Overview
Gnathostomal visceral larva migrans, primarily caused by Toxocara catis (toxocariasis), involves larval migration through various organs, leading to eosinophilic infiltration and organ-specific pathology, as exemplified by cases involving the heart and liver 1.Diagnosis
Clinical Presentation: History of exposure to cats, symptoms mimicking respiratory or gastrointestinal infections, and signs of organ involvement (e.g., myocarditis, hepatomegaly) 1.
Laboratory Tests: Elevated eosinophil counts, positive serological tests for Toxocara antibodies (ELISA, IFAT) 1.
Imaging: Echocardiography for myocarditis, abdominal ultrasound for hepatic involvement 1.
Pathology: Histopathological examination showing eosinophilic infiltration and larval forms in affected tissues 1.Management
First-Line Treatment: Albendazole (200-400 mg/day for 3-7 days) or Mebendazole (100 mg twice daily for 3-7 days) 1.
Adjunctive Therapy: Corticosteroids (e.g., prednisone) for severe cases with significant organ involvement to reduce inflammation and eosinophilic response 1.
Supportive Care: Management of organ-specific complications (e.g., heart failure, liver dysfunction) 1.Special Populations
Pediatrics: Increased vigilance in young children due to higher susceptibility and potential for severe complications, as seen in the fatal case of a 19-month-old 1.Key Recommendations
Serological Testing: Routinely screen for Toxocara antibodies in patients with unexplained organ-specific symptoms and a history of cat exposure (Evidence: Moderate) 1.
Early Treatment Initiation: Initiate antihelminthic therapy (Albendazole or Mebendazole) promptly upon diagnosis to mitigate organ damage (Evidence: Moderate) 1.
Corticosteroid Use: Consider corticosteroids in cases with severe organ involvement to manage inflammation and reduce morbidity (Evidence: Weak) 1.References
1 Wygant CM, Cohle SD. Fatal visceral larva migrans from Toxocara catis infection of the heart and liver in a child. Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology 2023. link