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The dog roundworm Toxocara canis, the cat roundworm Toxocara cati, and less commonly other helminths may cause visceral larva migrans T canis is highly prevalent in dogs Humans are infected after ingestion of eggs in material contaminated by dog or other feces With T canis, infection is spread principally by puppies and lactating females, and the eggs must be on the ground for several weeks before they are infectious After ingestion by humans, larvae migrate to various tissues but cannot complete their life cycle Visceral larva migrans is seen principally in young children Most infections are asymptomatic The most commonly involved organs are the liver and lungs Presentations include cough, fever, wheezing, hepatomegaly, splenomegaly, lymphadenopathy, pulmonary infiltrates, and eosinophilia Involvement of the CNS can occur rarely, leading to eosinophilic meningitis and other abnormalities Ocular larva migrans is a distinct syndrome, usually in children older than is typical for visceral larva migrans Children present with visual deficits, pain, and a retinal mass, which can be confused with retinoblastoma Baylisascaris procyonis, a roundworm of raccoons, can rarely cause visceral larva migrans in humans, with typically more severe manifestations than those with T canis, including eosinophilic meningitis and eye disease The diagnosis of visceral larva migrans is suggested by the finding of eosinophilia in a child with hepatomegaly or other signs of the disease, especially with a history of exposure to puppies The diagnosis is confirmed by the identification of larvae in a biopsy of infected tissue, usually performed when other diseases are suspected Serologic tests may be helpful; an available ELISA was estimated to have 78% sensitivity and 92% specificity Most patients recover without specific therapy, although symptoms may persist for months Treatment with antihelminthics or corticosteroids may be considered in severe cases No drugs have been proven to be effective, but albendazole (400 mg twice daily for 5 days), mebendazole, thiabendazole, diethylcarbamazine, and ivermectin have been used, and albendazole has been recommended as the treatment of choice.

Despommier D Toxocariasis: clinical aspects, epidemiology, medical ecology, and molecular aspects Clin Microbiol Rev 2003 Apr;16(2):265 72 [PMID: 12692098] Gavin PJ et al Baylisascariasis Clin Microbiol Rev 2005 Oct; 18(4):703 18 [PMID: 16223954] Good B et al Ocular toxocariasis in schoolchildren Clin Infect Dis 2004 Jul 15;39(2):173 8 [PMID: 15307025] Moreira-Silva SF et al Toxocariasis of the central nervous system: with report of two cases Rev Soc Bras Med Trop 2004 Mar Apr;37(2):169 74 [PMID: 15094904] Vidal JE et al Eosinophilic meningoencephalitis due to Toxocara canis: case report and review of the literature Am J Trop Med Hyg 2003 Sep;69(3):341 3 [PMID: 14628955]

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A number of species of Gnathostoma, which are parasites of carnivores, can occasionally infect humans Most cases have been seen in southeast Asia, but the disease has also been described in many other areas Eggs shed in the feces of mammals are ingested by marine crustaceans, which are then ingested by fish, frogs, snakes, or mammals Larvae then encyst in muscles Human infection follows eating undercooked fish, shellfish, chicken, or pork and can also be transmitted by ingesting copepods in contaminated water After ingestion, larvae cannot complete development in humans, but rather migrate through tissues Acute gastrointestinal symptoms, including nausea, vomiting, abdominal pain, and fever, may develop soon after infection and persist for 2 3 weeks The disease may then progress to findings consistent with cutaneous or visceral larva migrans Migratory subcutaneous erythematous swellings may be painful or pruritic Migrating larvae may also invade other tissues, leading to findings in the eyes, lungs, intestines, and elsewhere The most serious complications are due to invasion of the CNS, leading to eosinophilic meningoencephalitis and other serious findings Although a less common cause of eosinophilic meningitis than A cantonensis infection, gnathostomiasis tends to be more severe Severe pain due to migration through spinal roots and focal neurologic findings may be seen Symptoms are highly variable over time CSF eosinophilic pleocytosis and peripheral eosinophilia are seen The diagnosis of gnathostomiasis is suggested by the history of intermittent subcutaneous swellings and typical CNS findings Worms can occasionally be identified in skin lesions Serologic tests may be helpful in establishing a diagnosis Treatment is with ivermectin (200 mcg/kg single dose) or albendazole (400 mg/kg daily for 21 days); both treatments have reported cure rates over 90%

Bhattacharjee H et al Intravitreal gnathostomiasis and review of literature Retina 2007 Jan;27(1):67 73 [PMID: 17218918] Bussaratid V et al Efficacy of ivermectin treatment of cutaneous gnathostomiasis evaluated by placebo-controlled trial Southeast Asian J Trop Med Public Health 2006 May;37(3):433 40 [PMID: 17120960] Nontasut P et al Double-dose ivermectin vs albendazole for the treatment of gnathostomiasis Southeast Asian J Trop Med Public Health 2005 May;36(3):650 2 [PMID: 16124432]

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CUTANEOUS LARVA MIGRANS (CREEPING ERUPTION)

Cutaneous larva migrans is caused principally by larvae of the dog and cat hookworms, Ancylostoma braziliense and A caninum Other animal hookworms, gnathostomiasis, and

Daschner A et al Anisakis simplex: sensitization and clinical allergy Curr Opin Allergy Clin Immunol 2005 Jun;5(3):281 5 [PMID: 15864089] Montalto M et al Anisakis infestation: a case of acute abdomen mimicking Crohn s disease and eosinophilic gastroenteritis Dig Liver Dis 2005 Jan;37(1):62 4 [PMID: 15702862] Pellegrini M et al Acute abdomen due to small bowel anisakiasis Dig Liver Dis 2005 Jan;37(1):65 7 [PMID: 15702863] Weir E Sushi, nemotodes and allergies CMAJ 2005 Feb 1; 172(3):329 [PMID: 15684113]

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