Published online February 1, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. e336-e339 (doi:10.1542/peds.2005-1596)
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Toxocariasis (Visceral Larva...
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Visceral Larva Migrans Associated With Earthworm Ingestion: Clinical Evolution in an Adolescent Patient

Antonella Cianferoni, MDa, Lynda Schneider, MDa, Peter M. Schantz, VMD, PhDb, Daniel Brown, MD, PhDa and LeAnne M. Fox, MD, MPHc,d

Divisions ofa Immunology
c Infectious Diseases, Children's Hospital, Boston, Massachusetts
b Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
d Center for International Health and Development, Boston University, Boston, Massachusetts

A 16-year-old girl developed a cough, hypereosinophilia (absolute eosinophil count: 32000/mm3), hypergammaglobulinemia, and multiple noncavitary pulmonary nodules 1 month after having ingested an earthworm on a dare. Spirometry revealed moderate restriction and reduced gas diffusion. Parabronchial biopsy demonstrated eosinophilic organizing pneumonitis with multiple eosinophilic microabscesses, and Toxocara titers were elevated (>1:4096). Ophthalmologic examination ruled out ocular larva migrans. The patient received a 10-day course of albendazole (400 mg orally twice daily) and demonstrated significant clinical improvement with resolution of cough and pulmonary function abnormalities. Her white blood cell count and hypergammaglobulinemia normalized within 20 days, yet eosinophils (absolute eosinophil count: 1780/mm3) and Toxocara serologies (>1:4096) remained elevated 3 months after completing antihelminthic therapy. In this instance, the ingested earthworm served as the paratenic carrier of Toxocara larvae from the soil to the patient. This case highlights the clinical evolution of pulmonary visceral larva migrans infection caused by Toxocara spp. associated with a discrete ingestion in an adolescent patient. In addition, it provides a rare opportunity to define the incubation period of visceral larva migrans and emphasizes the importance of education regarding sources of Toxocara infection.

Key Words: visceral larva migrans • Toxocara • pediatric • eosinophilia • pulmonary

Abbreviations: FVC, forced vital capacity • FEV1, forced expiratory volume in 1 second • FEF25–75, forced expiratory flow rate between 25% and 75% of the forced vital capacity • WBC, white blood cell • Ig, immunoglobulin • VLM, visceral larva migrans

Accepted Sep 9, 2005.


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Related articles in Pediatrics:

Cianferoni A, Schneider L, Schantz PM, Brown D, Fox LM. Visceral Larva Migrans Associated With Earthworm Ingestion: Clinical Evolution in an Adolescent Patient. PEDIATRICS 2006;117:e336–e339.

Pediatrics 2006 118: 852. [Extract] [Full Text]  



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