544 TRANSACTIONS
OF THE ROYAL
SOCIETY
OF TROPICAL
Toxocariasis
MEDICINE
Little is known about the incidence of toxocariasis in Africa. WISEMAN & WOODRUFF (1971) surveyed some parts of East and West Africa for the prevalence of the infection amongst dogs and humans. They indicated that it represents a public health problem in those areas. RIFAAT et al. (1969) pointed out the high incidence of Toxocara canis infection among dogs in Cairo. To our knowledge human toxocariasis has not hitherto been reported in the Sudan and we now report a case in a Sudanese boy. and investigation
A seven-year-old boy weighing 20 kg from the Gezira area presented with fever and abdominal distension of one month’s duration. On examination the positive findings were: a temperature of 100”F, an enlarged liver 13 cm below the costal margin and a palpable spleen 5 cm below the costal margin. There was no clinical evi-
240(
FIG
1 ABSOLUTE COUNTS
EOSINOPHIL PER CU.MM.
HYGIENE, VOL. 71, No. 6, 1977.
in a Sudanese
A. A. DAFFALLA Departments of Biochemistry Faculty of Medicine,
Case history
AND
boy
AND M. I. ALI OMER and Paediatrics and Child Health, P.O. Box, 102, Khartoum
dence of liver failure or cirrhosis. He was admitted for investigation of hepatosplenomegaly and the following results were obtained: normal liver function tests and chest X-ray; no evidence of malaria or salmonellosis; Schistosoma mansoni ova were found in the faeces; haemoglobin 12.5 g% with an ESR of 78 mmihr; total white cell count 30,000 uer mm3. of which 24.000 were eosinophils. As the’eosinophil count was too high to be accounted for by schistosomiasis alone, boric marrow and liver were examined by biopsy. The bone marrow showed a picture of hypercellularity with predominant eosinophilic erythropoesis. Liver biopsy showed excessive eosinophilic granulomata but no ova. In view of these findings, the toxocaral skin test (using Burroughs Wellcome skin testing antigen) and fluorescent antibody test were performed and both were positive. Management
One dose of hycanthone, 60 mg l.M was given on the 27 September 1975. Three weeks later the high eosinophilia persisted (Fig. 1). It was then decided to give diethylcarbamazine 9 mg per kg body-weight for three weeks. The patient was discharged afterwards and followed up in the out-patient department for four months. During this period a progressive decline of the eosinophil count and regression of the hepatosplenomegaly was observed and there was marked improvement in the patient’s general condition. Discussion
Human toxocariasis can be symptomless with spontaneous cure, but it can also give rise to serious complications such as chronic endophthalmitis (WILDER, 1950; DUGLJID, 1961) and encephalitis with convulsions (BRAIN & ALLAN, 1964). The diagnosis is usually suspected on clinical grounds or in association with a raised eosinophil count. The case we are reporting presented with hepatosplenomegaly with fever and high eosinophilia. S. mansoni infection was found and treated but the eosinophila persisted and the patient remained generally unwell. Tests for toxocariasis were performed and found positive. The patient was accordingly treated with diethylcarbamazine to which he showed a dramatic response. In the tropics where other helminth infections with similar features are common, human toxocariasis can easily be overlooked. This report demonstrates the incidence of double infection and indicates the need for further study of the prevalence of human toxocariasis in the. Sudan. Acknowledgement
The authors are very grateful to Professor A. W. Woodruff for doing the fluorescent antibody test.
A. A. DAFFALLA
References Brain, L. & Allan, B. (1964). Encephalitis due to infection with Toxocaru canis. Report of a suspected case. Lancet, i, 1355-1357. Duguide, I. M. (1961). Features of ocular infestation by Toxocara.
British
Journal
of Ophthalmology,
45, 789-
796. Rifaat, M. A., Khalil, H. M. & Khalid, M. L. M. (1969). Incidence of Toxocara canis infection among stray dogs in Cairo. Ain Shams Medical Journal, 20, 345-346. Wilder, H. C. (1950). Nematode endophthalmitis.
AND
M. I. ALI
545
OMER
Transactions of the American Academy mology and Oto-laryngology, 55, 99-103.
Wiseman, in East in host humans
Ophthal-
R. A. & Woodruff, A. W. (1971). Toxocariasis Africa and Malta. The frequency of infection animals and its incidence and distribution in as revealed by skin sensitivity tests. Trans-
actions of the Royal Society Hygiene, 65, 439-449.
Accepted
of
for publication
of Tropical
3rd July 1977.
Medicine
and
OF THE ROYAL
SOCIETY
OF TROPICAL
Toxocariasis
MEDICINE
Little is known about the incidence of toxocariasis in Africa. WISEMAN & WOODRUFF (1971) surveyed some parts of East and West Africa for the prevalence of the infection amongst dogs and humans. They indicated that it represents a public health problem in those areas. RIFAAT et al. (1969) pointed out the high incidence of Toxocara canis infection among dogs in Cairo. To our knowledge human toxocariasis has not hitherto been reported in the Sudan and we now report a case in a Sudanese boy. and investigation
A seven-year-old boy weighing 20 kg from the Gezira area presented with fever and abdominal distension of one month’s duration. On examination the positive findings were: a temperature of 100”F, an enlarged liver 13 cm below the costal margin and a palpable spleen 5 cm below the costal margin. There was no clinical evi-
240(
FIG
1 ABSOLUTE COUNTS
EOSINOPHIL PER CU.MM.
HYGIENE, VOL. 71, No. 6, 1977.
in a Sudanese
A. A. DAFFALLA Departments of Biochemistry Faculty of Medicine,
Case history
AND
boy
AND M. I. ALI OMER and Paediatrics and Child Health, P.O. Box, 102, Khartoum
dence of liver failure or cirrhosis. He was admitted for investigation of hepatosplenomegaly and the following results were obtained: normal liver function tests and chest X-ray; no evidence of malaria or salmonellosis; Schistosoma mansoni ova were found in the faeces; haemoglobin 12.5 g% with an ESR of 78 mmihr; total white cell count 30,000 uer mm3. of which 24.000 were eosinophils. As the’eosinophil count was too high to be accounted for by schistosomiasis alone, boric marrow and liver were examined by biopsy. The bone marrow showed a picture of hypercellularity with predominant eosinophilic erythropoesis. Liver biopsy showed excessive eosinophilic granulomata but no ova. In view of these findings, the toxocaral skin test (using Burroughs Wellcome skin testing antigen) and fluorescent antibody test were performed and both were positive. Management
One dose of hycanthone, 60 mg l.M was given on the 27 September 1975. Three weeks later the high eosinophilia persisted (Fig. 1). It was then decided to give diethylcarbamazine 9 mg per kg body-weight for three weeks. The patient was discharged afterwards and followed up in the out-patient department for four months. During this period a progressive decline of the eosinophil count and regression of the hepatosplenomegaly was observed and there was marked improvement in the patient’s general condition. Discussion
Human toxocariasis can be symptomless with spontaneous cure, but it can also give rise to serious complications such as chronic endophthalmitis (WILDER, 1950; DUGLJID, 1961) and encephalitis with convulsions (BRAIN & ALLAN, 1964). The diagnosis is usually suspected on clinical grounds or in association with a raised eosinophil count. The case we are reporting presented with hepatosplenomegaly with fever and high eosinophilia. S. mansoni infection was found and treated but the eosinophila persisted and the patient remained generally unwell. Tests for toxocariasis were performed and found positive. The patient was accordingly treated with diethylcarbamazine to which he showed a dramatic response. In the tropics where other helminth infections with similar features are common, human toxocariasis can easily be overlooked. This report demonstrates the incidence of double infection and indicates the need for further study of the prevalence of human toxocariasis in the. Sudan. Acknowledgement
The authors are very grateful to Professor A. W. Woodruff for doing the fluorescent antibody test.
A. A. DAFFALLA
References Brain, L. & Allan, B. (1964). Encephalitis due to infection with Toxocaru canis. Report of a suspected case. Lancet, i, 1355-1357. Duguide, I. M. (1961). Features of ocular infestation by Toxocara.
British
Journal
of Ophthalmology,
45, 789-
796. Rifaat, M. A., Khalil, H. M. & Khalid, M. L. M. (1969). Incidence of Toxocara canis infection among stray dogs in Cairo. Ain Shams Medical Journal, 20, 345-346. Wilder, H. C. (1950). Nematode endophthalmitis.
AND
M. I. ALI
545
OMER
Transactions of the American Academy mology and Oto-laryngology, 55, 99-103.
Wiseman, in East in host humans
Ophthal-
R. A. & Woodruff, A. W. (1971). Toxocariasis Africa and Malta. The frequency of infection animals and its incidence and distribution in as revealed by skin sensitivity tests. Trans-
actions of the Royal Society Hygiene, 65, 439-449.
Accepted
of
for publication
of Tropical
3rd July 1977.
Medicine
and
