Larva Migrans Cutânea - a Propósito de um Caso Clínico

A larva migrans cutânea representa uma das dermatoses mais frequentes nos turistas que regressam de países tropicais e sub-tropicais. O agente mais frequente é a larva Ancylostoma brasiliensis que habita no intestino de cães e gatos. Os humanos são afetados quando contatam com solo contaminado com os excrementos de animais infetados. Apresentamos o caso de uma professora, 39 anos de idade, natural e residente em Portugal que, após regressar de férias no Nordeste do Brasil, refere dermatose localizada à 4ª prega interdigital e porção adjacente do dorso dos pés, constituída por várias lesões eritematosas, pruriginosas, de trajecto serpiginoso, compatíveis com larva migrans cutânea. O quadro regrediu após terapêutica com Albendazol. Devido à maior frequência de fluxos migratórios na atualidade, as dermatoses tropicais podem tornar-se mais frequentes nos países de clima temperado. Salienta-se a importância do aconselhamento dos turistas para a prevenção desta dermatose, nomeadamente através do uso de calçado protetor.

Larva migrans within scalp sebaceous gland

A case of larva migrans or serpiginous linear dermatitis on the scalp of a teenager is reported. An ancylostomid larva was found within a sebaceous gland acinus. The unusual skin site for larva migrans as well as the penetration through the sebaceous gland are highlighted. The probable mechanism by which the parasite reached the skin adnexa is discussed.

Larva migrans cutânea: ocorrência de casos humanos e identificação de larvas de Ancylostoma spp em parque público do município de Taciba, São Paulo

Descreve-se a ocorrência de larva migrans cutânea em crianças de Taciba, São Paulo, Brasil, pelo contato com areia de parques públicos, onde observou-se larvas de Ancylostoma spp. A enfermidade foi controlada após adotar-se medidas educacionais sanitárias, desativação e isolamento dos locais para reduzir acesso de animais e troca de areia.

Sero-epidemiology of toxocariasis in a rural settlement in Sao Paulo state, Brazil

The seroprevalence of Toxocara canis and risk factors for infection with this parasite were explored in a rural settlement in Sao Paulo state, Brazil. Total IgA and IgE levels in 79 subjects were determined by turbidimetry and chemiluminescence, respectively. Total counts of leucocytes and erythrocytes and differential counts of leucocytes were made by flow cytometry. ELISA for the detection of anti-Toxocara IgG, IgA and IgE were standardized using Toxocara excretory-secretory antigens (TES) obtained from the cultured second-stage larvae of T. canis. Seventeen (21.5%) of the subjects were found positive for anti-Toxocara IgG, with no significant differences in such seropositivity with age or gender. Thirty (38%) of the subjects showed eosinophilia and 70 (89%) had elevated levels of total IgE. Among the 17 subjects found seropositive for anti-Toxocara IgG, the percentage of leucocytes represented by eosinophils (P=0.0069) and total levels of IgE (P=0.0452) were positively correlated with the levels of anti-TES IgE. Although anti-TES IgA was detected in 10 (59%) of the subjects, there was no significant correlation between the levels of total IgA and those of Toxocara-specific IgA. Only one of the 17 subjects found positive for anti-Toxocara IgG had attended a secondary school and all but two belonged to households with monthly incomes of < U.S.$100. In the study community at least, seropositivity may be related to poor living standards and lack of basic sanitary conditions. The presence of anti-Toxocara IgE and IgA may facilitate the diagnosis of toxocariasis and may well be useful for monitoring the success of treatment.

Occupational and domiciliary contact with dogs as factors of risk to human infection with Toxocara larvae

The contact with dogs at home or place of work has been investigated as factors of risk in the occurrence of the visceral larva migrans syndrome caused by Toxocara, in man. Through the E.L.I.S.A. (enzyme-linked immunosorbent assay) technique, the presence of antibodies to Toxocara was searched in the sera of 79 women who have been raising or had raised dogs at home in the last two years and 123 men, who were municipal public employees in charge of the capture and keeping of stray dogs. The control groups were constituted by 205 sera from women who denied domiciliary contact with dogs, at least in the last two years, and 139 sera from men whose occupation did not urge them to contact with dogs. A significant more elevated frequency of antibodies to Toxocara was observed among women with domiciliary contact with dogs; nevertheless, there was not a significant difference in the positive rates in the case of men with occupational contact with dogs.

Standardization of dot-ELISA for the serological diagnosis of toxocariasis and comparision of the assay with ELISA

The dot-enzyme-linked immunosorbent assay (dot-ELISA) was standardized using somatic (S) and excretory-secretory (ES) antigens of Toxocara-canis for the detection of specific antibodies in 22 serum samples from children aged 1 to 15 years, with clinical signs of toxocariasis. Fourteen serum samples from apparently normal individuals and 28 sera from patients with other pathologies were used as controls. All samples were used before and after absorption with Ascaris suum extract. When the results were evaluated in comparison with ELISA, the two tests were found to have similar sensitivity, but dot-ELISA was found to be more specific in the presence of the two antigens studied. Dot-ELISA proved to be effective for the diagnosis of human toxocariasis, presenting advantages in terms of yield, stability, time and ease of execution and low cost.

PRESENCE OF ANTI-TOXOCARA ANTIBODIES IN CHILDREN SELECTED AT HOSPITAL UNIVERSITÁRIO, CAMPO GRANDE, MS, BRAZIL

Visceral Larva Migrans syndrome (VLM) results from the presence or migration of helminth larvae in humans, who nonetheless only play the role of paratenic hosts in the helminths' life cycle. In humans, VLM can be caused by larvae of various nematode species, chiefly those of the ascarid Toxocara canis, which can then be found at a variety of body sites, such as the liver, lungs, heart, and brain. Clinical and pathological manifestations depend primarily on larvae number and location, infection duration, reinfection occurrence, and host's immunological condition. Signs and symptoms may range from asymptomatic infection to severe disease. In humans, infection is acquired through ingestion of T. canis eggs present in soil, containing larvae in the infective stage7, 8, 9. Indeed, eggs of Toxocara sp. have been found in sandboxes in several public places in the city of Campo Grande, Mato Grosso do Sul state2. This study was carried out to detect the presence of anti-Toxocara antibodies in children attending the Pediatrics division of Hospital Universitário of Universidade Federal de Mato Grosso do Sul at Campo Grande, Brazil. Over the years 1992-94, 454 serum samples, obtained from children of 5.25 ± 3.28 years of mean age and selected at that hospital on the basis of eosinophil count greater than or equal to 1000/mm3 of blood, were tested for the presence of antibodies by means of the ELISA technique employing Toxocara canis larvae excretory-secretory antigens5. A high prevalence rate for toxocariasis (35.55%) was found, which was observed to be associated with eosinophil levels lower than those usually reported in literature. Furthermore, a higher frequency of positive serology among boys was also observed (13 cases in contrast to only 3 among girls), a result also reported by other authors

TOXOCARIASIS: SEROLOGICAL DIAGNOSIS BY INDIRECT ANTIBODY COMPETITION ELISA

Toxocariasis is caused by infection of man by Toxocara canis and Toxocara cati larvae, the common roundworm of dogs and cats. Because larvae are difficult to detect in tissues, diagnosis is mostly based on serology. Non specific reactions are observed mainly due to cross-reactivity with Ascaris sp antigens. This investigation aimed at developing and evaluating an indirect antibody competition ELISA (IACE) employing a specific rabbit IgG anti-Toxocara canis excretory-secretory antigens as the competition antibody, in order to improve indirect ELISA specificity performed for toxocariasis diagnosis. For that, the rabbit IgG was previously absorbed by Ascaris suum adult antigens. Sensitivity and specificity of IACE were first evaluated in 28 serum samples of mice experimentally infected with T. canis embryonated eggs. Adopting cut-off value established in this population before infection, sensitivity and specificity were 100% after 20 days post-inoculation. For human population IACE was evaluated using sera from 440 patients with clinical signs of toxocariasis and the cut-off value was established with 60 serum samples from apparently healthy individuals. Using as reference test the indirect ELISA performed by Adolfo Lutz Institute, sensitivity was 60.2%, specificity was 98% and concordance was 77.3%. Repeatability of IACE was evaluated by the inter-reactions variation coefficient (2.4%).

Toxocara seroprevalence in children from a subtropical city in Argentina

Most studies from Argentina have focused on toxocariasis as an environmental problem of big cities, and there are no available data about children infection from small or middle-sized cities. In order to assess the prevalence of anti-Toxocara antibodies in infantile population, 206 children from Resistencia, of both sexes, aged 1-14 years old were studied by Elisa testing with E/S T. canis L2 antigens. Hematological parameters and immunoglobulin levels were determined; five days' stool samples were studied and epidemiological data were obtained by means of a questionnaire to parents. Results showed that 73% of the children had one or more dogs living at home, 57% reported geophagia and 37.9% were positive for Toxocara serology, but there was no significant difference in prevalence neither for boys and girls, nor concerning age. An increased risk of infection was observed in age groups 5-6 and 7-8 for boys, and in age groups 3-4 and 5-6 for girls.

Toxocara spp. eggs in public squares of Sorocaba, São Paulo State, Brazil

The visceral larva migrans (VLM) is a syndrome observed in human infection with helminth larval eggs such as the Toxocara spp. that usually infects dogs and cats. Among the risk factors involved in the occurrence of VLM, particularly important is the size of these animal populations. Sorocaba is a city with a dog population twice as large as that recommended by the World Health Organization. This fact has led to a survey of the presence of Toxocara spp. eggs in public square soils of this city. Thirty squares were selected, fifteen located in the outskirts of the city and fifteen downtown. Soil samples were collected from five distinct sites in the same area. The material was homogenized and drained and 100 g was mixed with a saturated solution of magnesium sulfate and 5% potassium iodine. The floating material was analyzed under the light microscope. Toxocara spp. eggs were found in 16 squares, nine of which were located in the outskirts of the city and seven downtown. It was concluded that Sorocaba squares present a high rate of contamination with Toxocara spp. eggs. The squares in the outskirts of the city presented a higher occurrence of these eggs in comparison with those downtown, although the difference was not statistically significant (p > 0.05).

Human toxocariasis: frequency of anti-Toxocara antibodies in children and adolescents from an outpatient clinic for lymphatic filariasis in Recife, Northeast Brazil

In a transversal study on a sample of 386 children and adolescents from an outpatient clinic for filariasis in Recife, Northeast Brazil, the frequency of anti-Toxocara antibodies and its relation to age, gender, number of peripheral eosinophils, Wuchereria bancrofti microfilariae and intestinal helminths was determined. The total anti-Toxocara IgG antibody frequency was 39.4%, by ELISA technique. The difference in frequency between males (40.1%) and females (37.6%) was not statistically significant. The 6 to 10-year-old subset presented the highest frequency of anti-Toxocara antibodies (60%), and within this age group there was a statistically significant male bias. There was also a significant association between the number of eosinophils and the presence of anti-Toxocara antibodies. Intestinal parasite frequency was 52.1%, but no association was found between this data and the presence of anti-Toxocara antibodies. In the present sample, 42.2% of the patients were Wuchereria bancrofti carriers, however, again this was not associated with the presence of anti-Toxocara antibodies. In conclusion, anti-Toxocara antibodies were highly prevalent in this sample. The present data show that there is no cross correlation between anti-Toxocara IgG antibody and the presence of intestinal helminths and filariasis.

Environmental contamination by Toxocara sp. eggs in Ribeirão Preto, São Paulo State, Brazil

Toxocariasis is a zoonosis mainly caused by Toxocara canis, an intestinal nematode of dogs. Man acquires the infection through accidental ingestion of viable eggs, and the toxocariasis clinical manifestations may vary from an asymptomatic infection up to the Visceral Larva Migrans syndrome. Seventy eight public squares of Ribeirão Preto, São Paulo, Brazil, including Bonfim Paulista district were visited aiming to evaluate the soil contamination by Toxocara eggs. The squares were divided in five different areas corresponding to the Sanitary Districts of the city. From May to December 2003, soil samples weighting about 250 g each were collected from five distinct sites of each public square. The laboratorial analysis was done by centrifugal-flotation techniques in magnesium sulphate solutions with 5% of potassium iodide (d = 1.33) and zinc sulphate (d = 1.20), and by the sedimentation- flotation in conic chalices with zinc sulphate (d = 1.20). Toxocara sp. eggs were found on 16 (20.5%) squares, with the lowest prevalence (12%) at the central area. From these results, it is expected that the legal authority will adopt protection measures for the city public areas, reducing thus the contamination risk by Toxocara sp. eggs.

Frequency of soil contamination by Toxocara canis eggs in the south region of São Paulo municipality (SP, Brazil) in a 18 month period

Soil contamination by embryonic eggs of Toxocara canis is the main source of human infection by this ascarid larvae resulting, sometimes, in the occurrence of visceral larva migrans syndrome. The objective of the present research is to determine the frequency of T. canis eggs in soil samples monthly collected in nine public places, located at the South Region of São Paulo municipality in a 18-month period, from February 2004 to July 2005. The soil samples collected were treated with a 30% antiformine solution and with a sodium dichromate solution (d = 1.40) and microscopic slides were prepared and examined under light microscopy for searching T. canis eggs. Two peaks of higher frequency had been found, one in February - May 2004 and the other in April - July 2005.

Neurotoxocarosis

Infection of humans with embryonated eggs of Toxocara canis (larva migrans) remains asymptomatic, or results in covert or common toxocarosis, visceral larva migrans syndrome, or ophthalmologic and neurologic impairment. Though neurological manifestations of Toxocara canis larvae are rare, toxocarosis remains an important differential diagnosis of various neurological disorders. Manifestations of the central nervous system are dementia, meningo-encephalitis, myelitis, cerebral vasculitis, epilepsy, or optic neuritis. Manifestations of the peripheral nervous system comprise radiculitis, affection of cranial nerves, or musculo-skeletal involvement. If toxocarosis is neglected, ignored, or refused as a differential of these abnormalities, it may be easily overlooked for years. Early recognition and treatment of the infection is, however, of paramount importance since it reduces morbidity and mortality and the risk of secondary superinfection. Like the visceral manifestations, neurological manifestations of toxocarosis are treated by benzimidazole components, most frequently albendazole, corticosteroids, or diethylcarbamazine. If detected and treated early, the prognosis of neurological manifestations of toxocarosis is favourable.

Environmental contamination by Toxocara spp. Eggs in a rural settlement in Brazil

In order to study the environmental contamination by Toxocara spp. eggs in a rural community from the Pontal do Paranapanema region, São Paulo State, Brazil, soil samples from 31 out of 121 plots were collected in eight different places on each house. The samples were submitted to flotation technique in sodium nitrate (d = 1.20g/cm³). Eggs of Toxocara spp. were recovered in nine (29.03%) out of the 31 plots. At least one dog was registered in 27 of the 31 plots examined (87.1%) and at least one cat in 17 (54.84%). The number of pets per plot ranged from one to six (mean of 2.3) for dogs and one to 14 (mean of 1.29) for cats. In 16 plots (51.61%), the presence of both dogs and cats was observed. There was no relation between the presence of pets in the plots and soil contamination (p > 0.05). However, the environmental contamination by Toxocara spp. eggs associated to the poor conditions of the inhabitants may be an important risk factor for the human population to ocular or visceral larva migrans.