Visceral larva migrans syndrome: analysis of serum cytokine levels in children with hepatic lesions confirmed in radiological findings

Abstract

Human toxocariasis is a helminth zoonosis resulting from accidental infection of humans by the roundworms Toxocara canis (T. canis) and cati (T. cati). The infection occurs in five forms: systemic (VLM), ocular, neurological, covert and asymptomatic. The aim of this study was to characterize the radiological and immunological findings in hepatic inflammation during the course of systemic infection by Toxocara sp. in children. Fifteen children, 2 to 17 years of age, with serological diagnosis of T. canis infection underwent abdominal ultrasonography and computer tomography (CT). Eosinophil counts, immunoglobulin E titres, interleukins IL-1α, IL-4, Il-6, IL-10 and interferon gamma were measured for all patients. Abdominal ultrasound revealed multiple hypoechoic areas in the livers of all patients. On the CT images, the hepatic lesions were seen as multiple, ill-defined, oval low-attenuating nodules that measured 6 to 9 millimetres in diameter. The nodules were usually best seen in the portal venous phase and were not seen on arterial-phase images. Significant intergroup differences were observed in the concentrations of IL-1α, IL-4, IL-6 and IL-10. The level of IFN-γ was not significantly elevated in patient sera relative to controls. The analysis shows that the production of anti-inflammatory cytokines is insufficient for granuloma formation in children presenting liver lesions in the course of VLM.

Production of interleukins 4 and 10 in children with hepatic involvement in the course of Toxocara spp. infection

“…The described hepatic lesions were confirmed in adult patients . In our analysis, we showed that analogous nodules in the liver parenchyma could be found in small children with hepatomegaly .…”

“…infection. A direct correlation between tissue lesions induced by Toxocara larvae migration and elevated levels of IL‐4 and IL‐6 has been shown in previous studies . Both IL‐4 and IL‐6 were described as important proinflammatory cytokines that correlated with the intensity of the inflammatory response.…”

“…We divided these patients based on their clinical presentation of hepatomegaly with/without radiological signs of granuloma in hepatic parenchyma. We classified the patients to two groups: the first group (H+/G−) included 25 children that presented hepatosplenomegaly (H+) in clinical examination without typical parenchymal lesions (G−) in ultrasonography; the second group (H+/G+) consisted of 17 children that presented hepatosplenomegaly with Toxocara ‐specific granulomas (G+) in their abdominal ultrasonography . The age of the analysed patients ranged from 2 to 17 years (mean age: 7·62 ± 3·31 years in (H+/G−) group; 6·85 ± 3·89 years in (H+/G+); P = 0·3386).…”

“…In our previous study, we showed that children with generalized toxocariasis are the specific patients with ineffective production of anti‐inflammatory cytokines. The eosinophilic infiltrations and granulomas in the liver may be due to the imbalance between pro‐ and anti‐inflammatory cytokines .…”

Point-of-Care Ultrasound Assessment of Tropical Infectious Diseases—A Review of Applications and Perspectives

“…has been reported for fascioliasis-related hepatic and biliary disease, 52,94,95 pulmonary and abdominal paragonimiasis, 96 and clonorchiasis. 97 Other helminthic infections for which US has been used include onchocerciasis, [98][99][100] abdominal and ocular toxocariasis, 101,102 and ascariasis and its complications such as bile duct invasion. [103][104][105] Further parasitic diseases for which experimental US experience is available include Chagas disease, 106 myiasis, 106,107 and even malaria.…”