Medical Care
Chemotherapy is the treatment of choice in most patients with liver, lung, or eye involvement. Occasionally, ocular involvement requires ocular surgery.
Treatment includes mebendazole, thiabendazole, corticosteroids, and specific organ treatment. The prognosis of toxocariasis is generally favorable.
Surgical Care
For liver or lung involvement, no surgical care is required.
For ocular involvement with retinal detachment, laser treatment may be considered.
Consultations
A consultation with an ophthalmologist is indicated in cases of ocular larva migrans.
Consultation with a neurologist is indicated in cases of brain involvement with neurologic symptoms or seizures.
Consultation with an infectious disease specialist may be indicated when questions exist regarding the indications for and selection of treatment for visceral larva migrans.
Diet
No diet restrictions are required.
Activity
No activity restriction is required.
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. [11]
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.
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.
Inpatient & Outpatient Medications
Continue antihelmintic 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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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.
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Funduscopic examination of the right eye of a patient with ocular toxocariasis showing rhegmatogenous retinal detachment.
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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).
