0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23
1534 Visceral Larva MigransVISCERAL LARVA MIGRANS
J. GORDON FRIERSON, MD
history & physical
History
■Exposure; Ingestion of eggs ofToxocara canisorcati, through con-
taminated fingers, objects, or eating dirt. The eggs hatch in the intes-
tine, producing larvae which migrate through intestinal wall and to
all organs of body.Signs & Symptoms
■Usually seen in small children or mentally ill. Mild infections asymp-
tomatic. Symptoms include fever, hepatomegaly, abdominal pain,
myalgias, sometimes wheeze or cough, urticaria.tests
■Basic tests: blood: eosinophilia, may be very pronounced.
■Basic tests: urine: normal
■Specific tests: Diagnosis usually clinical. Biopsy of liver or other tissue
may show larva.
■Other tests: Serology by ELISA (done at CDC and other labs) helpful,
but can be elevated in 1–10% of “normal” children. Rising titer more
specific.differential diagnosis
■Migratory phase of several nematodes, such as hookworm, ascaris,
strongyloides. Hypereosinophilic syndromes.management
What to Do First
■Assess severity. IV fluids if needed.General Measures
■Determine source of infection, and remove it.
specific therapy
Indications
■Patient with significant symptoms.