ABSTRACT The human toxocariasis is the most important cosmopolite helminth infection in the world. The infection can modulate the immune response of the infected paratenic host, and it is suggested that it is an important risk factor for the development of asthma and be associated with increased levels of different markers of atopy. The aim of this study was to conduct a systematic review and meta-analysis of the association between human toxocariasis with asthma and atopic diseases. The literature search identified 1705 papers on the association of Toxocara spp with asthma, Then, 24 papers were selected based on the inclusion and exclusion criteria, following the PRISMA protocols. These papers served to analyze association data as a risk factor for increased asthma and investigate the association of this infection with the appearance of atopy markers (specific IgE). The results did not indicate association between asthma and Toxocara spp seropositivity, although there was a positive trend (OR 1.47; 95% CI 0.92-2.33). However, when studies were classified by type a positive association in the case-control type studies was found (OR 1.69; 95% CI 1.06-2.70). Furthermore, there was a positive association with this atopic marker in the analysis of the association of toxocariasis with specific IgE (OR 1.77; 95% CI 1.19-2.64). The evidence found was not entirely conclusive regarding the possibility of having T. canis infection as a risk factor for the development of asthma, although there is a positive statistical trend. On the other hand, the association with specific IgE results supports previous findings in the literature, where helminth infections can stimulate the production of this type of antibody, leading to a positive association with atopy.

RESUMEN La toxocariasis humana es la helmintiasis cosmopolita más importante del mundo. La infección puede modular la respuesta inmune del huésped paraténico infectado, y se sugiere que es un factor de riesgo importante para el desarrollo de asma y estar asociado con niveles elevados de diferentes marcadores de atopia. El objetivo de este estudio fue realizar una revisión sistemática y un metanálisis de la asociación entre la toxocariasis humana con asma y enfermedades atópicas. La búsqueda bibliográfica identificó 1705 artículos sobre la asociación de Toxocara spp con asma. Luego, se seleccionaron 24 artículos con base en los criterios de inclusión y exclusión, siguiendo los protocolos PRISMA. Estos trabajos sirvieron para analizar datos de asociación como factor de riesgo de aumento del asma e investigar la asociación de esta infección con la aparición de marcadores de atopia (IgE específica). Los resultados no indicaron asociación entre asma y seropositividad a Toxocara spp, aunque hubo una tendencia positiva (OR 1,47; IC 95% 0.92-2.33). Sin embargo, cuando los estudios se clasificaron por tipo se encontró una asociación positiva en los estudios de tipo caso-control (OR 1,69; IC 95% 1.06-2.70). Además, hubo una asociación positiva con este marcador atópico en el análisis de la asociación de la toxocariasis con la IgE específica (OR 1.77; IC 95% 1.19-2.64). La evidencia encontrada no fue del todo concluyente respecto a la posibilidad de tener infección por T. canis como factor de riesgo para el desarrollo de asma, aunque existe una tendencia estadística positiva. Por otro lado, la asociación con resultados de IgE específica respalda hallazgos previos en la literatura, donde las infecciones por helmintos pueden estimular la producción de este tipo de anticuerpos, lo que lleva a una asociación positiva con la atopia.

Abstract The cytokine microenvironment is crucial in generating and polarizing the immune response. A means of monitoring this environment would be of great value for better understanding Toxocara canis immune modulation. The aim of this study was to analyze the dynamics of cytokine transcription ex vivo, during early (24-48 hours) and late (15-30 days) times post-infection, in the mesenteric lymph nodes, spleen and intestinal mucosa of Balb/c mice experimentally infected with T. canis larvae. Mice in the treated group were infected with 100 third-stage larvae (L3), whereas mice in the control group were not infected. Analyses were performed at different times: 24-48 hours post-infection (HPI), 15-30 days post-infection (DPI). IL4, IL10, IL12 and Ym1 mRNA transcriptions were analyzed through qPCR. This study showed cytokine transcription mediated by migrating larvae in the mesenteric lymph nodes and spleen at 24-48 HPI, whereas cytokine transcription in the intestinal mucosa was observed only at late times (15-30 DPI). These results suggest that the T. canis larvae migration during infection might play a role in cytokine dynamics. Since the cytokine microenvironment is crucial in modulating immune response, knowledge of cytokine dynamics during T. canis infections pave the way to better understand its interaction with the host. response modulation vivo 2448 24 48 (24-4 1530 15 30 (15-3 postinfection, postinfection post infection, Balbc Balb c T 10 thirdstage third stage L3, L3 L , (L3) 24-4 HPI (HPI) 15-3 DPI. DPI . (DPI) IL4 IL IL10 IL1 Ym qPCR DPI) host 244 2 4 (24- 153 1 3 (15- (L3 24- (HPI 15- (DPI (24 (15 (L (2 (1 (

Resumo O microambiente das citocinas é crucial na geração e polarização da resposta imune. Monitorar esse ambiente é importante para entender a modulação imune de Toxocara canis. Este estudo analisou a dinâmica da transcrição de citocinas ex vivo, durante os períodos pós-infecção precoce (24-48 horas) e tardio (15-30 dias) em linfonodos mesentéricos, baço e mucosa intestinal em camundongos, infectados experimentalmente com larvas de T. canis. Camundongos foram infectados com 100 larvas de terceiro estágio (L3), enquanto os camundongos do grupo controle não foram infectados. Foram analisados diferentes períodos: 24-48 horas pós-infecção (HPI), 15-30 dias pós-infecção (DPI). A transcrição do mRNA de IL4, IL10, IL12 e Ym1 foi analisada por qPCR. Observou-se a transcrição de citocinas mediada por larvas migratórias nos linfonodos mesentéricos e baço por 24-48 HPI, enquanto na mucosa intestinal a transcrição de citocinas foi observada apenas na infecção tardia (15-30 DPI). Esses resultados sugerem que a migração das larvas de T. canis, durante a infecção, pode desempenhar um papel na dinâmica das citocinas. Uma vez que o microambiente das citocinas é crucial na modulação da resposta imune, o conhecimento da dinâmica das citocinas, durante as infecções por T. canis, permite uma melhor compreensão da sua interação com o hospedeiro. canis vivo pósinfecção pós 2448 24 48 (24-4 1530 15 30 (15-3 T 10 L3, L3 L , (L3) 24-4 HPI (HPI) 15-3 DPI. DPI . (DPI) IL4 IL IL10 IL1 Ym qPCR Observouse Observou se DPI) hospedeiro 244 2 4 (24- 153 1 3 (15- (L3 24- (HPI 15- (DPI (24 (15 (L (2 (1 (

ABSTRACT Objective: To characterize ocular toxocariasis clinically and epidemiologically. Methods: An observational, descriptive and cross-sectional study was conducted with patients diagnosed with ocular toxocariasis, attended at the Instituto Cubano de Oftalmología Ramón Pando Ferrer in the period from April 2019 to December 2022. Results: The male sex predominated (53.7 %), together with the age group 0-10 years (73.1 %). 56.1 % of the patients lived in rural areas. Cohabitation with domestic animals accounted for 75.6 %. The most frequently reported symptom was decreased visual acuity (48.8 %). The most frequent form of presentation was peripheral granuloma in the right eye (52.4 %). The most observed complication was retinal detachment (58.5 %). Conclusions: Ocular infection by Toxocara spp. is a preventable, as well as incapacitating, disease that limits the educational, occupational and general life development of affected patients, particularly children, males and those living in rural areas cohabitating with domestic animals, especially dogs.

RESUMEN Objetivo: Caracterizar clínica y epidemiológicamente la toxocariasis ocular. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal con pacientes diagnosticados de toxocariasis ocular, atendidos en el Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período de abril de 2019 a diciembre de 2022. Resultados: Predominó el sexo masculino (53,7 %) y el grupo etario de 0 a 10 años (73,1 %). El 56,1 % de los pacientes vivían en área rural. La convivencia con animales domésticos representó el 75,6 %. El síntoma más referido fue la disminución de la agudeza visual (48,8 %). La forma de presentación más frecuente fue el granuloma periférico de forma unilateral en ojo derecho (52,4 %). La complicación más observada fue el desprendimiento de retina (58,5 %). Conclusiones: La infección ocular por Toxocara spp. es una enfermedad prevenible e incapacitante que limita el desenvolvimiento educacional, laboral y de la vida en general de los pacientes afectados, particularmente la población infantil, el sexo masculino y los que residen en área rural en convivencia con animales domésticos, en especial perros.

ABSTRACT Toxocariasis is a prevalent zoonosis with a significant socioeconomic impact, particularly in poor communities around the world. It is caused by larval forms of nematode species, parasites of the Toxocara genus. The spectrum of clinical manifestations in toxocariasis varies widely from asymptomatic cases to systemic infections. In the case of ocular toxocariasis, impaired visual acuity is the most common manifestation when symptoms are present. Ocular presentations include chronic endophthalmitis, posterior pole granuloma, or a peripheral granuloma. We present the case of a 12-year-old patient with ocular toxocariasis in the form of a posterior pole granuloma with vitreous tractional bands, which is accompanied by a hyperpigmented lesion in the macular area in the healing phase. The purpose of our publication is to highlight the multiple ocular complications that can occur in patients with ocular toxocariasis, which ultimately lead to irreversible visual loss.

RESUMEN La toxocariasis es una zoonosis prevalente con un importante impacto socioeconómico, particularmente en las comunidades pobres de todo el mundo. Es causada por formas larvarias de especies de nematodos, parásitos del género Toxocara. El espectro de manifestaciones clínicas en la toxocariasis varía ampliamente, desde casos asintomáticos a infecciones generalizadas. En el caso de la toxocariasis ocular, el deterioro de la agudeza visual es la manifestación más común cuando los síntomas están presentes. Las presentaciones oculares incluyen endoftalmitis crónica, granuloma de polo posterior o granuloma periférico. Presentamos el caso de una paciente de 12 años, con toxocariasis ocular en forma de granuloma de polo posterior con bandas traccionales a vítreo, acompañada de una lesión hiperpigmentada en el área macular en fase cicatrizal. El propósito de esta publicación es describir las múltiples complicaciones oculares que pueden concomitar en el paciente con toxocariasis ocular, que finalmente conllevan a una pérdida visual irreversible.

ABSTRACT The Western-blotting technique was applied to identify antigenic fractions of excretory-secretory Toxocara canis antigen recognized by IgG antibodies throughout an experimental infection in mice challenged by different inocula. Mice were inoculated with 5, 50 and 500 embryonated eggs and serum samples were collected 15, 30, 60, 90 and 120 days post-infection. Serum samples were analyzed using an excretory-secretory Toxocara antigen. Antibodies recognized antigenic fractions from 30 to 90 kDa. The protein fraction of 30-35 kDa was the most frequently recognized regardless of the size of inoculum and the stage of infection represented by the different collection times, but the antigenic recognition was more evident in groups infected with 50 and 500 eggs. This study presents an antigenic panel of the excretory-secretory antigen of T. canis and suggests that the 30-35 kDa antigenic fraction is a promising marker of the infection and should be further explored in future studies on experimental toxocariasis.

Resumo O objetivo deste trabalho foi avaliar a modulação imunológica precoce e tardia da infecção experimental de larvas de T. canis em camundongos. Estes foram infectados com 100 larvas infectantes e eutanasiados em diferentes períodos: 24 e 48 horas pós infecção (HPI), 15 e 30 dias após a infecção (DPI). A resposta humoral foi avaliada por ELISA indireto. RT-PCR quantitativo (qPCR) foi usado para quantificar a transcrição de mRNA das citocinas IL4, IL10, IL12 e Ym1 nos períodos de infecção precoce e tardia. A infecção por T. canis foi capaz de gerar IgG total específico aos 15 e 30 DPI. A análise do isótipo IgG revelou uma diferenciação significativa para IgG1 em comparação com IgG2a, IgG2b e IgG3, caracterizando uma resposta Th-2. Avaliando-se a transcrição gênica na fase inicial da infecção, foram observados níveis mais elevados de transcrição de IL10, IL4 e Ym1 e a regulação negativa de IL12. Na fase tardia, foram observados níveis aumentados de transcrição de IL4, Ym1 e IL12, e foi observada regulação negativa da transcrição de IL-10. Os dados obtidos sugerem, que durante a infecção experimental com T. canis, a participação das citocinas IL4, IL10, IL12 e Ym1 podem desempenhar um papel importante na imunomodulação de T. canis.

Abstract The objective of this work was to evaluate the early and late immunological modulation of an experimental infection of T. canis larvae in mice. Mice were infected with 100 infective larvae and euthanized at different period: 24, 48 hours post infection (HPI), 15- and 30 days post infection (DPI). The humoral response was evaluated by indirect ELISA. Quantitative RT–PCR (qPCR) was used to quantify the mRNA transcription of cytokines IL4, IL10, IL12 and Ym1 in the early and late infection periods. Infection with T. canis was able to generate specific total IgG at 15- and 30- DPI. Analyzing the IgG isotype revealed a significant differentiation for IgG1 compared with IgG2a, IgG2b and IgG3, characterizing a Th-2 response. Evaluating the gene transcription at the early phase of infection, higher transcription levels of IL10, IL4 and Ym1 and a downregulation of IL12 were observed. By the late phase, increased transcription levels of IL4, Ym1 and IL12 were observed, and downregulation of IL-10 transcription was observed. The data obtained suggest that during experimental infection with T. canis, the participation of the IL4, IL10, IL12 cytokines and Ym1 can play an important role in T. canis immunomodulation.

Resumo A toxocaríase é uma zoonose de distribuição mundial. A conexão entre doenças parasitárias e condições que deprimem o sistema imunológico, como o uso de drogas imunossupressoras, tem sido estudada. O objetivo deste estudo foi avaliar o efeito da Ciclosporina A (CsA) na intensidade da infecção, resposta humoral e transcrição gênica das interleucinas IL-4, IL-10 e IL-12 em camundongos experimentalmente infectados com Toxocara canis. Para tanto, os camundongos foram divididos em dois grupos tratados com CsA (G1: 10 mg/Kg e G2: 50 mg/kg), os grupos G3 e G4 receberam PBS. Após a última administração da droga ou PBS (via oral a cada 48 horas por 15 dias), os grupos G1, G2 e G3 foram inoculados com 1200 ovos de T. canis. Foram coletadas amostras de sangue nos dias zero, 15 e 30 dias pós-inoculação (PI), para teste de ELISA e os camundongos foram eutanasiados 30 dias PI. Os órgãos e tecido muscular estriado foram coletados para a recuperação das larvas. Os esplenócitos foram analisados por RT-PCR. A intensidade da infecção nos camundongos tratados com 50 mg/kg de CsA foi 65,5% maior do que no grupo controle (p=0,001). Uma análise da cinética do anticorpo anti-Toxocara revelou que os grupos tratados com CsA apresentaram níveis médios de anticorpos significativamente maiores no dia 15 PI. A transcrição das três interleucinas testadas não apresentou diferença estatística entre G2 e G3 (controle). Concluiu-se que a imunossupressão desencadeada pela CsA (50 mg/Kg) favoreceu o estabelecimento de um maior número de larvas de T. canis sem, no entanto, alterar a produção de imunoglobulinas e a transcrição de IL-4, IL-10 e IL-12 no dia 30 PI.

Abstract Toxocariasis is a zoonotic disease of worldwide distribution. The connection between parasitic diseases and conditions that depress the immune system, such as the use of immunosuppressive drugs, has been studied. The purpose of this study was to evaluate the effect of Cyclosporine A (CsA) on the intensity of infection, humoral response and gene transcription of interleukins IL-4, IL-10 and IL-12 in mice experimentally infected with Toxocara canis. To this end, mice were divided into two groups treated with CsA (G1: 10 mg/Kg and G2: 50 mg/kg), the G3 and G4 group received PBS. After the last administration of the drug or PBS (orally every 48 hours for 15 days), groups G1, G2 and G3 were inoculated with 1200 eggs of T. canis. Was collected blood samples on days zero, 15 and 30 days post-inoculation (PI), for ELISA test and the mice were euthanized 30 days PI. The organs and striated muscle tissue were collected for the recovery of larvae. The splenocytes were analyzed by RT-PCR. The intensity of infection in the mice treated with 50 mg/kg of CsA was 65.5% higher than in the control group (p=0.001). An analysis of the kinetics of anti-Toxocara antibody revealed that the groups treated with CsA showed significantly higher mean levels of antibodies on day 15 PI. The transcription of the three tested interleukins showed no statistical difference between G2 and G3 (control). It was concluded that the immunosuppression triggered by CsA (50 mg/Kg) favored the establishment of a larger number of T. canis larvae without, however, altering immunoglobulin production and IL-4, IL-10 and IL-12 transcription on day 30 PI.

Abstract Case report: The case concerns a 6 year-old girl who refers a 6-month history of decreased visual acuity in the right eye. The only relevant data during interrogation was contact with dogs. The initial diagnosis was a retinal hamartoma. The patient was studied with complete blood count, blood chemistry, magnetic resonance imaging, and A- and B-scan ultrasonography. Anti-Toxocara canis antibodies were measured (IgG 24.5 U, normal range 0-9 U; IgM and IgA < 2.5 U within normal range). Discussion: After a comprehensive evaluation that ruled out a retinoblastoma, along with laboratory tests and imaging findings, we established a diagnosis of a central granuloma with centripetal vitreoretinal contraction caused by ocular toxocariasis.

Resumen Caso clínico: Paciente de sexo femenino, de 6 años, que acudió refiriendo baja visual del ojo derecho de 6 meses de evolución; antecedente de contacto con perros. El diagnóstico clínico inicial fue el de un hamartoma retiniano. Se realizó un abordaje con estudios de biometría hemática, química sanguínea, resonancia magnética de cráneo y ultrasonido en modo AB. Se solicitó posteriormente determinación de anticuerpos para Toxocara cani (inmunoglobulina [Ig] G 24.5 U, valores de referencia 0-9U; IgM e IgA < 2.5 U, dentro de parámetros). Discusión: Tras haber realizado el abordaje de la paciente de manera integral descartando un retinoblastoma, sumado a los hallazgos clínicos y de laboratorio, se establece diagnóstico final de granuloma central por toxocariasis con contracción vitreorretiniana centrípeta. La paciente se encuentra bajo vigilancia y seguimiento en el hospital.

ABSTRACT The objective of this study was to determine ocular manifestations of toxocariasis in schoolchildren. A study was conducted in two schools in the Anzoátegui state in Venezuela in 2019. The ELISA test was used to determine IgG antibodies against Toxocara spp. The families completed a questionnaire, and the children were clinically evaluated by pediatricians and ophthalmologists. 118 children participated, 18.6% presented anti-Toxocara spp. The clinical manifestations with a statistically significant association were allergic reactions, epiphora, and decreased visual acuity. The ophthalmological evaluation found keratitis, uveitis, iritis, retinal granuloma, endophthalmitis, amaurosis, leukocoria, retinal detachment and endotropia. The findings show a high frequency of eye disease in children with toxocariasis from a state of Venezuela.

RESUMEN El objetivo de este estudio fue determinar manifestaciones oculares de la toxocariasis en escolares. Se realizó un estudio en dos escuelas del estado Anzoátegui en Venezuela en el 2019. Se empleó la prueba de ELISA para determinar los anticuerpos IgG contra Toxocara spp. Las familias completaron un cuestionario y los niños fueron evaluados clínicamente por pediatras y oftalmólogos. Participaron 118 niños, el 18,6% presentó anticuerpos anti-Toxocara spp. Las manifestaciones clínicas con asociación estadísticamente significativa fueron las reacciones alérgicas, epífora y disminución de la agudeza visual. En la evaluación oftalmológica se encontró queratitis, uveítis, iritis, granuloma retiniano, endoftalmitis, amaurosis, leucocoria, desprendimiento de retina y endotropía. Los hallazgos muestran una alta frecuencia de enfermedad ocular en niños con toxocariasis de un estado de Venezuela.

Abstract Background: Toxocariasis is a widely spread parasitic disease. The most frequent clinical form is asymptomatic (AT) although it may present with visceral larva migrans (VLM), ocular larva migrans (OLM) or covert (TE) involvement. Aims: To describe the clinical presentation, laboratory, evolution and treatment characteristics of the cases and to compare the various clinical forms of presentation. Patients and Methods: Retrospective analysis of all children diagnosed with toxocariasis attended at the Infectology Service of the Pedro de Elizalde Children's General Hospital between 2012-2019. Results: We included 85 patients. 63.5% were males and the median age was 60 months. 49 patients presented AT, 14 VLM, 15 OLM and 7 TE. Children with LMV had lower age and higher eosinophil count. All the cases of OLM evolved with a poor visual prognosis. Treatment with albendazole was indicated in all cases of LMV, in active cases of LMO, in 4 TE and in 3 AT. Conclusion: This study represents one of the largest conducted in our country. The ocular forms had bad prognosis, while the visceral and covert forms had good evolution. It is essential to emphasize the prevention and early diagnosis of the disease in order to establish timely treatment and avoid sequelae.

Resumen Introducción: La toxocariasis es una enfermedad parasitaria ampliamente distribuida. Las formas clínicas descritas son la asintomática (TA), larva migrans visceral (LMV), larva migrans ocular (LMO) y encubierta (TE). Objetivos: Describir las características clínicas, de laboratorio, evolución y tratamiento de los casos y comparar las diversas formas clínicas de presentación. Pacientes y Métodos: Análisis retrospectivo de todos los pacientes pediátricos con diagnóstico de toxocariasis atendidos en el Servicio de Infectología del Hospital General de Niños Pedro de Elizalde entre 2012 y 2019. Resultados: Se incluyeron 85 pacientes. El 63,5 % fueron varones y la mediana de edad fue de 60 meses. Cuarenta y nueve pacientes presentaron TA, 14 LMV, 15 LMO y 7 TE. Los pacientes con LMV presentaron menor edad y recuento de eosinófilos más altos. Todos los casos de LMO presentaron mal pronóstico visual. Se indicó tratamiento con albendazol en todos los casos de LMV, en los casos activos de LMO, en 4 TE y en 3 TA. Conclusión: Este estudio representa uno de los más grandes llevados a cabo en el país. Todas las formas clínicas excepto las LMO tuvieron buena evolución. Resulta fundamental enfatizar en la prevención y en el diagnóstico precoz de la enfermedad para instaurar de manera oportuna el tratamiento y evitar secuelas.

ABSTRACT Neurotoxocariasis is uncommon. Its manifestations include events of meningitis, encephalitis and less frequently vasculitis, which manifest as headache, seizures, focalization, confusion, cognitive alterations and /or fever. Peripheral eosinophilia with clinical and neurological imaging elements, allow its early suspicion. We report a 48-year-old agricultural worker, admitted in our hospital for one week of gastrointestinal complaints, headache, progressive left hemiparesis and impaired consciousness. He had leukocytosis (13,530/μL) with peripheral eosinophilia (25%, absolute count 3,400 /μL). CSF analysis revealed no abnormalities and brain CT showed poorly defined hypodense lesions on subcortical areas and semioval centers. Magnetic resonance imaging showed multiple foci with increased signals predominantly in the white matter in both hemispheres, especially at frontal and occipital regions and at semioval centers. Lesions reinforced after paramagnetic contrast. Serological studies found specific IgG antibodies by ELISA against antigens of the genus Toxocara, which were confirmed by a positive IgG Western Blot. The patient was treated with albendazole (800 mg/d) for 14 days associated with parenteral and then oral corticosteroids with a favorable response and gradual complete recovery.

La neurotoxocariasis es infrecuente. Sus manifestaciones incluyen eventos de meningitis, encefalitis y con menor frecuencia vasculitis, que se manifiestan como cefalea, convulsiones, focalización, confusión, alteraciones cognitivas o fiebre. La eosinofilia periférica, junto a elementos clínicos e imágenes compatibles, permiten su sospecha. Informamos el caso de un trabajador agrícola de 48 años que ingresó por una semana de molestias gastrointestinales, cefalea, hemiparesia izquierda progresiva y deterioro de conciencia. Los exámenes revelaron leucocitosis (13.530/μL) con eosinofilia periférica (25%, recuento absoluto 3.400/μL). El análisis del LCR sin anomalías y la tomografía computada cerebral mostró lesiones hipodensas mal definidas en áreas subcorticales y centros semiovales. La resonancia magnética mostró múltiples focos con aumento de la señal predominantemente en la sustancia blanca en ambos hemisferios. Las lesiones presentaron refuerzo tras contraste paramagnético. Los estudios serológicos indicaron anticuerpos IgG específicos por ELISA contra antígenos del género Toxocara. El paciente fue tratado con albendazol (800 mg /día) durante 14 días asociado a corticoides con respuesta favorable y una recuperación gradual completa.

ABSTRACT The objective of this study was to determine ocular manifestations of toxocariasis in schoolchildren. A study was conducted in two schools in the Anzoátegui state in Venezuela in 2019. The ELISA test was used to determine IgG antibodies against Toxocara spp. The families completed a questionnaire, and the children were clinically evaluated by pediatricians and ophthalmologists. 118 children participated, 18.6% presented anti-Toxocara spp. The clinical manifestations with a statistically significant association were allergic reactions, epiphora, and decreased visual acuity. The ophthalmological evaluation found keratitis, uveitis, iritis, retinal granuloma, endophthalmitis, amaurosis, leukocoria, retinal detachment and endotropia. The findings show a high frequency of eye disease in children with toxocariasis from a state of Venezuela.

RESUMEN El objetivo de este estudio fue determinar manifestaciones oculares de la toxocariasis en escolares. Se realizó un estudio en dos escuelas del estado Anzoátegui en Venezuela en el 2019. Se empleó la prueba de ELISA para determinar los anticuerpos IgG contra Toxocara spp. Las familias completaron un cuestionario y los niños fueron evaluados clínicamente por pediatras y oftalmólogos. Participaron 118 niños, el 18,6% presentó anticuerpos anti-Toxocara spp. Las manifestaciones clínicas con asociación estadísticamente significativa fueron las reacciones alérgicas, epífora y disminución de la agudeza visual. En la evaluación oftalmológica se encontró queratitis, uveítis, iritis, granuloma retiniano, endoftalmitis, amaurosis, leucocoria, desprendimiento de retina y endotropía. Los hallazgos muestran una alta frecuencia de enfermedad ocular en niños con toxocariasis de un estado de Venezuela.

Abstract We present the case of an 8-year-old girl with an atypical presentation of toxocariasis, from the Peruvian Amazon. A month ago, the clinical presentation was characterized by the presence of abdominal pain, paleness and geophagia, associated with an abdominal mass and generalized lymphadenopathy. There were no respiratory, dermal, ocular or neurological symptoms. Marked peripheral eosinophilia was found in the blood count, and moderate eosinophilia in the spinal cord aspírate. The diagnosis was confirmed by serology with the enzyme-linked immunosorbent assay (ELISA), which showed the presence of IgG and IgM anti- Toxocara antibodies. Treatment with albendazole 400 mg once daily was administered for five days with favorable evolution.

Resumen Se presenta el caso de una niña de 8 años, procedente de la Amazonia peruana, con una presentación atípica de una toxocariasis. El cuadro clínico, de un mes de evolución, fue caracterizado por dolor abdominal crónico, palidez y geofagia, asociado a una masa abdominal y linfoadenopatías generalizadas. No hubo sintomatología respiratoria, dérmica, ocular o neurológica. En el hemograma se encontró una anemia y eosinofilia periférica acentuada y una eosinofilia moderada en el aspirado medular. El diagnóstico fUe confirmado por serología por el método de enzimoinmunoanálisis (ELISA), que mostró la presencia de anticuerpos anti-Toxocara de tipo IgG e IgM. Se administró tratamiento con albendazol 400 mg al día, durante cinco días, con una evolución favorable.

ABSTRACT Toxocara canis and catis are helminths that parasitize the intestine of dogs or cats, their definitive hosts. Females shed infective eggs into the environment, which, when accidentally ingested by humans, only develop the embryonic larval stage and cause toxocariasis. This is a zoonosis that is widespread throughout the world, especially in those areas where poor habitat and hygienic conditions prevail. The clinical picture can vary from asymptomatic forms to visceral larva migrans (VLM) or ocular larva migrans (OLM), due to the dissemination of embryonic larvae in the liver, lungs and to a lesser extent the CNS. VLM is clinically characterized by the presence ofhepatomegaly, pulmonary infiltration with cough, eosinophilia of varying intensity, hyper Ig E and Ig G anti-toxocara antibodies. Since fever is not a prominent clinical symptom, the following clinical case is presented.

RESUMEN Toxocara canis y catis son helmintos que parasitan el intestino del perro o del gato, sus huéspedes definitivos. Las hembras eliminan huevos infectantes al medio ambiente, que, ingeridos accidentalmente por el ser humano, sólo desarrollan el estado larvario en etapa embrionaria y causan la toxocariasis. Esta es una zoonosis extendida por todo el mundo, especialmente en aquellas áreas donde prevalecen condiciones deficientes de hábitat e higiene. El cuadro clínico puede variar desde formas asintomáticas a la larva migrans visceral (LMV) o larva migrans ocular (LMO), debidas a la diseminación de larvas embrionadas en el hígado, pulmones y en menor medida el SNC. La LMV se caracteriza clínicamente por la presencia de hepatomegalia, infiltración pulmonar con tos, eosinofilia de variada intensidad, hiper Ig E y anticuerpos Ig G anti-toxocara. Por no ser la fiebre un síntoma clínico destacado, se presenta el siguiente caso clínico.