Visceral Larva Migrans Workup

Updated: May 14, 2018
  • Author: Raymond D Pitetti, MD, MPH; Chief Editor: Russell W Steele, MD  more...
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Workup

Laboratory Studies

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  • 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%. Positive results should be confirmed using Western blotting.

  • Hypergammaglobulinemia may be present.

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Imaging Studies

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  • Children with visceral larva migrans may exhibit an abnormal liver parenchymal pattern on both abdominal ultrasonography and CT scanning. [4, 5]

  • 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.

A study described the characteristic radiologic findings of pulmonary toxocariasis on initial and follow-up chest CT. The study found that pulmonary toxocariasis manifested as multiple lesions in four radiologic patterns with subpleural and lower lung predominance on initial and follow-up CT. The study further reported that a linear opacity may be one of many clues in the diagnosis of pulmonary toxocariasis on CT. [6]

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Procedures

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  • 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.

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Histologic Findings

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

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