Severe Toxocariasis in Children-Diagnostic Difficulties

Area of Science:

• Pediatric Infectious Diseases
• Parasitology
• Pulmonology
• Neurology

Background:

• Acute interstitial pneumonia is a common initial diagnosis for pediatric respiratory distress.
• Parasitic infections, such as toxocariasis, can present with diverse and atypical symptoms, complicating diagnosis.

Purpose of the Study:

• To report a case of severe toxocariasis in an infant presenting with pulmonary and neurological manifestations.
• To highlight the diagnostic challenges and clinical course of toxocariasis in young children.

Main Methods:

• Clinical case presentation of an 18-month-old girl with prolonged fever and cough.
• Diagnostic workup included complete blood count, inflammatory markers, serum iron and calcium levels, immunoglobulin E (IgE) and G (IgG) quantification, pulmonary X-rays, and bone marrow examination.
• Serological testing for Toxocara canis antibodies was performed, alongside neuroimaging (CT scan) and electroencephalogram (EEG).

Main Results:

• Initial presentation suggested acute interstitial pneumonia, but the patient developed recurrent respiratory failure and non-febrile seizures.
• Laboratory findings revealed anemia, leukocytosis, marked eosinophilia (20% in bone marrow), elevated inflammatory markers, hyperproteinemia with hypergammaglobulinemia, and significantly increased IgE and IgG levels.
• Diagnosis of toxocariasis was confirmed by a positive anti-Toxocara canis antibody test (55.6 NTU); brain CT and EEG were normal.

Conclusions:

• Severe toxocariasis can mimic other pediatric respiratory and neurological conditions, necessitating a broad differential diagnosis.
• Eosinophilia and specific serological markers are crucial for diagnosing toxocariasis, even with atypical presentations.
• Prompt antiparasitic treatment is recommended for confirmed cases of toxocariasis with significant organ involvement.