Table 1. Epidemiological, clinical, laboratory and outcome features of patients diagnosed with toxocariasis (n = 28) at the Institute of Tropical Medicine, Antwerp, Belgium from 2000 to 2013.
| Case n° | Date of diagnosis | Age, year/ gender | Origin | Travel destination (duration) | Symptoms at presentation | Symptom duration | Interval travel-symptom onset or screening | Absolute eosinophil count at first documented assessment (% of WBC) | Toxocara serology (+ titer since 2010) | Initial treatment, evolution and outcome (interval for follow-up) | Comments |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | April 2000 | 45/M | Belgium | Cambodia (10 months) | Abdominal pain, cough, wheezing | 1 week | During stay | 3560 (25%) (in Cambodia) | Negative (in Cambodia) | Praziquantel 2 days, with no clinical improvement; albendazole thereafter for 3 weeks Clinical cure and normalization of eosinophil count (assessed in Belgium) | Documented seroconversion (week 5 post-symptom onset in Belgium) |
| 2 | May 2000 | 23/F | Belgium | Laos, Cambodia (2 months) | Fever, abdominal pain, diarrhea, urticarial rash | 10 days | 3 weeks after return | 14160 (57%) | Positive | Albendazole 5 days, with clinical cure and normalization of eosinophil count (in 2002) | Spontaneous clinical improvement before therapy |
| 3 | Novem-ber 2000 | 23/F | Belgium | Indonesia (2 years) | none | - | 12 days after return | 2080 (23%) | Positive | Ivermectine and praziquantel, with normalization of eosinophil count (assessed at month 6 post-treatment) | No albendazole because abroad again when serological results became available |
| 4 | June 2002 | 35/F | Belgium | Southeast Asia (1 year) | Fever, vomiting, abdominal pain, cough, bronchitis | 8 weeks | End of stay | 730 (9%) | Positive | No treatment first, but no clinical improvement after one month; albendazole 5 days thereafter Clinical cure and normalization of eosinophil count (assessed at week 8 post-treatment) | |
| 5 | Augustus 2002 | 51/F | Belgium | Spain (1 week) | Cough and thoracic pain ; pruritus; no improvement with antibiotics | 3 weeks | End of stay | 2320 (24%) | Positive | Albendazole 5 days, with clinical cure and normalization of eosinophil count (assessed at week 4 post-treatment) | Spontaneous decrease of eosinophil count before therapy (till 920, 10%); Clear exposure to young dogs during travel |
| 6 | January 2003 | 52/M | Belgium | Multiple shorts stay in African countries | Dry cough, fever | 3 weeks | 5 weeks after return | 1070 (16%) | Positive | Albendazole 5 days, with clinical cure and normalization of eosinophil count (assessed at week 3 post-treatment) | Spontaneous decrease of eosinophil count before therapy (till 590, 9%) |
| 7 | February 2003 | 37/M | Belgium | Nepal (8 months) | Pruritus and urticarial rash | 6 weeks | End of stay | 510 (9%) | Positive | Ivermectin 1 day, with no improvement; albendazole 5 days when results available Clinical cure thereafter | Clinical follow-up by phone No laboratory control |
| 8 | March 2003 | 42/M | Belgium | Romania (1 year) | Diarrhea, abdominal pain, night sweats, dyspnea | 12 weeks | During stay | 950 (11%) | Positive | Albendazole 5 days with clinical cure and normalization of eosinophil count (assessed at month 6 post-treatment) | |
| 9 | April 2004 | 49/M | Belgium | Laos (1 year) | Fever, abdominal pain, diarrhea | 5 days | 1 week after return | 7600 (55%) | Negative | Albendazole 5 days, with clinical cure and normalization of eosinophil count (assessed at week 4 post-treatment) | Documented seroconversion (week 4 post-treatment) |
| 10 | January 2007 | 52/F | Belgium | South Africa (2 weeks) | Localized edema, urticarial rash, abdominal pain | 10 days | 4 weeks after return | 2340 (26%) | Negative | Albendazole 5 days (week 2 after first contact), with clinical cure and normalization of eosinophil count (assessed at week 6 post-treatment) | Spontaneous decrease eosinophil count before therapy (till 990, 13%) Documented seroconversion (week 6 post-treatment) |
| 11 | July 2007 | 46/F | Belgium | Slovenia (2 weeks) | Paresthesia, followed by anesthesia in both legs and genital region; transient loss of strength | 10 weeks | ? (precise dates of travel not found) | 490 (5%) | Positive | Albendazole 5 days + steroids; DEC administered after 1 week Slow clinical improvement Resolution of MRI lesions | Toxocara ELISA positive in CSF CSF examination: 33 WBC with 12% eosinophils Transverse myelitis at MRI |
| 12 | December 2007 | 53/F | Belgium | China (10 days) | no | - | 1 month after return | 1410 (18%) | Positive | Ivermectin 1 day, with no eosinophil decline 2 weeks later: 1300 (19%) Albendazole 5 days thereafter, with normalization of eosinophil count (assessed at week 8 post-treatment) | |
| 13 | February 2009 | 49/M | Belgium | Kenya (1 month) + other neighboring countries | Urticarial rash + intermittent edema face and hands, sweats | 8 weeks | End of stay | 670 (10%) | Positive | Albendazole 5 days, with clinical cure and normalization of eosinophil count (week 5 post-treatment) | Laboratory control in another institution |
| 14 | February2009 | 49/M | Belgium | Philippines (2 weeks) | Fever, cough dyspnea, wheezing | 12 days | Day of return | 1640 (13%) | Negative | Mebendazole 3 days + ivermectine 1 day, with clinical cure and normalization of eosinophil count (assessed at week 2 post-treatment) | Documented seroconversion (2 week post-treatment) Chest X-rays: two infiltrates |
| 15 | April 2009 | 52/F | Belgium | Turkey (3 weeks) | Abdominal pain and intermittent diarrhea | 16 weeks | 1 week after return | 1720 (19%) | Positive | Albendazole 5 days | Lost to follow-up |
| 16 | December 2009 | 49/M | Belgium | Several short trips to Central Africa | Urinary and fecal incontinency; sexual dysfunction | 28 weeks | 6 weeks after one of the trips | 430 (4%) | Positive | Albendazole + steroids ; later DEC, with slight clinical improvement and resolution of MRI lesions | Toxocara ELISA positive in CSF CSF examination: 40 WBC with 18% eosinophils Transverse myelitis at MRI (thoracic vertebra 5th till 11th) |
| 17 | November 2010 | 52/F | Lebanon (lives in Belgium) | Angola (3 months) | Urticarial rash, fatigue, sweats | 4 weeks | 4 weeks after return | 2950 (32%) | Positive (3.7) | Albendazole 5 days, with clinical cure and normalization of eosinophil count (assessed at week 14 post-treatment) | Spontaneous decrease before therapy (till 860, 11%) |
| 18 | April 2011 | 40/F | Belgium | Bolivie or Nepal (1 month) | Fever, cough, urticarial rash | 4 weeks | 4 weeks after return | 1810 (24%) | Positive (3,8) | Albendazole 3 days only, with decrease of eosinophil count after one month (710, 12%) but re-increase in September to initial levels Start DEC and normalization of eosinophil count (assessed at week 6 post-treatment) | Albendazole badly tolerated (vomiting, protracted anosmia); stopped after 3 days Chest X-rays: infiltrates |
| 19 | May 2011 | 35/F | Netherlands | Stewardess (Netherlands Antilla (4 days, Laos (3 days, Ghana 3 days) | Abdominal pain, diarrhea, vomiting, thoracic pain and dyspnea; no improvement with antibiotics | 3 weeks | 1 week after trip to Antilla | 10130 (54%) | Positive (1.6) | Ivermectin 1 day; albendazole 5 days when results available, with clinical cure and normalization of eosinophil count (assessed at week 3 post-treatment) | Chest X-rays: infiltrates |
| 20 | June 2011 | 68/F | Belgium | Egypt (3 weeks) | Cough and wheezing | 8 weeks | End of stay | 540 (7%) | Positive (3.5) | Albendazole 5 days, with clinical cure and normalization of eosinophil count (assessed at week 2 post-treatment) | CT Scan thorax : infiltrates Chest X-rays: normal |
| 21 | November 2011 | 57/M | Lebanon | Democratic Republic of the Congo (residence) | no | Just after return | 2590 (23%) | Positive (2.3) | Albendazole 5 days, with normalization of eosinophil count documented (assessed at week 8 post-treatment) | Laboratory control in another clinic | |
| 22 | April 2012 | 65/F | Belgium | India (10 weeks) | Cough, fever, arthralgia, diarrhea, vomiting, itching; | 4 weeks | End of stay | 5850 (42%) | Negative (in Italy) | Albendazole 5 days, 2 weeks later in Belgium, with clinical cure and normalization of eosinophil count (assessed at week 3 post-treatment) | Admission 6 days in Italy first where steroids were required Chest X-rays (Italy): infiltrates Documented seroconversion (Toxocara titer 1.6; 4 weeks after symptom onset) |
| 23 | June 2012 | 4/F | Ethiopia | Ethiopia (residence) | no | At arrival (adoption) | 1100 (11%) | Positive (1.6) | Albendazole 5 days, with normalization of eosinophil count (assessed at week 7 post-treatment) | ||
| 24 | June 2012 | 64/F | Belgium | Turkey (4 months) | no | Return 1 month ago | 2970 (26%) | Positive (3.1) | Albendazole 5 days, with normalization of eosinophil count (assessed at week 9 post-treatment) | Spontaneous decrease (till 1190, 11%) before therapy | |
| 25 | June 2012 | 31/M | Belgium | Pilote ; Central/West Africa | Abdominal pain and diarrhea | 10 days | Upon return | 1260 (15%) | Positive (1.1) | Albendazole 5 days, with clinical cure and normalization of eosinophil count (assessed at week 4 post-treatment) | Shigella co-infection |
| 26 | September 2012 | 52/M | Belgium | Madagascar (14 months) | Abdominal pain, urticarial, quincke edema | 4 weeks | During stay | 780 (8%) | Positive (1.3) | No treatment Spontaneous cure assessed at week 4 | |
| 27 | May 2013 | 66/M | Belgium | Burkina Faso (2 weeks) or France (1 month) ? | Fever, urticarial, lymphadenopathies | 5 days | 8 weeks (Burkina); 2 weeks (France) | 3110 (33%) | Negative (0.7) | No treatment Spontaneous cure assessed at week 3 (280, 5%) | Documented seroconversion at week 3 post-symptom onset (titer 1.1) |
| 28 | July 2013 | 53/M | Belgium | Italy | Fever, night sweats, arthralgia, | 3 weeks | 10 days | 1350 (16%) | Positive (1.6) | No treatment Spontaneous cure assessed at week 4 |
Note: rows 3, 12, 21, 23, and 24 represent asymptomatic cases
M denotes male; F female; WBC white blood cell; CSF cerebrospinal fluid; MRI magnetic resonance imaging; DEC diethylcarbamazine