Treatment of Toxocara Infection with Visceral Symptoms
For patients with positive Toxocara antibodies and visceral symptoms, a 7-day course of albendazole is insufficient; the recommended treatment is albendazole 400 mg twice daily for 5 days. 1, 2
Clinical Presentation and Diagnosis
- Visceral larva migrans (VLM) occurs when Toxocara larvae penetrate the gut mucosa and enter the portal and systemic circulation 1
- Common symptoms include fever, eosinophilia, wheeze, cough, abdominal pain, hepatosplenomegaly, and urticarial rash 1, 2
- Diagnosis is primarily confirmed through serology, with marked peripheral eosinophilia typically present 2
Treatment Algorithm for Toxocara Infection
First-line Treatment for Visceral Larva Migrans (VLM)
- Albendazole 400 mg twice daily for 5 days is the standard recommended treatment for visceral toxocariasis 1, 2
- Some cases are mild and self-limiting, but treatment is recommended when symptoms are present 1
- The standard adult dosing is 400 mg twice daily, with pediatric dosing adjusted by weight 3
Treatment Considerations for Severe or Refractory Cases
- For severe cases with significant inflammation, adding prednisolone 40-60 mg daily may be necessary 2, 3
- Cases that fail to respond to the standard 5-day course may require extended therapy 4, 5
- Evidence from case reports suggests that recurrent toxocariasis may require prolonged albendazole therapy of 3-8 weeks 6, 5, 7
Special Clinical Scenarios
Ocular Toxocariasis
- Requires longer treatment: albendazole 400 mg twice daily for 2 weeks combined with corticosteroids 2, 8
- Joint management with ophthalmology is essential 8
- May occur without systemic eosinophilia, making diagnosis challenging 2, 8
Neurotoxocariasis
- Requires extended treatment with albendazole for 3-4 weeks, often with corticosteroids 1, 2
- Presents with myelitis, encephalitis, or meningitis 1
Monitoring and Precautions
- Patients treated with albendazole for >14 days should be monitored for hepatotoxicity and leukopenia 1
- Corticosteroids must be used with caution if there is potential co-infection with Strongyloides due to risk of hyperinfection 2, 3
- Exclude strongyloidiasis prior to steroid use 1
Pitfalls to Avoid
- Insufficient treatment duration is a common cause of recurrence; a 7-day course may be inadequate for complete parasite elimination 6, 4, 5
- Failure to add corticosteroids in cases with significant inflammation can lead to worsening symptoms due to inflammatory reactions to dying parasites 2
- Overlooking potential ocular involvement, which requires longer treatment and specialized management 8, 9