Pulmonary Presentation of Toxocara sp. Infection in Children

Abstract

Introduction: The aim of this study was to investigate the associations between radiological findings, blood eosinophilia, hyperimmunoglobulinemia E and G and Toxocara seropositivity in Polish children with newly diagnosed pulmonary infiltration. Material and methods:We retrospectively analyzed the documentation of 119 patients, aged 1 to 18 years (mean age: 7.21 ± 4.82), who were seropositive in regards to Toxocara sp. antibodies. In all cases, peripheral blood eosinophils and leukocyte counts, serum total IgE, IgG levels and specific IgG antibodies against excretory and secretory Toxocara sp. antigens were measured at the first presentation. After the confirmation of seropositivity, all children had a routine radiological examination. Results: In the documentation of 23 children (mean age 3.58 ± 2.63 years) we found abnormalities in the radiological examination of their lungs. Fifteen children who had abnormalities in radiological findings presented clinical respiratory complaints such as chronic cough, wheezing, asthma and haemoptysis. Eight children were asymptomatic. The analysis of peripheral eosinophils and leukocyte number, the level of IgE and specific anti-Toxocara IgG presented significantly higher values in children with radiological lesions than in children who had correct radiology. The levels of total IgG and gamma globulins were not significantly different. In 10 patients CT showed irregular round nodules with and without halo ranging from 1 to 13 mm. The number of nodules varied from a single lesion to multiple, disseminated ones. All nodules were located in peripheral areas of the lungs. None of them were found in the central areas. In 13 patients, CT images showed ground-glass opacities with ill-defined margins. None of the CT images presented lymphadenopathy and pleural effusion. Conclusion:The pulmonary lesions in small children with high eosinophilia and hyperimmunoglobulinemia E could be related to toxocariasis and for this reason they are eligible to undergo therapy with prolonged observation for several months, rather than start invasive malignancy investigations.

The Hygiene Hypothesis and Its Inconvenient Truths about Helminth Infections

“…Indeed, there are several important studies that show Toxocara spp . elicit Loeffler’s type pathology during their larval migrations through the human lungs, causing an asthma phenotype [ 11 , 54 , 55 ]. A large population-based study conducted in the US demonstrated that patients with seropositivity to Toxocara had decreased FEV1 when additional population-based factors such as age, sex, and body mass index were controlled [ 56 ].…”

Eosinophilic Pneumonia Due to Toxocariasis: A Rare Case Report in a Paediatric Patient and Literature Review

“…After ingestion of Toxocara eggs, the larvae hatch and migrate to different tissues, resulting in a systemic inflammatory reaction. 7,8 Symptoms vary according to the host's immune response and the number and location of these larvae. In individuals infected by a large volume of Toxocara eggs, there is significant eosinophilia and retention of large amounts of the parasite in liver and lung tissue, causing classic manifestations of Toxocara pneumonia.…”

“…Lung injuries are more frequent in children under 1 year of age. 7 One of the pulmonary affections related to infection by T. canis is eosinophilic pneumonia, which occurs due to several factors, including Type I hypersensitivity reaction, activated by alveolar macrophages following an external trigger; direct action of the infectious agent; or resulting from an inflammation cascade triggered by inflammatory cytokines, which cause eosinophilic recruitment. 9,10 Some parasites bind to alveolar or parenchymal epithelial cells, causing the release of IL-33 and thymic stromal lymphopoietin, which are potent triggers of the Th2 immune response, responsible for the recruitment of eosinophils and T-helper cells.…”

The New Status of Parasitic Diseases in the COVID-19 Pandemic—Risk Factors or Protective Agents?

“…Toxocariasis is caused by infection with Toxocara canis/cati visceral larva migrans (VLM), with children being particularly at risk [ 58 ]. Following infection, the larva penetrates into the intestinal wall and migrates to various organs through the bloodstream.…”