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Key Features

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  • Visceral involvement, including hepatomegaly, marked eosinophilia, and anemia

  • Posterior or peripheral ocular inflammatory mass

  • Elevated antibody titers in serum or aqueous fluid; demonstration of Toxocara larvae in biopsy specimen

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Clinical Findings

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  • Visceral larva migrans

    • Usually asymptomatic

    • Anorexia, fever, fatigue, pallor, abdominal pain and distention, nausea, vomiting, and cough may be present in children aged 1–5 years

    • Hepatomegaly is common, splenomegaly is unusual, and adenopathy is absent

    • Lung involvement, usually asymptomatic, can be demonstrated readily by radiologic examination

    • Seizures are common, but more severe neurologic abnormalities are infrequent

  • Ocular larva migrans

    • Occurs in older children and adults who have a unilateral posterior or peripheral inflammatory eye mass

    • History of visceral larva migrans and eosinophilia are typically absent

    • Anti-Toxocara antibody titers are low in the serum and high in vitreous and aqueous fluids

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Diagnosis

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  • Eosinophilia with leukocytosis, anemia, and elevated liver function tests are typical

  • Hypergammaglobulinemia may be present and elevated isohemagglutinins sometimes result from cross-reactivity between Toxocara antigens and human group A and B blood antigens

  • Diagnosis is confirmed by finding larvae in granulomatous lesions

  • High ELISA serology and the exclusion of other causes of hypereosinophilia provide a presumptive diagnosis in typical cases

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Treatment

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  • Albendazole (400 mg twice a day for 5 days) or mebendazole (100–200 mg twice a day for 5 days) is indicated for severe complications involving the brain, lung, or heart

  • Treating any cause of pica, such as iron deficiency, is important

  • Corticosteroids are used to treat marked inflammation of lungs, eyes, or other organs

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