LARVA MIGRANS

• Albendazole - this broad-spectrum medication is effective against

  a wide range of parasitic worm infections,

  including:

  • Roundworms (nematodes) such as hookworm, pinworm, whipworm, ascaris, and trichinosis
  • Tapeworms (cestodes)
  • Flukes (trematodes)
  • Filarial worms, which cause lymphatic filariasis, onchocerciasis (river blindness), loiasis, and mansonelliasis
• Mebendazole - This medication is primarily used to treat infections caused by roundworms (nematodes), including:

  ● Pinworm

  ● Hookworm

  ● Roundworm (ascariasis)

  ● Whipworm

  ● Trichinosis

  ● Enterobiasis (pinworm infection)
• Diethylcarbamazine - This medication is specifically used to treat infections caused by filarial worms, including:

  ● Lymphatic filariasis

  ● Elephantiasis (a cause by lymphatic filariasis)

  ● Loiasis

  ● Mansonelliasis
• Supportive therapy - steroids during wheezing, inflammed tissues; removal of granulomas from the eyes
• prevention

  • Careful child supervision
  • Wash hand before eating and after playing with pets
  • Cover sandboxes
  • Regular deowrming of pets
  • Cook liver and other organ meat well before eating
• Diagnosis

  • Serology - ELISA (enzyme liked immunosorbent assay)
  • Peripheral blood count - High eosinophilia (may be absent on Ocular Larva Migrans)
  • Imaging - X-ray
  • Histology - encysted larvae in liver, lungs, brain, eye
• Difference of T. cati & T. canis

  • T. cati - 75 x 65 μm
  • T. canis - 80 x 75 μm
• • Toxocara spp. contains large central mass (zygote)
  • Resembles Ascaris eggs but larger, thinner shell, and albuminoid outer layer
  • color - dark brown
  • surface - rough, pitted
• Difference of T. cati, T. canis, T. leonia

  • T. cati - Alae broad and ends abruptly; 3 lips
  • T. canis - Alae narrower and ends gradually; 3 lips
  • T. leonia -Alae narrower and ends gradually; 3 lips
• Toxocara spp.

  • Buccal cavity - 3 lips
  • Cervical alae - wing-like projection
• Ocular Larva Migrans

  • eye involvement often leads to unilateral vision loss, cross eye (strabismus)
  • more often in children (5 - 10 y/o) and young adults compared to VLM (more often in young children 4 - 5y/o)
  • Symptoms of VLM may or may not be present
• Etiologic agents of T. canis and cati

  • most common ocular toxocariasis
  • Bayliscaris procyonis - reservoir host: raccoons
  • Ancylostoma spp
  • Gnathostoma spinigerum
• Visceral larva migrans Disease affecting younger children (< 5 years old)
• Visceral Larva Migrans migrate to lungs, liver, eyes, brain, muscles (visceral organs)
• Visceral Larva Migrans

  • symptoms due to antigens secretedd by the migrating larvae
  • wheezing, breathlessness, asthma-like, cough, itchy, tiredness, muscle pain, seizure
• Visceral Larva Migrans diagnosis

  • Physical examination and medical history
  • skin biopsy not necessary
  • peripheral eosinophilia
  • coherence tomography
• Visceral Larva Migrans treatment (without drugs - self-heal)

  With anti- helminthic drugs:

  ● Albendazole (oral)

  ● Mebendazole (oral)

  ● Thiabendazole (topical)

  ● Ivermectin (oral)

  
  

  Supportive Therapy

  ● Antihistamines (relieve itching)

  ● Topical corticosteroids (relieve inflammation)

  ● Antibiotics (secondary infection)

  
  

  Surgical care ( to kill larvae)

  ● Cryosurgery- painful and requires multiple

  treatment

  ● Liquid Nitrogen

  ● Ethyl chloride spray

  ● Carbon Dioxide slush
• Visceral Larva Migrans Prevention

  ● Avoid direct contact with contaminated soil:

  wear shoes on the beach, lay towel behind your

  backs on the sand, garden gloves

  ● Prohibit dogs and cats o beaches

  ● Deworm pets regularly

  ● Cover sandboxes when not in use to avoid

  animals defecating
• Visceral Larva Migrans Creeping eruption

  ● Abnormal tracks below the skin surface in the

  feet (30%)

  ● Stinging sensation upon penetration

  ● Larva starts migrating 1 week to several months

  after penetration

  ● Larva forms tract 1-2 cm beyond
• Visceral larva migrans Migratory tract/ trail

  ● 2-4mm wide

  ● Erythematous (reddish), elevated, vesicular,

  itchy

  ● Erratic pattern (snake -like) serpiginous

  ● Progresses 2mm to 2cm/ day
• VLM

  At risk groups

  anyone in contact with sand/ soil in warm, moist, shady

  areas:

  ● Sunbathers

  ● Fishermen

  ● Hunters

  ● Gardeners

  ● Construction workers

  ● Children playing in sandboxes, beach
• Larva migrans is a type of parasitic infection that involves the young form of the parasite
• Larva migrans, human is only an accidental host or the dead-end host; the larva will no longer develop to another stage of its life cycle
• 3 types of larva migrans

  1. Cutaneous Larva Migrans
  2. Visceral Larva Migrans
  3. Ocular Larva Migrans
• The most common cause of Cutaneous Larva Migrans is an animal hookworm
• cutaneous larva migrans is called the larva currens/ racing larva
• Cutaneous larva migrans is called ground itch if the causative agent is a human hookworm
• Cutaneous larva migrans is self-limiting, but physicians typically still provide drug prescriptions for infected patients