Clinical features and course of ocular toxocariasis in adults

• Published in: PLoS neglected tropical diseases Vol. 8; no. 6; p. e2938
• Main Authors: Ahn, Seong Joon, Woo, Se Joon, Jin, Yan, Chang, Yoon-Seok, Kim, Tae Wan, Ahn, Jeeyun, Heo, Jang Won, Yu, Hyeong Gon, Chung, Hum, Park, Kyu Hyung, Hong, Sung Tae
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.06.2014; Public Library of Science (PLoS)
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Aged; Albendazole - therapeutic use; Animals; Anthelmintics - therapeutic use; Anti-Inflammatory Agents; Care and treatment; Clinical outcomes; Cohort Studies; Diagnosis; Eye - pathology; Eye diseases; Eye Diseases - diagnosis; Eye Diseases - drug therapy; Eye Diseases - pathology; Feeding Behavior; Humans; Infections; Medical treatment; Medicine and Health Sciences; Middle Aged; Migration; Occupational Exposure; Pets; Public health administration; Retrospective Studies; Roundworm infections; Ruminants; Studies; Tomography, Optical Coherence; Toxocara - isolation & purification; Toxocariasis - diagnosis; Toxocariasis - drug therapy; Toxocariasis - pathology; Treatment Outcome; Young Adult
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0002938

To investigate the clinical features, clinical course of granuloma, serologic findings, treatment outcome, and probable infection sources in adult patients with ocular toxocariasis (OT). In this retrospective cohort study, we examined 101 adult patients diagnosed clinically and serologically with OT. Serial fundus photographs and spectral domain optical coherence tomography images of all the patients were reviewed. A clinic-based case-control study on pet ownership, occupation, and raw meat ingestion history was performed to investigate the possible infection sources. Among the patients diagnosed clinically and serologically with OT, 69.6% showed elevated immunoglobulin E (IgE) levels. Granuloma in OT involved all retinal layers and several vitreoretinal comorbidities were noted depending on the location of granuloma: posterior pole granuloma was associated with epiretinal membrane and retinal nerve fiber layer defects, whereas peripheral granuloma was associated with vitreous opacity. Intraocular migration of granuloma was observed in 15 of 93 patients (16.1%). Treatment with albendazole (400 mg twice a day for 2 weeks) and corticosteroids (oral prednisolone; 0.5-1 mg/kg/day) resulted in comparable outcomes to patients on corticosteroid monotherapy; however, the 6-month recurrence rate in patients treated with combined therapy (17.4%) was significantly lower than that in patients treated with corticosteroid monotherapy (54.5%, P=0.045). Ingestion of raw cow liver (80.8%) or meat (71.2%) was significantly more common in OT patients than healthy controls. Our study discusses the diagnosis, treatment, and prevention strategies for OT. Evaluation of total IgE, in addition to anti-toxocara antibody, can assist in the serologic diagnosis of OT. Combined albendazole and corticosteroid therapy may reduce intraocular inflammation and recurrence. Migrating feature of granuloma is clinically important and may further suggest the diagnosis of OT. Clinicians need to carefully examine comorbid conditions for OT. OT may be associated with ingestion of uncooked meat, especially raw cow liver, in adult patients.