Toxocariasis Workup

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

Laboratory Studies

  • The diagnosis of toxocariasis requires a high index of suspicion and depends on serologic testing (eg, ELISA, immunoblot).
  • Peripheral blood eosinophilia is the most important finding; however, it may be absent in patients with ocular or covert toxocariasis.
  • Serum total IgE: Patients with toxocariasis often have a marked increase in total IgE levels.
  • ELISA with Toxocara excretory-secretory antigen (TES-Ag)
    • An elevated anti–TES-Ag IgE level indicates acute infection or progressive inflammation caused by toxocariasis.
    • An increase in the immunoglobulin G (IgG) level confirms a past or present infection with minimum inflammation.
    • In ocular toxocariasis, an IgG or IgE titer is lower because the worm burden is smaller.
    • ELISA with aqueous fluid is therefore useful when ocular toxocariasis is suspected.
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Imaging Studies

  • In a patient with pulmonary involvement, chest radiography may show multiple pulmonary nodules with surrounding ground-glass opacities, or possibly pleural effusion.
  • Ultrasonography reveals multiple hypoechoic areas in the liver.
  • CT scan
    • Hepatic lesions are of low density.
    • Pulmonary involvement manifests as multiple pulmonary nodules and surrounding ground-glass opacities or, rarely, pleural effusion.
    • In the CNS, granulomas appear cortically or subcortically, showing a hyperintense appearance on proton density and T2-weighted images. The image on the left is a posteroanterior chest rThe 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.
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Other Tests

  • An immunoblot is more specific than ELISA when bands from 24-35 kD are considered out of typical 7-band patterns (24, 28, 30, 35, 132, 147, 200 kD).
  • Funduscopic examination should be performed in patients suspected of having acute toxocariasis.
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Procedures

  • Biopsy is rarely performed to confirm the presence of Toxocara larvae.
  • A needle biopsy of the liver is required for histologic diagnosis in cases of liver involvement; however, some results are false-negative because lesions in the liver are very small.
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Histologic Findings

The encapsulated larvae can be found in the liver, lung, brain, and/or enucleated eye. The larvae occur in a matrix of epithelioid cells surrounded by a fibrous capsule with weak inflammatory reactions. In ocular toxocariasis, a mobile larva can be directly observed under the retina.

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Staging

No clinical or histological staging of toxocariasis exists.

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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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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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