What is the management and treatment of Toxocara canis infection?

Management and Treatment of Toxocara canis Infection

For visceral larva migrans (VLM), treat with albendazole 400 mg twice daily for 5 days; for ocular toxocariasis, use albendazole 400 mg twice daily for 2 weeks combined with corticosteroids and mandatory ophthalmology co-management; and for neurotoxocariasis, extend albendazole to 3-4 weeks with corticosteroids. 1, 2

Clinical Syndrome Recognition and Treatment Algorithm

Visceral Larva Migrans (VLM)

• Primary treatment: Albendazole 400 mg orally twice daily for 5 days 1, 2
• Alternative regimen: Mebendazole 100 mg twice daily for 3 days plus ivermectin 200 µg/kg once daily for 3 days during the prepatent period 1
• VLM typically presents in children under 5 years with fever, eosinophilia, dyspnea, wheeze, cough, abdominal pain, hepatosplenomegaly, and urticarial rash 1
• Add corticosteroids (prednisolone 40-60 mg once daily) only in severe disease with marked symptoms 1, 2
• Most infections are asymptomatic and may not require treatment 3, 4

Ocular Toxocariasis

• Mandatory joint management with ophthalmology is essential for optimal outcomes 1, 2, 5
• Treatment regimen: Albendazole 400 mg twice daily for 3 days (mild disease) to 14 days (severe disease) 1
• Corticosteroids are required: Use topical or systemic corticosteroids to control inflammation 1, 2, 5
• Presents with visual changes, retinal granuloma, or uveitis 1, 5
• Critical distinction: Eosinophilia is less common when ocular disease occurs as the only manifestation 1, 2, 5
• Formal ophthalmological examination is essential before initiating treatment 1
• Surgery may be required in some cases 1

Neurotoxocariasis

• Seek specialist advice immediately for all cases of CNS involvement 1
• Treatment: Albendazole for 3-4 weeks plus corticosteroids 1, 2
• Can present with myelitis, encephalitis, or meningitis 1
• Repeat anthelmintic therapy may be required if initial treatment fails 1

Critical Treatment Considerations

Corticosteroid Use - Important Caveat

• Screen for Strongyloides infection before initiating corticosteroids to prevent hyperinfection syndrome 1, 2, 5
• This is a potentially fatal complication that must be avoided 1

Pregnancy and Lactation

• Avoid albendazole during pregnancy, especially the first trimester due to potential embryo-fetal toxicity 1, 2
• If treatment is required during pregnancy, consider delaying until after the first trimester 1
• Albendazole has very low excretion into breastmilk and is likely compatible with breastfeeding 1

Special Populations

• Children under 5 years are at highest risk and require weight-based dosing adjustments 2
• Immunocompromised patients (HIV, transplant recipients) may require more aggressive treatment and monitoring 2

Transmission and Prevention Context

• Infection occurs through ingestion of soil containing embryonated Toxocara eggs from dog or cat feces, or through eating raw meat (particularly liver) 1
• Direct contact with pets is NOT a transmission route because eggs require 1-2 weeks to embryonate after excretion 6
• Worldwide distribution, including temperate areas 1

Common Pitfalls to Avoid

• Do not close infected wounds if treating bite wounds with potential Toxocara exposure 1
• Do not assume eosinophilia will be present in isolated ocular toxocariasis 1, 2, 5
• Do not use corticosteroids without ruling out Strongyloides co-infection first 1, 2, 5
• Do not treat ocular disease without ophthalmology involvement as specialized management is required 1, 2, 5