Pediatric neurotoxocariasis with concomitant cerebral, cerebellar, and peripheral nervous system involvement: case report and review of the literature

Abstract

Objective: To alert pediatricians to the neurologic consequences of toxocariasis and to describe the first pediatric case of neurotoxocariasis with concomitant cerebral, cerebellar and peripheral nervous system involvement. Description:We report a case of neurotoxocariasis in a previously healthy 5-year-old boy with unusual symptoms and multi-site involvement of both the central and peripheral nervous system. Differential diagnoses are discussed and the relevant literature is reviewed. Since the early 1950s, fewer than fifty cases have been described, mostly in adult patients. Comments:Although human toxocariasis is one of the most common zoonotic helminth infections, neurotoxocariasis is a rare condition, especially in pediatric patients. Although toxocariasis usually presents as a self-limiting disease with no central nervous system involvement, when it does occur, it can be devastating. Neurotoxocariasis should be added to the differential diagnosis of pediatric patients with unusual neurologic symptoms accompanied by high levels of eosinophils in the cerebrospinal fluid. Early diagnosis and treatment can prevent long-term neurologic sequelae.J Pediatr (Rio J). 2010;86(6):531-534: Pediatrics, nervous system, toxocariasis. ResumoObjetivo: Alertar a comunidade pediátrica às consequências neurológicas da toxocaríase e descrever o primeiro caso pediátrico de neurotoxocaríase com acometimento simultâneo do cérebro, cerebelo e sistema nervoso periférico.Descrição: Relatamos um caso de neurotoxocaríase em criança do sexo masculino, 5 anos de idade, previamente hígido, com sintomas incomuns e acometimento multifocal dos sistemas nervosos central e periférico. Discutimos o diagnóstico diferencial e fazemos uma breve revisão da literatura. Desde o início da década de 1950, menos de 50 casos de neurotoxocaríase foram descritos, a maioria em adultos.Comentários: A toxocaríase é uma das helmintíases mais comuns em humanos. A neurotoxocaríase, porém, é uma patologia rara, especialmente na população pediátrica. Embora a toxocaríase costume seguir um curso autolimitado, sem envolvimento do sistema nervoso central, as manifestações neurológicas podem ser devastadoras quando ocorrem. A neurotoxocaríase deve fazer parte do diagnóstico diferencial de pacientes pediátricos com sintomas neurológicos atípicos e eosinofilia no líquor. Se diagnosticada e tratada precocemente, é possível evitar as sequelas neurológicas a longo prazo. J Pediatr (Rio J) IntroduçãoAs parasitoses são um problema de saúde pública, sendo que algumas afetam o sistema nervoso central (SNC) 1 . A prevalência das helmintíases permanece elevada, apesar de consideráveis avanços no saneamento básico e melhor acesso à terapia anti-helmíntica 2,3 .A toxocaríase (larva migrans), transmitida ao ser humano pela ingestão de ovas de Toxocara canis ou, eventualmente, Toxocara cati, é uma das helmintíases mais comuns. Estima-se que a soroprevalência de infecção por Toxocara canis no Brasil seja da ordem de 39% em crianças de 6 meses a 6 anos de idade. São três as ...

Cerebral Toxocariasis: Silent Progression to Neurodegenerative Disorders?

“…Symptomatic disease manifestations depend on the infection intensity, the duration of migration, the organs involved, and immune-and age-mediated host responses (20). Currently, both pediatric and adult patients with toxocariasis report a wide variety of inflammation-related conditions, such as asthma, pneumonia, lymphadenopathy, endomyocarditis, granulomatous hepatitis, generalized endophthalmitis, meningoencephalitis, and cutaneous manifestations (33,(62)(63)(64)(65)(66)(67)(68)(69). Notably, the focus of much research has been on the role of T. canis in neuropathological disorders, particularly epilepsy (70)(71)(72)(73).…”

“…A third form, common or covert toxocariasis (CT), was described in 1992 and 1993 for patients who were seropositive and presented with weakness, gastrointestinal disorders, and lethargy (77,78). Human toxocariasis is currently classified clinically into four types, including VLM, OT, CT, and NT (19,20,66). Regarding toxocariasis immunopathogenesis, TES antigens have been found to play a pivotal role in triggering granulomatous inflammation, a mani-festation of delayed-type hypersensitivity mediated by Th1 cells, as well as IgE, eosinophilia, and enhanced cytokine expression (e.g., interleukin-13 [IL-13], IL-5, and IL-4) characteristic of Th2-mediated responses (79).…”

“…The impact of T. canis infection on cognitive development in humans is sorely lacking, with very few clinical or populationbased studies having examined the relationship between neuropsychological parameters and T. canis seropositivity (18,181). Some clinical studies have described various cognitive deficits associated with infection, including a lack of developmental progress and speech (181), depressive symptoms and cognitive deficits possibly indicative of dementia (75), mental confusion and cognitive impairment (66,182), impairments of mental fluency and short-term and working memory spans, and slowed information processing (2).…”

A Rarely Seen Cause of Brain Abscess: Neurotoxocariasis

“…Toksokariazis, nispeten sık bir zoonotik helmintik enfeksiyon olmasına rağmen nöro-toksokariazis nadir bir tablodur 3 . Toksokariazise bağlı nörolojik manifestasyonlar çeşitli klinik tablolar şeklinde görülür.…”

Avaliação Soroepidemiológica Da Infecção Por Toxocara SPP Em Crianças Indígenas

“…Em alguns indivíduos a infecção é subclínica e só é detectada durante um exame oftalmológico de rotina (9) . A neurotoxocarose sucede com a migração das larvas à Parte Central do Sistema Nervoso (PCSN), ocasionando quadros neurológicos, como meningite eosinofílica, meningoencefalite, encefalite associada à vasculite, aracnoidite com lesão medular ou mesmo epilepsia (10) . Em relação ao diagnóstico da toxocaríase humana, esse se baseia em um conjunto de dados clínicos, laboratoriais e epidemiológicos.…”