Larva migrans visceral: forma mista de apresentação em adulto - aspectos clínicos e laboratoriais

Barra, LA. Costa; Santos, W. Ferreira dos; Chieffi, P.P.; Bedaque, E.A.; Salles, P.S. Campos; Capitão, C.G.; Vianna, S.; Hanna, R.; Pedretti Júnior, L.

doi:10.1590/S0037-86821996000400011

Resumos

Relatamos o caso de um paciente do sexo mascidino, dezoito anos de idade, procedente de Xapuri no Estado do Acre (Brasil), com história de episódios repetidos de meningoencefalites (três num ano), acompanhadas no local de origem. Em nosso serviço, no Instituto de Infectologia Emílio Ribas, obsewamos um quadro de poliartralgias, alterações radiológicas e broncoscópicas pulmonares e sinais neurológicos de irritação tneníngea e de comprometimento do tronco-encefãlico (com tomografia axial de crânio e exames liquóricos normais), acompanhando-se de eosinofilia periférica e títulos sorológicos elevados para Toxocara canis (EIISA). Consubstanciada a hipótese diagnostica de toxocaríase (larva migrans visceral - IMV), procedeu-se ao tratamento com tiabendazol, ocorrendo remissão clínica e laboratorial completa. Um mês após, ocorreu novo episódio de cefaléia acompanhada por rigidez de nuca (que remitiu em três dias com dexametasona) e, a partir daí, não mais obsewamos quaisquer alterações clínicas ou laboratoriais em cerca de três anos e meio de acompanhamento ambulatorial.

Larva migrans visceral; Toxocara canis; ELISA; Tiabendazol

We relate a case of an 18-year-old man, resident of Xapuri (State of Acre, Brazil), with a history of repeated episodes of meningoencephalitis (three in one year), each one was examined by a local doctor. In our service (Emilio Ribas Institute of Infectology) we observed a patient with polyjoint aches, radiological and broncoscopical pulmonary alterations (without clinical features), meningeal and brain stem manifestations - with normal brain computed tomography and cerebrospinal fluid. Blood eosinophils and serological Toxocara canis test (ELISA) were greatly increased. With the hipothesis of Toxocariasis (Visceral Lana Migrans) we administered Thiabendazole that brought complete clinical and laboratorial remission. Lnspite of a new episode of headache with meningeal manifestation approximately one month later (treated with dexamethasone resulting in a full remission after three days) we have not finded other manifestations in approximately three and a half years of ambulatory' care.

Visceral lawa migrans; Toxocara canis; ELISA; Thiabendazole

RELATO DE CASO

Larva migrans visceral: forma mista de apresentação em adulto - aspectos clínicos e laboratoriais

LA. Costa Barra; W. Ferreira dos Santos; P.P. Chieffi; E.A. Bedaque; P.S. Campos Salles; C.G. Capitão; S. Vianna, R. Hanna; L. Pedretti Júnior

^{Endereço para correspondência} Endereço para correspondência: Dr. Luiz Alberto Costa Barra. Instituto de Infectologia Emílio Ribas. Av. Dr. Arnaldo 165, 1 o Andar, 01246-090 São Paulo, SP, Brasil. Fax: (011) 280-3954.

RESUMO

Relatamos o caso de um paciente do sexo mascidino, dezoito anos de idade, procedente de Xapuri no Estado do Acre (Brasil), com história de episódios repetidos de meningoencefalites (três num ano), acompanhadas no local de origem. Em nosso serviço, no Instituto de Infectologia Emílio Ribas, obsewamos um quadro de poliartralgias, alterações radiológicas e broncoscópicas pulmonares e sinais neurológicos de irritação tneníngea e de comprometimento do tronco-encefãlico (com tomografia axial de crânio e exames liquóricos normais), acompanhando-se de eosinofilia periférica e títulos sorológicos elevados para Toxocara canis (EIISA). Consubstanciada a hipótese diagnostica de toxocaríase (larva migrans visceral - IMV), procedeu-se ao tratamento com tiabendazol, ocorrendo remissão clínica e laboratorial completa. Um mês após, ocorreu novo episódio de cefaléia acompanhada por rigidez de nuca (que remitiu em três dias com dexametasona) e, a partir daí, não mais obsewamos quaisquer alterações clínicas ou laboratoriais em cerca de três anos e meio de acompanhamento ambulatorial.

Palavras-chaves: Larva migrans visceral. Toxocara canis. ELISA. Tiabendazol.

ABSTRACT

We relate a case of an 18-year-old man, resident of Xapuri (State of Acre, Brazil), with a history of repeated episodes of meningoencephalitis (three in one year), each one was examined by a local doctor. In our service (Emilio Ribas Institute of Infectology) we observed a patient with polyjoint aches, radiological and broncoscopical pulmonary alterations (without clinical features), meningeal and brain stem manifestations with normal brain computed tomography and cerebrospinal fluid. Blood eosinophils and serological Toxocara canis test (ELISA) were greatly increased. With the hipothesis of Toxocariasis (Visceral Lana Migrans) we administered Thiabendazole that brought complete clinical and laboratorial remission. Lnspite of a new episode of headache with meningeal manifestation approximately one month later (treated with dexamethasone resulting in a full remission after three days) we have not finded other manifestations in approximately three and a half years of ambulatory' care.

Keywords: Visceral lawa migrans. Toxocara canis. ELISA. Thiabendazole.

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Recebido para publicação em 25/04/95.

Instituto de Infectologia Emílio Ribas, Instituto de Medicina Tropical de São Paulo, São Paulo, SP e Hospital de Ease de Rio Branco, Rio Branco,AC.

1. Beaver PC, Snyder CH, Carrera GM, Dent J, Lasserty J. Chronic eosinophilia due to visceral larva migrans. Report of three cases. Pediatrics 9:7,1952.
2. Campos DM, Souza MN, Zacariotti ETP, Nardini R, Campos MLL, Barbosa AP, Gebrin MCE, Lima FML. larva migrans visceral: Relato de três casos. Revista da Sociedade Brasileira de Medicina Tropical 23:117-120,1990.
3. Chieffi PP, Ueda M, Camargo ED, Souza AMC, Guedes MLS, Gerbi LJ, Spir M, Moreira AS. Visceral larva migrans: A soroepidemiological survey in five municipalities of São Paulo State, Brazil. Revista do Instituto de Medicina Tropical de São Paulo 32:204-210,1990.
4. Ehrhard T, Kernbaum S. Toxocara canis et toxocarose humaine. Bulletin de L'Institut Pasteur 77:225-287,1979.
5. Fenoy S, Cuellar C, Guillen JL. Persistence of Immune Response in Human Toxocariasis as measured by ELISA. International Journal for Parasitology 22:1037-1038,1992.
6. Fortenberry JD, Kenney RD, Younger J. Visceral Larva Migrans producing static encephalopathy in an infant. The Pediatric Infectious Disease Journal 10:403-406,1991.
7. Gillespie SH, Biowell D, Voller A, Robertson BD, Maizels RM. Diagnosis of Human Toxocariasis by antigen capture enzyme linked immunosorben assay. Journal of Clinical Pathology 46:551-554, 1993.
8. Glickman LT, Magnaval JF, Domanski L, Shofer Sf, Lauria SS, Gottstein B, Brochier B. Visceral Larva migrans in French Adults: a new disease syndrome? American Journal of Epidemiology 125:1019-1034,1987.
9. Glickman LT, Magnaval JF. Zoonotic round form infections. Infectious Diseases Clinics of North America 7: 717-732,1993.
10. Hill IR, Denham DA, Scholtz CL. Toxocara canis larvae in the brain of a british child.Transactions of the Royal Society of Tropical Medicine and Hygiene 79:351-354,1995.
11. Jacob CMA, Pastorino AC, Peres BA, Mello EO, Okay Y, Oselka GW. Clinical and laboratorial features of Visceral Toxocariasis in infancy. Revista do Instituto de Medicina Tropical de Säo Paulo 36:19-26,1994.
12. Le Luyer B, Menager V, Aldebert C, Le Roux P, Briquet MT, Boulioche J. Arthropathies inflammatoires revelatrices d'une Larva Migrans a Toxocara canis - Annales de Pediatrie (Paris) 37:445-448,1990.
13. Nash,TE.Visceral Larva Migrans and other anusual helminth infection. In: Mandell GL, Douglas RG, Benett JE (eds) Principle and Practice of Infections Diseases. 3rd edition, Churchill Livingstone, New York, p. 2157-2161,1990.
14. Ponder D, Marshall GS, Rabalais GP, Wood BP. Radiological case of the month. The American Journal of Diseases of Children 145:699-700, 1991.
15. Riog J, Romeu J, Riera C, Texido A, Domingo C, Morera J. Acute eosinophilic pneumonia due to Toxocariasis with bronchoalveolar lavage findings. Chest 102:294-296,1992.
16. Russeger L, Schmutzhard E. Spinal toxocaral abscess. Lancet 2:398,1989.
17. Sellal F, Piccard F, Mutschler Y Marescaux C, Collaro M, Magnaval JF. Myelitis caused by Toxocara canis (Larva Migrans). Revue Neurologique, 148:53-55,1992.
18. Taylor MRH, Keane CT, O'Connor i; Girdwood RWA, Smith H. Clinical features of covert Toxocariasis. Scandinavian Journal of Infectious Diseases., 19:693-696,1987.

Endereço para correspondência:

Dr. Luiz Alberto Costa Barra.

Instituto de Infectologia Emílio Ribas.

Av. Dr. Arnaldo 165, 1

^o Andar, 01246-090

São Paulo, SP, Brasil.

Fax: (011) 280-3954.

Datas de Publicação

Publicação nesta coleção
05 Abr 2013
Data do Fascículo
Ago 1996

Histórico

Aceito
25 Abr 1995
Recebido
25 Abr 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Beaver PC, Snyder CH, Carrera GM, Dent J, Lasserty J. Chronic eosinophilia due to visceral larva migrans. Report of three cases. Pediatrics 9:7,1952.

[2] 2. Campos DM, Souza MN, Zacariotti ETP, Nardini R, Campos MLL, Barbosa AP, Gebrin MCE, Lima FML. larva migrans visceral: Relato de três casos. Revista da Sociedade Brasileira de Medicina Tropical 23:117-120,1990.

[3] 3. Chieffi PP, Ueda M, Camargo ED, Souza AMC, Guedes MLS, Gerbi LJ, Spir M, Moreira AS. Visceral larva migrans: A soroepidemiological survey in five municipalities of São Paulo State, Brazil. Revista do Instituto de Medicina Tropical de São Paulo 32:204-210,1990.

[4] 4. Ehrhard T, Kernbaum S. Toxocara canis et toxocarose humaine. Bulletin de L'Institut Pasteur 77:225-287,1979.

[5] 5. Fenoy S, Cuellar C, Guillen JL. Persistence of Immune Response in Human Toxocariasis as measured by ELISA. International Journal for Parasitology 22:1037-1038,1992.

[6] 6. Fortenberry JD, Kenney RD, Younger J. Visceral Larva Migrans producing static encephalopathy in an infant. The Pediatric Infectious Disease Journal 10:403-406,1991.

[7] 7. Gillespie SH, Biowell D, Voller A, Robertson BD, Maizels RM. Diagnosis of Human Toxocariasis by antigen capture enzyme linked immunosorben assay. Journal of Clinical Pathology 46:551-554, 1993.

[8] 8. Glickman LT, Magnaval JF, Domanski L, Shofer Sf, Lauria SS, Gottstein B, Brochier B. Visceral Larva migrans in French Adults: a new disease syndrome? American Journal of Epidemiology 125:1019-1034,1987.

[9] 9. Glickman LT, Magnaval JF. Zoonotic round form infections. Infectious Diseases Clinics of North America 7: 717-732,1993.

[10] 10. Hill IR, Denham DA, Scholtz CL. Toxocara canis larvae in the brain of a british child.Transactions of the Royal Society of Tropical Medicine and Hygiene 79:351-354,1995.

[11] 11. Jacob CMA, Pastorino AC, Peres BA, Mello EO, Okay Y, Oselka GW. Clinical and laboratorial features of Visceral Toxocariasis in infancy. Revista do Instituto de Medicina Tropical de Säo Paulo 36:19-26,1994.

[12] 12. Le Luyer B, Menager V, Aldebert C, Le Roux P, Briquet MT, Boulioche J. Arthropathies inflammatoires revelatrices d'une Larva Migrans a Toxocara canis - Annales de Pediatrie (Paris) 37:445-448,1990.

[13] 13. Nash,TE.Visceral Larva Migrans and other anusual helminth infection. In: Mandell GL, Douglas RG, Benett JE (eds) Principle and Practice of Infections Diseases. 3rd edition, Churchill Livingstone, New York, p. 2157-2161,1990.

[14] 14. Ponder D, Marshall GS, Rabalais GP, Wood BP. Radiological case of the month. The American Journal of Diseases of Children 145:699-700, 1991.

[15] 15. Riog J, Romeu J, Riera C, Texido A, Domingo C, Morera J. Acute eosinophilic pneumonia due to Toxocariasis with bronchoalveolar lavage findings. Chest 102:294-296,1992.

[16] 16. Russeger L, Schmutzhard E. Spinal toxocaral abscess. Lancet 2:398,1989.

[17] 17. Sellal F, Piccard F, Mutschler Y Marescaux C, Collaro M, Magnaval JF. Myelitis caused by Toxocara canis (Larva Migrans). Revue Neurologique, 148:53-55,1992.

[18] 18. Taylor MRH, Keane CT, O'Connor i; Girdwood RWA, Smith H. Clinical features of covert Toxocariasis. Scandinavian Journal of Infectious Diseases., 19:693-696,1987.