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Respiratory Distress Secondary to Toxocariasis
October 2012, Vol 142, No. 4_MeetingAbstracts Chest Infections | October 2012
Respiratory Distress Secondary to Toxocariasis Keyur Patel*, MD; Safina Kureshi, MD; Ravdeep Kaur, BS; Kevin Maupin, MD; Raheel Khan, MD CAMC, Charleston, WV
Chest. 2012;142(4_MeetingAbstracts):255A. doi:10.1378/chest.1390244
Abstract SESSION TYPE: Infectious Disease Student/Resident Case Report Posters II PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM INTRODUCTION: Toxocariasis infection is rarely seen in developed countries. The infection occurs when a human host ingests embryonated eggs from contaminated sources, such as soil or sandboxes. The larvae can disseminate from the intestine to various organs, including the liver, brain, and lungs, where they can survive for months to years, causing extensive tissue damage. CASE PRESENTATION: A 14 month old Caucasian female presents with persistent cough and wheezing. She was diagnosed with pneumonia and discharged home. Four months later, she was re-admitted for respiratory distress. She had a history of playing in soil and Pica, secondary to iron deficiency. The patient’s last exposure to animals was six months earlier, while playing at her father’s house. On physical examination she appeared unkempt with dirt under her fingernails and dried yellowish bloody discharge from her nares. Wheezing was heard bilaterally with notable subcostal retractions.
Laboratory results were remarkable for a Leukocyte count of 31,100 cells with 75% Eosinophils, 10% Neutrophils, 1% Band, and 9% Lymphocytes. Her hemoglobin was 11.4 mg/dL, hematocrit 34 mg/dL, and platelets were 409,000. Her chest x-ray revealed bilateral pulmonary infiltrates. The patient’s serology from her previous visit had now resulted with a positive Toxocara Canis Antibody level of 2.62 (normal <1.0), IgE level of 3143 IU/ml (normal 1-16), abnormal liver function tests; thus our patient was diagnosed with systemic Toxocariasis. The patient had a normal fundoscopic examination and furthermore underwent a bronchoscopy to assess for worm infestation and underlying etiology for her persistent respiratory symptoms. It revealed increased secretions, and visualization of a worm. Due to previous non-compliance to the medication regimen, our patient was given her full course of treatment inpatient. DISCUSSION: This is a unique case of Toxocariasis infection in a pediatric patient who resides in the U.S. Although our patient had only pulmonary and liver involvement, previous cases have shown that it can additionally involve the ocular and central nervous systems as well. As seen with many parasitic infections, our patient had elevated levels of IgE and Eosinophils. CONCLUSIONS: This case highlights the importance of considering a parasitic infection in a child with persistent cough and wheeze along with Eosinophilia, even in developed countries. 1) Inoue Koji, Inoue Yoshikazu. Chronic Eosinophilic Pneumonia due to Visceral larvae Migrans. Internal Medicine 2002, 41.6: 478-482. 2) Schantz PM and Glickman LT. Toxocaral visceral larval migrans. N Engl J Med 1978, 298: 436-439. DISCLOSURE: The following authors have nothing to disclose: Keyur Patel, Safina Kureshi, Ravdeep Kaur, Kevin Maupin, Raheel Khan No Product/Research Disclosure Information
CAMC, Charleston, WV
Respiratory Distress Secondary to Toxocariasis Keyur Patel*, MD; Safina Kureshi, MD; Ravdeep Kaur, BS; Kevin Maupin, MD; Raheel Khan, MD CAMC, Charleston, WV
Chest. 2012;142(4_MeetingAbstracts):255A. doi:10.1378/chest.1390244
Abstract SESSION TYPE: Infectious Disease Student/Resident Case Report Posters II PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM INTRODUCTION: Toxocariasis infection is rarely seen in developed countries. The infection occurs when a human host ingests embryonated eggs from contaminated sources, such as soil or sandboxes. The larvae can disseminate from the intestine to various organs, including the liver, brain, and lungs, where they can survive for months to years, causing extensive tissue damage. CASE PRESENTATION: A 14 month old Caucasian female presents with persistent cough and wheezing. She was diagnosed with pneumonia and discharged home. Four months later, she was re-admitted for respiratory distress. She had a history of playing in soil and Pica, secondary to iron deficiency. The patient’s last exposure to animals was six months earlier, while playing at her father’s house. On physical examination she appeared unkempt with dirt under her fingernails and dried yellowish bloody discharge from her nares. Wheezing was heard bilaterally with notable subcostal retractions.
Laboratory results were remarkable for a Leukocyte count of 31,100 cells with 75% Eosinophils, 10% Neutrophils, 1% Band, and 9% Lymphocytes. Her hemoglobin was 11.4 mg/dL, hematocrit 34 mg/dL, and platelets were 409,000. Her chest x-ray revealed bilateral pulmonary infiltrates. The patient’s serology from her previous visit had now resulted with a positive Toxocara Canis Antibody level of 2.62 (normal <1.0), IgE level of 3143 IU/ml (normal 1-16), abnormal liver function tests; thus our patient was diagnosed with systemic Toxocariasis. The patient had a normal fundoscopic examination and furthermore underwent a bronchoscopy to assess for worm infestation and underlying etiology for her persistent respiratory symptoms. It revealed increased secretions, and visualization of a worm. Due to previous non-compliance to the medication regimen, our patient was given her full course of treatment inpatient. DISCUSSION: This is a unique case of Toxocariasis infection in a pediatric patient who resides in the U.S. Although our patient had only pulmonary and liver involvement, previous cases have shown that it can additionally involve the ocular and central nervous systems as well. As seen with many parasitic infections, our patient had elevated levels of IgE and Eosinophils. CONCLUSIONS: This case highlights the importance of considering a parasitic infection in a child with persistent cough and wheeze along with Eosinophilia, even in developed countries. 1) Inoue Koji, Inoue Yoshikazu. Chronic Eosinophilic Pneumonia due to Visceral larvae Migrans. Internal Medicine 2002, 41.6: 478-482. 2) Schantz PM and Glickman LT. Toxocaral visceral larval migrans. N Engl J Med 1978, 298: 436-439. DISCLOSURE: The following authors have nothing to disclose: Keyur Patel, Safina Kureshi, Ravdeep Kaur, Kevin Maupin, Raheel Khan No Product/Research Disclosure Information
CAMC, Charleston, WV