eMedicine Specialties > Pediatrics: General Medicine > Parasitology
Toxocariasis: Treatment & Medication
Updated: Jan 27, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
Most patients with toxocariasis recover without therapy.
- Treatment with anthelmintic agents is indicated for severe complications such as those involving the brain, lung, and heart. Because anthelmintic treatment can lead to an increased inflammatory reaction, corticosteroids sometimes are used with or without specific therapy.
- Visceral larva migrans (VLM) is always treated with anthelmintic agents.
- Treatment of covert toxocariasis should be individualized. The decision to treat depends on the age of the patient, severity of the symptoms, and certainty of the diagnosis.
- An experienced ophthalmologist should be involved in the treatment of patients with ocular larva migrans (OLM). Treatment of this entity does not require anthelmintic therapy but relies on local corticosteroids and surgery.
Surgical Care
- Surgical care may be necessary for OLM.
Consultations
- Infectious diseases specialists and ophthalmologists often are helpful. Other consultants may be needed, depending on the tissues affected.
Diet
- Correction of underlying causes of pica may prevent reinfection.
Activity
- Activity limitation may be required in cases with cardiac involvement and retinal detachment.
Medication
Anthelmintic agents are used primarily for severe complications of visceral larva migrans (VLM), such as brain, heart, and lung involvement.
Anthelmintic agents
These eradicate the larvae. Parasite biochemical pathways are different from the human host, thus toxicity is directed to the parasite, egg, or larvae. 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
Diethylcarbamazine (Hetrazan)
The DOC in most textbooks, but the FDA does not list toxocariasis as an indication. It is obtained only through the manufacturer.
Adult
6 mg/kg/d PO divided tid for 10 d
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
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
Caution to avoid allergic reaction
Thiabendazole (Mintezol)
Broad-spectrum anthelmintic drug; mechanism of action is unclear, but may inhibit the helminth-specific enzyme fumarate reductase.
Adult
500 mg PO bid for 7 d; alternatively 50 mg/kg/d PO divided bid, not to exceed 3 g/d
Pediatric
50 mg/kg/d PO divided bid for 7 d; not to exceed 3 g/d
May elevate serum levels of theophylline, increasing toxicity (monitor serum levels and reduce dose prn)
Documented hypersensitivity
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
May cause the parasite to migrate in intestinal infections with Ascaris species; 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)
Has poor PO bioavailability; absorption is enhanced by fatty meals; systemic anthelmintic effect is attributed to its sulfoxide metabolite; albendazole may induce its own metabolism.
Adult
400 mg PO bid for 5-10 d
Pediatric
10-15 mg/kg/d PO divided bid; not to exceed adult dose
Coadministration with carbamazepine may decrease efficacy; dexamethasone, cimetidine, and praziquantel may increase toxicity
Documented hypersensitivity
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)
Mebendazole (Vermox)
Synthetic broad-spectrum anthelmintic. Likely the drug for which the most experience exists and the safest drug in its class. Inhibits microtubule formation and causes glucose depletion in the worms.
Adult
100 mg PO bid for 3 d
Pediatric
<2 years: Not established
>2 years: Administer as in adults
Carbamazepine and phenytoin may decrease effects; cimetidine may increase levels
Documented hypersensitivity
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
Has increased liver enzyme levels when taken for prolonged periods
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| Differential Diagnoses & Workup: Toxocariasis |
 Treatment & Medication: Toxocariasis |
| Follow-up: Toxocariasis |
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Further Reading
Keywords
toxocariasis, allergic asthma, anemia, arthralgia, aseptic meningitis, chronic idiopathic urticaria, covert toxocariasis, cystoid macular edema, encephalitis, eosinophilia, eosinophilic cellulitis, eosinophilic meningitis, eosinophilic pneumonia, epilepsy, granulomatous hepatitis, Henoch-Schönlein purpura, hepatomegaly, Loeffler endomyocarditis, lymphadenopathy, lymphedema, lymphoma, migratory cutaneous lesions, monoarthritis, myocarditis, ocular larva migrans, OLM, parasitic infection, pericardial tamponade, pica, pleural effusions, pyogenic liver abscess, respiratory failure, small-vessel vasculitis, Toxocara canis, T canis, Toxocara catis, T catis, toxocarosis, traction retinal detachment, uveitis, visceral larva migrans, VLM, vitreitis, Well syndrome
