Materiały źródłowe

• #1 CDC – DPDx – Toxocariasis

  https://www.cdc.gov/dpdx/toxocariasis/index.html

  Diagnosis of toxocariasis relies mostly on indirect means, particularly serology, since larvae are trapped in tissues and not readily detected morphologically. […] While visualization of larvae in histologic sections provides unequivocal diagnosis, the probability of capturing a larva in a small biopsy specimen is low. […] Since the larvae do not develop into adults in humans, a stool examination would not detect any Toxocara eggs. […] For both VLM and OLM, a presumptive diagnosis rests on clinical signs, compatible exposure history (e.g. history of exposure to puppies/kittens or pica/geophagia behaviors), laboratory findings (including eosinophilia), and the detection of antibodies to Toxocara. […] Antibody detection tests are the only means of confirmation of a clinical diagnosis of visceral larva migrans (VLM) and ocular larva migrans (OLM), clinical syndromes associated with Toxocara infections.

• #2 Clinical Overview of Toxocariasis | Parasites – Toxocariasis | CDC

  https://www.cdc.gov/toxocariasis/hcp/clinical-overview/index.html

  Currently, the recommended test is an enzyme-linked immunosorbent assay (ELISA) with larval stage antigens. […] Diagnosis of either visceral toxocariasis or ocular toxocariasis is based on the presence of signs of VT or OT and history of exposure to a potential source of infectious Toxocara eggs or larvae (e.g., in undercooked infected meat or offal). The diagnosis of visceral toxocariasis is based on compatible disease and exposure history with positive results by serological testing. […] The currently recommended test is an enzyme-linked immunosorbent assay (ELISA) with larval stage antigens. […] Positive serological results should be interpreted with consideration of the patient’s clinical status. […] In ocular toxocariasis, Toxocara antibody levels in serum can be low or absent despite clinical disease. […] Careful attention to disease course, exposure history and serological testing can be useful for differential diagnosis.

• #3 Toxocariasis: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/23401-toxocariasis

  Your healthcare provider will perform a physical examination to diagnose toxocariasis. […] They may request a blood test to check for evidence of toxocariasis. A blood test will check for Toxocara antibodies in your blood. Antibodies are proteins your immune system makes to help defend your body against infection.

• #4 Toxocariasis Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/229855-workup

  The diagnosis of toxocariasis requires a high index of suspicion and depends on serologic testing (eg, ELISA, immunoblot). […] Peripheral blood eosinophilia is the most important finding; however, it may be absent in patients with ocular or covert toxocariasis. […] Serum total IgE: Patients with toxocariasis often have a marked increase in total IgE levels. […] ELISA with Toxocara excretory-secretory antigen (TES-Ag) may show the following: An elevated antiTES-Ag IgE level indicates acute infection or progressive inflammation caused by toxocariasis. […] An increase in the immunoglobulin G (IgG) level confirms a past or present infection with minimal inflammation. […] In ocular toxocariasis, an IgG or IgE titer is lower because the worm burden is smaller. […] ELISA with aqueous fluid is therefore useful when ocular toxocariasis is suspected.

• #5 CDC – DPDx – Toxocariasis

  https://www.cdc.gov/dpdx/toxocariasis/index.html

  The currently recommended serologic test for toxocariasis is enzyme immunoassay (EIA) with larval stage antigens extracted from embryonated eggs or released in vitro by cultured third-stage larvae. […] The TES-ELISA used at CDC measures total Toxocara-specific immunoglobulin and results are reported as an endpoint titer (1:2, 1:2, 1:4, 1:16, etc.). […] A titer of 1:32 is considered positive. […] Evaluation of this assay in groups of patients with presumptive diagnoses of VLM or OLM indicated sensitivity of 78% and 73%, respectively, at a titer of 1:32. […] Further confirmation of serologic diagnosis of OLM can be obtained by testing aqueous or vitreous humor samples for antibodies. […] Specificity has been reported to be 92% (VLM) and 91% (OLM) at a titer of 1:32 (serum). […] Evaluation of the true sensitivity and specificity of serologic tests for toxocariasis in human populations is not possible because of the lack of feasible parasitological methods to detect migrating Toxocara larvae in tissue. […] When interpreting serologic findings, clinicians must be aware that a measurable titer does not necessarily indicate current clinical Toxocara infection. […] Positive serological results should always be interpreted with consideration of the patients clinical picture.

• #6 Ocular toxocariasis: clinical features, diagnosis, treatment, and prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4116038/

  OT is diagnosed clinically by identification of clinical signs on ophthalmologic examination. […] Serological tests, such as enzyme-linked immunosorbent assay (ELISA) for detection of serum antibody against the Toxocara larvae, can confirm the diagnosis. […] In addition, serum immunoglobulin E and detection of ocular fluid antitoxocara antibody by ELISA may give additional aid to the diagnosis. […] Definitive diagnosis of ocular toxocariasis can be obtained by histological demonstration of the toxocara larva or its fragments from biopsy of infected tissue. However, the collection of suitable biopsy material is risky and difficult in eyes with OT and rarely justified on clinical grounds. Thus, current diagnosis of OT is made clinically by the identification of the typical ophthalmologic signs and by the presence of serum antibody to the Toxocara larvae.

• #7 Detection and Treatment Of Ocular Toxocariasis

  https://www.reviewofophthalmology.com/article/detection-and-treatment-of-ocular-toxocariasis

  Imaging modalities can provide additional information in many patients. Optical coherence tomography of posterior pole granulomas usually demonstrates a highly reflective mass located above the RPE and can also show factors potentially contributing to vision loss, such as the presence of intraretinal or subretinal fluid. B-scan ultrasonography is particularly helpful when vitritis or other opacities preclude a view of the fundus. […] Rarely the diagnosis of ocular toxocariasis is made histopathologically following identification of a dead larva in the center of an eosinophilic granuloma.

• #8 Toxocariasis Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/229855-workup

  An immunoblot is more specific than ELISA when bands from 24-35 kD are considered out of typical 7-band patterns (24, 28, 30, 35, 132, 147, 200 kD). […] Funduscopic examination should be performed in patients suspected of having acute toxocariasis. […] Biopsy is rarely performed to confirm the presence of Toxocara larvae. […] A needle biopsy of the liver is required for histologic diagnosis in cases of liver involvement; however, some results are false-negative because lesions in the liver are very small. […] The encapsulated larvae can be found in the liver, lung, brain, and/or enucleated eye. […] No clinical or histological staging of toxocariasis exists.

• #9 Serodiagnostic methods for diagnosing larval toxocariasis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32381194/

  Toxocariasis is a human infection primarily caused by larvae of Toxocara canis from dogs, and also by T. cati from cats. […] Diagnosis of toxocariasis is based on clinical, epidemiological, and serological data. […] Indirect IgG ELISA is a widely used serodiagnostic method for toxocariasis, with native T. canis TES most commonly used as the antigen. […] Western blots, using the same antigen, can be used to confirm positive ELISA findings to reduce false-positive results. […] Improvements in Toxocara serodiagnosis include the use of recombinant TES antigens, simpler and more rapid assay formats, and IgG4 subclass detection. […] Development of antigen detection tests using polyclonal and monoclonal antibodies, nanobodies, or aptamers can complement the antibody detection assays, and enhance the effectiveness of the serodiagnosis.

• #10

  https://link.springer.com/article/10.1007/s40475-013-0001-8

  Diagnosis of toxocariasis is almost always accomplished using immunodiagnostic methods. […] The utility of the TES-Ag ELISA for diagnosis of VT was originally evaluated using 62 sera from cases with presumed clinical VT. […] Positive serology results from the TES-Ag ELISA are important in establishing a diagnosis of VT. […] The currently accepted best practice for immunodiagnosis of clinical toxocariasis is to detect Toxocara-specific IgG using the TES-Ag ELISA. […] In Europe, TES-Ag ELISA positive results are confirmed using a TES-Ag IB. […] The development of novel tests utilizing recombinant antigens to detect specific antibodies represents the single greatest opportunity for improved diagnostics of human toxocariasis.

• #10

  https://link.springer.com/article/10.1007/s40475-013-0001-8

  The clinical spectrum of human disease caused by Toxocara canis and Toxocara cati ranges from visceral and ocular larva migrans to covert and common toxocariasis. […] Detection of parasite-specific antibodies is an important and necessary step in establishing a diagnosis of toxocariasis. […] Most immunodiagnostic methods have historically used and continue to use the Toxocara excretory-secretory antigens (TES-Ag) in an ELISA format to detect Toxocara-specific antibodies. […] The TES-Ag ELISA has proven to be specific, robust, and reliable, although questions about specificity and reduced sensitivity leave ample room for improvement in laboratory diagnosis of toxocariasis. […] Establishing a diagnosis of toxocariasis in humans is difficult, largely because the clinical syndromes can be vague, and general laboratory findings may be associated with other parasitic and viral infections and immune system abnormalities.

• #11 Toxocara Species – Toxocariasis | Choose the Right Test

  https://arupconsult.com/content/toxocara-species

  Toxocariasis can be difficult to diagnose because its symptoms are often nonspecific. […] Diagnosis of VT and OT is based on clinical evaluation, patient history, and laboratory testing. […] Toxocariasis diagnosis should be based on a detailed clinical evaluation to identify potential signs and symptoms of infection. […] Finally, laboratory testing should be used to find supportive evidence of infection. Serology is the preferred laboratory test for diagnosis. […] Serology to detect Toxocara antibodies is recommended to aid in the diagnosis of toxocariasis (OT and VT). […] A positive Toxocara antibody test result should be interpreted in the context of a patients clinical evaluation and patient history. […] Observation of a significant increase in antibody concentration between paired acute and convalescent samples may be useful to confirm an active infection.

• #12 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Toxocariasis-Background-Types-Diagnosis-Treatment.aspx

  VLM should be suspected in any child with an unexplained febrile illness and eosinophilia (an increase in a type of white blood cell). […] A definitive diagnosis of VLM can be made by testing for common roundworm antigens and blood group substance A. However, these immunological tests are not reliable for OLM because patients tend to have lower levels of the roundworm antigen in their blood. OLM is diagnosed through an ophthalmologic exam.

• #13 Challenges in Toxocariasis Diagnosis: From Pericarditis, through Hepatic Tumor, to the Detection of Brain Aneurysms: Case Report

  https://www.mdpi.com/2076-0817/13/3/254

  Toxocariasis is the parasitic infection caused by the larvae of Toxocara roundworms species: Toxocara canis from dogs and, less frequently, Toxocara cati from cats. The high proportion of asymptomatic cases of toxocariasis and the uncharacteristic clinical manifestations mimicking other medical conditions make diagnosis challenging. […] The diagnosis of toxocariasis was based on clinical manifestations, exposure history (raw meat consumption, owning a dog with no regular parasite screening, travel to increased risk countries), positive serology and eosinophilia. […] Diagnosis of neurotoxocariasis is mainly based on the detection of specific antibodies against Toxocara spp. in CSF or serum, and clinical and radiological improvement after antiparasitic therapy. However, definitive diagnosis is based only on histological confirmation which is rarely available. […] This case should prompt more attention to neglected parasitic diseases and the necessity to include them in differential diagnoses. Toxocariasis should be considered in any patient presenting with persistent hypereosinophilia with multisystem involvement.

• #14

  https://www.alliedacademies.org/articles/toxocariasis-17743.html

  Toxocariasis is one of the most prevalent zoonotic helminth diseases in the world, having a greater incidence in tropical and rural areas. […] The history, blood tests, including differential blood cell count, CSF studies, including detection of antibodies anti-Toxocara canis, and neuroimaging are used to diagnose neurotoxocariasis. […] Toxocariasis is a hidden parasitic illness in people, and the only way to diagnose it is by immunodiagnosis. […] Seroprevalence rates among youngsters were likewise shockingly high in a recent research in the Republic of Ireland. […] Despite the fact that there is a paucity of research on the relationship between human toxocariasis and cognition and neuropsychiatric function, many of the existing data imply that toxocariasis is linked to cognitive and neuropsychiatric function.

• #15 Toxocariasis: a silent threat with a progressive public health impact | Infectious Diseases of Poverty | Full Text

  https://idpjournal.biomedcentral.com/articles/10.1186/s40249-018-0437-0

  Demonstrating the presence of Toxocara larvae in tissue biopsy, cerebrospinal fluid (CSF) or ocular fluids using direct microscopy remains the gold standard for the diagnosis of toxocariasis. […] Serological tests are used to support the clinical diagnosis of toxocariasis. […] Molecular techniques have high analytical specificity, and shorter turnaround times than other diagnostics. […] Despite growing efforts to develop a range of diagnostic methods for detection of human toxocariasis, accurate diagnosis remains a challenge.

• #16 Ocular toxocariasis: a neglected parasitic disease in Egypt | Bulletin of the National Research Centre | Full Text

  https://bnrc.springeropen.com/articles/10.1186/s42269-019-0185-8

  Intraocular fluids include aqueous humor which is a clear liquid found in the space present between the cornea and the lens, and vitreous humor which is present in the space between the lens and the retina. Detection of specific Toxocara antibodies in aqueous and/or vitreous samples using different immunological methods assists the confirmation of ocular toxocariasis diagnosis. […] Molecular-based methods for Toxocara detection in clinical and environmental samples have been described by several investigators. […] Medical imaging techniques such as ocular ultrasound, computed tomography, optical coherence tomography, fluorescein angiography, and magnetic resonance imaging are used to detect granulomatous lesions related to Toxocara larva migration within the eye and may be helpful in the differential diagnosis of ocular toxocariasis from other ocular diseases, particularly retinoblastoma. […] In surgically treated cases, the definitive diagnosis of ocular toxocariasis is via the histopathological identification of Toxocara larva or its fragments in the vitrectomy specimens.

• #16 Ocular toxocariasis: a neglected parasitic disease in Egypt | Bulletin of the National Research Centre | Full Text

  https://bnrc.springeropen.com/articles/10.1186/s42269-019-0185-8

  Fundoscopic examination is a significant tool either for direct observation of a movable larva beneath the retina or for recognition of typical features of ocular toxocariasis such as peripheral chorioretinal granuloma, posterior pole granuloma, endophthalmitis, and pars planitis which is an inflammation in the narrow area between the iris and the choroid. […] Several immunodiagnostic techniques have been used for the diagnosis of ocular toxocariasis, such as enzyme-linked immunosorbent assay (ELISA), Dot-ELISA test, and western blot. […] The selected test for routine diagnosis of toxocariasis is ELISA test which possesses both sensitivity and specificity ranging between 73-100% and 90-91%, respectively. […] Currently, the best choice serodiagnostic methods are ELISA-IgG as a screening test and confirm the positive samples by western blot test.

• #17 Toxocariasis (Visceral larva migrans, Ocular larva migrans, Covert toxocariasis) (Toxocara canis and Toxocara cati) – IgG antibodies; Molecular diagnosis (PCR); Molecular identification (PCR and sequencing). – IVAMI

  https://www.ivami.com/en/clinical-microbiology/2848-toxocariasis-visceral-larva-migrans-ocular-larva-migrans-covert-toxocariasis-toxocara-canis-and-toxocara-cati-igg-antibodies-molecular-diagnosis-pcr-molecular-identification-sequencing

  Toxocariasis (Visceral larva migrans, Ocular larva migrans and covert toxocariasis: Toxocara canis and Toxocara cati) – IgG antibodies, molecular diagnosis (PCR) and molecular identification of species (PCR and sequencing) […] The diagnosis of human toxocariasis is based on detecting antibodies (ELISA), as it is typically positive in 100% of cases. […] Molecular diagnostics (PCR) diagnostic technique is also common for the same reason, and when applied to identify a larva is obtained in a tissue granuloma. […] Detection of IgG antibodies by ELISA. […] Molecular diagnosis (PCR), to identify larvae Toxocara spp. or Toxocara spp. […] Recommended sample: Detection of IgG: serum (0.5 to 1 mL). […] Molecular diagnosis (PCR) to identify larvae of Toxocara spp.: Tissue biopsy. […] Molecular diagnosis (PCR) to diagnose the presence of Toxocara spp eggs animal feces: (dogs, cats, …) or ground (earth). […] Detection of IgG (ELISA): 48 to 72 hours. […] Molecular diagnosis (PCR): 24 to 48 hours. […] Molecular diagnosis for species identification (PCR and sequencing): 72 to 96 hours.

• #18 Toxocariasis – Wikipedia

  https://en.wikipedia.org/wiki/Toxocariasis

  Finding Toxocara larvae within a patient is the only definitive diagnosis for toxocariasis; however, biopsies to look for second-stage larvae in humans are generally not very effective. […] PCR, ELISA, and serological testing are more commonly used to diagnose Toxocara infection. […] Serological tests are dependent on the number of larvae within the patient, and are unfortunately not very specific. […] ELISAs are much more reliable and currently have a 78% sensitivity and a 90% specificity. […] A 2007 study announced an ELISA specific to Toxocara canis, which will minimize false positives from cross reactions with similar roundworms and will help distinguish if a patient is infected with T. canis or T. cati. […] OLM is often diagnosed after a clinical examination. […] Granulomas can be found throughout the body and can be visualized using ultrasound, MRI, and CT technologies.

• #19 Toxocariasis: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/229855-overview

  Toxocariasis is an infection caused by the ingestion of larvae of the dog roundworm Toxocara canis or the cat roundworm Toxocara cati. […] Diagnosis of toxocariasis is difficult because confirmation of infection requires demonstration of larvae via biopsy. Therefore, clinicians use serologic testing (eg, enzyme-linked immunosorbent assay [ELISA], immunoblot) to infer diagnosis. […] Toxocariasis should be strongly considered when the patient has eosinophilia, characteristic clinical symptoms, and a positive finding on Toxocara serologic test.

• #20 TOXCG – Overview: Toxocara Antibody, IgG, Serum

  https://www.mayocliniclabs.com/test-catalog/Overview/616734

  Aiding in the diagnosis of Toxocara infection […] Diagnosis of Toxocara infections involves obtaining relevant clinical and exposure history and relies on antibody detection to Toxocara species. Eosinophilia may also be present, more commonly in visceral toxocariasis. Stool examination for ova and parasites is not useful since eggs are not excreted by humans, only by domestic animals. Currently, antibody testing is the only means of confirming a clinical diagnosis. The recommended serologic test for toxocariasis is an enzyme-linked immunosorbent assay using larval-stage antigens. However, a measurable titer does not distinguish between current and past Toxocara infection. Laboratory findings should be correlated with clinical history. […] Positive: IgG antibodies to Toxocara species detected, suggesting current or past infection. False-positive results may occur in patients with other helminth infections (eg, Ascaris lumbricoides, Schistosoma species, Strongyloides).

• #21 TOXCG – Overview: Toxocara Antibody, IgG, Serum

  https://www.mayocliniclabs.com/test-catalog/Overview/616734

  A single negative result does not rule out infection. Assay sensitivity may be decreased depending on the site of infection, in cases of low parasitic burden, and timing of sample collection relative to exposure. In ocular toxocariasis, Toxocara antibody levels in serum can be low or absent despite clinical disease. Repeat testing should be considered in patients who are at high risk of exposure or infection. […] Positive results should be interpreted with patient’s clinical status and exposure history. Positive results by this assay do not distinguish acute versus remote infection. False-positive results may occur in patients with other helminth infections.

• #22 Ocular toxocariasis: clinical features, diagnosis, treatment, and prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4116038/

  The current standard treatment for ocular toxocariasis is corticosteroid administration in patients with active intraocular inflammation. […] The role of anthelmintic therapy in OT remains controversial as there have been no randomized controlled trials on the use of anthelmintic agents for OT. […] Nonetheless, the use of anthelmintic drugs combined with corticosteroids has shown favorable outcomes in many studies. […] In our study, combined corticosteroid and albendazole therapy significantly reduced 6-month recurrence, as compared with the corticosteroid only group. […] Thus, further diagnostic improvement is necessary for better detection and prompt diagnosis of OT.

• #23 Toxocariasis – EyeWiki

  https://eyewiki.org/Toxocariasis

  Ocular toxocariasis is a rare infection caused by roundworms, Toxocara canis and Toxocara cati. […] Management includes quieting inflammation, eliminating the offending organism, and repairing vitreoretinal sequelae. […] Clinical diagnosis is based on history and examination as described in this article. […] The most useful test for ocular toxacariasis is an ELISA. […] Performing this test on aqueous or vitreous samples can prove to be diagnostic. […] Management of this disease focuses on three main points: minimizing inflammation, eliminating the offending organism, and addressing vitreal and retinal complications secondary to infection. […] The use of these drugs is unproven in the case of ocular toxocariasis. […] There is no standard protocol for medical follow up specific to ocular toxocariasis. […] The CDC reports that 25% of patients presenting with new cases of ocular toxocariasis require surgery. […] Prognosis is typically excellent for those patients without sequelae. […] Those that require surgical intervention typically have a poorer prognosis and visual acuity.

• #24 Atypical Toxocara canis-Induced Hepatic Visceral Larva Migrans: Diagnostic Challenges and Literature Review

  https://www.kjg.or.kr/journal/view.html?doi=10.4166/kjg.2024.051

  A definite diagnosis of human toxocariasis involves detecting larvae or larval DNA in tissue or body fluids samples. […] However, obtaining tissue biopsies or fluid samples for diagnosis is not always feasible. […] The Toxocara-ELISA test shows high sensitivity (78%) and specificity (92%). […] The high prevalence of serum Toxocara antibodies renders serological tests less definitive for confirming active disease. […] Therefore, to diagnose active toxocariasis, a seropositive result should also be accompanied by a clinical course aligned with active disease (including compatible symptoms, eosinophilia, high IgE levels, and histopathological samples). […] In this context, liver biopsy becomes crucial for confirming active infection. […] Monitoring the success of treatment involves assessing improvements in clinical presentation and radiologic findings, as well as a reduction in eosinophil count. […] Given the limitations of serological testing in endemic areas, a comprehensive diagnostic approach combining serological testing, histopathological analysis, and clinical correlation is crucial for accurate diagnosis and appropriate management of hepatic toxocariasis.

• #25 Laboratory diagnosis of human toxocariasis. | Read by QxMD

  https://qxmd.com/read_redirect/redirect_read.php?type=paper&pmid=23318165

  Toxocariasis is a helminth zoonosis caused by infection with the larvae of Toxocara spp. ascarid worms. Only two species, Toxocara canis and Toxocara cati, are recognised as causative agents of human disease. The best choice for serodiagnosis of the generalised forms of toxocariasis, visceral larva migrans (VLM) or covert toxocariasis, relies upon the initial use of TES-ELISA, after which any positive result should subsequently be tested by Western blotting (WB). Covert toxocariasis is mostly a benign infection, so a large majority of infected subjects are asymptomatic or have very few symptoms and therefore go undiagnosed. […] A positive serodiagnosis caused by residual antibodies that do not have any diagnostic significance can be associated with any infectious or non-infectious disease. If separated from the ongoing clinical and laboratory context, such a positive result has no diagnostic value and should be only taken into account after the possible etiologies of any observed syndromes have been ruled out.

• #26 Laboratory diagnosis of human toxocariasis. | Read by QxMD

  https://qxmd.com/read_redirect/redirect_read.php?type=paper&pmid=23318165

  Currently, the diagnosis of an active covert toxocariasis relies upon indirect arguments, e.g., the presence of otherwise unexplained symptoms along with blood eosinophilia and/or elevated levels of eosinophil cationic protein (ECP). This situation is far from ideal and more research should be carried out to solve this difficult problem.

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