager, Research and Development, Chuncheon Bioindustry Foundation, Chuncheon-do, Korea

Disclosure: Nothing to disclose.

Specialty Editor Board

Pranatharthi Haran Chandrasekar, MBBS, MD  Professor, Department of Internal Medicine, Director of Infectious Disease Fellowship, Harper Hospital, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gordon L Woods, MD  Consulting Staff, Department of Internal Medicine, University Medical Center

Gordon L Woods, MD is a member of the following medical societies: Society of General Internal Medicine

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

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  2. Nelson S, Greene T, Ernhart CB. Toxocara canis infection in preschool age children: risk factors and the cognitive development of preschool children. Neurotoxicol Teratol. Mar-Apr 1996;18(2):167-74. [Medline].

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The image on the left is a posteroanterior chest radiograph in a patient with toxocariasis. The image on the right is a CT scan of the patient with toxocariasis showing multiple pulmonary nodules with surrounding ground-glass opacities at first visit.
Funduscopic examination of the right eye of a patient with ocular toxocariasis showing rhegmatogenous retinal detachment.
Immunogold finding of Toxocara canis larva reacted with a seropositive human serum. Arrows indicate each particle. (A) High-density immunogold particles are distributed in the large columnlike secretory cell (LCSC), excretory duct (ED), and cuticle(C); (B) high-density immunogold particles are shown in the secretory cell (SC), excretory duct (ED), and cuticle; (C) immunogold particles are distributed in the excretory duct (ED); (D) high-density particles are displayed in the microvilli of the intestine (MI); (E) immunogold particles are shown in the excretory duct; and (F) high-density immunogold particles are distributed in the cuticle(C).
 
 
 
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