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Ecchymoses: an unusual manifestation of toxocariasis in children
V P Wickramasinghe1, S P Lamabadusuriya, M S Wijesundera
1Faculty of Medicine, University of Colombo.
Insights
Multiple ecchymoses in children with eosinophilia can be caused by toxocariasis, a parasitic infection. Early diagnosis and treatment of this acquired bleeding disorder are crucial for positive outcomes.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Parasitology
Background:
- Multiple ecchymoses and eosinophilia in children can indicate underlying medical conditions.
- Identifying the specific etiology is essential for effective treatment and management.
Purpose of the Study:
- To investigate the causes of multiple ecchymoses associated with eosinophilia in pediatric patients.
- To determine the prevalence of parasitic infections, specifically toxocariasis, in children presenting with these symptoms.
Main Methods:
- A prospective study was conducted on 14 children admitted to a Professorial Pediatric Unit with multiple ecchymoses and absolute eosinophilia.
- Diagnostic tests included bleeding time, clotting time, platelet count, platelet function tests, stool examination, and toxocara antibody tests.
- Patients positive for toxocariasis or geohelminths received appropriate antiparasitic treatment.
Main Results:
- Toxocariasis was identified as the cause in 12 out of 14 children, with a history of contact with pets.
- Ascariasis was diagnosed in the remaining 2 children.
- All patients exhibited prolonged bleeding times, which normalized post-treatment, along with a significant reduction in eosinophil counts.
Conclusions:
- Toxocariasis can manifest as ecchymoses due to an acquired bleeding disorder in children.
- Increased awareness of this association can lead to earlier diagnosis and treatment, reducing patient morbidity and parental anxiety.
Objective:
To investigate the aetiology of multiple ecchymoses associated with eosinophilia.
Setting:
Professorial Paediatric Unit (PPU) at Lady Ridgeway Hospital (LRH) for children, Colombo.
Design:
Prospective study from July 1998 to April 2000.
Materials And Methods:
Patients admitted to the PPU with multiple ecchymoses associated with an absolute eosinophilia (> 1 x 10(9)/1) were investigated further to determine the possible aetiology; bleeding time, clotting time, platelet count, platelet function tests, stools examination and toxocara antibody tests were performed. Patients who were positive for toxocara were treated either with thiabendazole or albendazole. Patients who had geohelminth infestations were treated with mebendazole.
Results:
14 children (11 boys) were studied. 7 were between 1 and 5 years, and 7 were above 5 years of age. The mean eosinophil count was 4.3 x 10(9)/1. All patients had a prolonged bleeding time, but clotting time and platelet counts (mean value 220 x 10(9)/1) were normal. Platelet function tests were done in 5 patients. Twelve patients were positive for toxocariasis and the other 2 were positive for ascariasis. All children who were positive for toxocariasis had contact with pet cats or dogs. Six patients were treated with thiabendazole and 6 with albendazole. The two patients who had ascariasis were treated with mebendazole. Post-treatment mean eosinophil count was 0.63 x 10(9)/1, and the bleeding time was 4 minutes.
Conclusion:
Toxocariasis could present with ecchymoses due to an acquired bleeding disorder. Awareness of this would help to investigate, diagnose and treat early, and lessen parental anxiety.
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