Visceral larva migrans: examinations by means of enzyme-linked immunosorbent assay of human sera for antibodies to excretory-secretory antigens of the second-stage larvae of Toxocara canis

Serological diagnosis of soil-transmitted helminth (Ascaris, Trichuris and hookworm) infections: A scoping review

BACKGROUND

The World Health Organization emphasizes the importance of integrated monitoring and evaluation in neglected tropical disease (NTD) control programs. Serological assays offer a potential solution for integrated diagnosis of NTDs, particularly for those requiring mass drug administration (MDA) as primary control and elimination strategy. This scoping review aims (i) to provide an overview of assays using serum or plasma to detect infections with soil-transmitted helminths (STHs) in both humans and animals, (ii) to examine the methodologies used in this research field and (iii) to discuss advancements in serological diagnosis of STHs to guide prevention and control programs in veterinary and human medicine.

METHODOLOGY

We conducted a systematic search in the Ovid MEDLINE, Embase and Cochrane Library databases, supplemented by a Google search using predefined keywords to identify commercially available serological assays. Additionally, we performed a patent search through Espacenet.

PRINCIPAL FINDINGS

We identified 85 relevant literature records spanning over 50 years, with a notable increased interest in serological assay development in recent years. Most of the research efforts concentrated on diagnosing Ascaris infections in both humans and pigs, primarily using ELISA and western blot technologies. Almost all records targeted antibodies as analytes, employing proteins and peptides as analyte detection agents. Approximately 60% of sample sets described pertained to human samples. No commercially available tests for Trichuris or hookworms were identified, while for Ascaris, there are at least seven different ELISAs on the market.

CONCLUSIONS

While a substantial number of assays are employed in epidemiological research, the current state of serological diagnosis for guiding STH prevention and control programs is limited. Only two assays designed for pigs are used to inform efficient deworming practices in pig populations. Regarding human diagnosis, none of the existing assays has undergone extensive large-scale validation or integration into routine diagnostics for MDA programs.

Seroprevalence of human toxocarosis in Europe: A review and meta-analysis

Toxocarosis is distributed worldwide and represents the most prevalent zoonotic helminth infection in industrialized countries, thereby posing a substantial risk for public health. Thus, toxocarosis is one of CDC's Neglected Parasitic Infections that has been targeted for public health action. This systematic review and meta-analysis summarizes Toxocara seroprevalence in general populations from Europe, populations suspected of Toxocara infection and defined risk groups. Random-effects meta-analysis of proportions based on 41 publications resulted in an overall seroprevalence of 6.2% (95% CI: 4.7-8.3%) in the general population of Europe. Subgroup analysis according to decades (1970-2010s) revealed a significant increase in seroprevalence, with the highest value (12.4%; 95% CI: 6.5-22.3%) in the 2010s (χ²=17.87, df=4, P=0.001). There were no significant differences between pooled prevalence rates of European sub-regions (χ²=3.01, df=3, P=0.389). Furthermore, meta-analysis of seroprevalence according to age groups, based on data from 22 publications, indicated a significantly higher pooled seroprevalence of 14.9% (95% CI: 8.5-24.8%) in people more than 50 years of age than in younger age cohorts (χ²=8.33, df=2, P=0.016). Occupational groups exposed to contaminated soil and infected animals bear substantial risk for acquiring Toxocara infection. Due to the close link between animal infection and human Toxocara exposure, a "One Health" approach for the prevention of Toxocara infection in both humans and animals is required.

In vitro production of Toxocara canis excretory-secretory (TES) antigen

Toxocara canis is a widespread gastrointestinal nematode parasite of dogs and cause Toxocara larva migrans, an important zoonotic disease in humans on ingestion of infective eggs. Toxocarosis is one of the few human parasitic diseases whose serodiagnosis uses a standardized antigen, T. canis excretory secretory antigen (TES). The present study describes collection of T. canis adult worm, collection and embryonation of T. canis eggs, hatching and separation of T. canis larvae, in vitro maintenance of T. canis second stage larvae for production of TES, concentration of culture fluid TES and yield of TES in correlation with various methods cited in literature.

Toxocara canis: molecular basis of immune recognition and evasion

Toxocara canis has extraordinary abilities to survive for many years in the tissues of diverse vertebrate species, as well as to develop to maturity in the intestinal tract of its definitive canid host. Human disease is caused by larval stages invading musculature, brain and the eye, and immune mechanisms appear to be ineffective at eliminating the infection. Survival of T. canis larvae can be attributed to two molecular strategies evolved by the parasite. Firstly, it releases quantities of 'excretory-secretory' products which include lectins, mucins and enzymes that interact with and modulate host immunity. For example, one lectin (CTL-1) is very similar to mammalian lectins, required for tissue inflammation, suggesting that T. canis may interfere with leucocyte extravasation into infected sites. The second strategy is the elaboration of a specialised mucin-rich surface coat; this is loosely attached to the parasite epicuticle in a fashion that permits rapid escape when host antibodies and cells adhere, resulting in an inflammatory reaction around a newly vacated focus. The mucins have been characterised as bearing multiple glycan side-chains, consisting of a blood-group-like trisaccharide with one or two O-methylation modifications. Both the lectins and these trisaccharides are targeted by host antibodies, with anti-lectin antibodies showing particular diagnostic promise. Antibodies to the mono-methylated trisaccharide appear to be T. canis-specific, as this epitope is not found in the closely related Toxocara cati, but all other antigenic determinants are very similar between the two species. This distinction may be important in designing new and more accurate diagnostic tests. Further tools to control toxocariasis could also arise from understanding the molecular cues and steps involved in larval development. In vitro-cultivated larvae express high levels of four mRNAs that are translationally silenced, as the proteins they encode are not detectable in cultured larvae. However, these appear to be produced once the parasite has entered the mammalian host, as they are recognised by specific antibodies in infected patients. Elucidating the function of these genes, or analysing if micro-RNA translational silencing suppresses production of the proteins, may point towards new drug targets for tissue-phase parasites in humans.

Analysis of the course and treatment of toxocariasis in children-a long-term observation

Toxocariasis is a helminthozoonotic disease caused by ascarid larvae of Toxocara genus: Toxocara canis and Toxocara cati. In the reported study, the clinical course of toxocariasis and administered therapy were evaluated in 103 children. The majority of the children (68.9%) were from the rural environment, with a prevalence of boys (62.1%). At diagnosis of infection, 36 (35%) children reported recurrent abdominal pain, 19 (18.4%) headache, 6 (5.8%) loss of appetite, 2 subfebrile conditions, and 2 arthralgia, Moreover, 23 (22.3%) children demonstrated symptoms of atopic diseases; in 30 (29.1%) children, moderate enlargement of lymphatic nodes was noted. In five children (4.9%), ophthalmic examination revealed unilateral changes in the eye: in two cases retinitis; in one case fibrotic lesions in the vitreous body, complicated 1 year from diagnosis by retinal detachment; and in other children parafoveal lesions and cataract. Only two children with ocular changes at diagnosis reported visual disorders. In 64.3% of children, eosinophilia was observed. A covert form of the disease was diagnosed in 95.1% of the children and an ocular form in 4.9%. In all the children, antiparasitic treatment was implemented, repeated several times in some of them. After therapy, the mean titer of specific antibodies, the number of children with abdominal pains and enlarged lymphatic nodes were decreased, while headaches maintained at unchanged levels. In approximately one fourth of the children with negative results of antibodies after the therapy, the symptoms of the disease were still reported. Evaluation of the efficacy of treatment is not easy due to non-characteristic symptoms and low kinetics of specific anti Toxocara IgG decrease; however, high IgG titers suggest non-effective treatment of concomitant infection requiring subsequent therapy. Due to risk of ocular form, which may develop in any stage of the disease, irrespectively of specific antibodies concentrations, it seems justified to implement antiparasitic treatment in all children infected with T. canis.

Toxocara canis myelitis: clinical features, magnetic resonance imaging (MRI) findings, and treatment outcome in 17 patients

Toxocara myelitis is a rare disease. Few cases have been reported in the literature. Patients present with myelopathy, occasional eosinophilia in blood and cerebrospinal fluid (CSF), with abnormal signals on magnetic resonance imaging (MRI). In the current study we report 17 cases of isolated Toxocara myelitis from a single tertiary referral center in Lebanon, with description of the clinical presentation, laboratory data, MRI findings, and response to antihelminthic treatment. Clinical and laboratory data were collected for 17 patients who presented with evidence of spinal cord disease. The clinical presentation included sensory, motor, and autonomic dysfunction, predominantly in the lower extremities. Patients exhibited a subacute or chronic course; this was either slowly progressive or remitting-relapsing with mild to moderate disability. The patients underwent extensive blood and CSF workup as well as MRI of the spinal cord and brain. Only 2 patients had a high eosinophil count in the CSF, although blood eosinophilia was seen in 6 patients. All patients tested positive for Toxocara canis antibodies in the blood and CSF. MRI of the spinal cord revealed a single characteristic lesion in the spinal cord with fusiform enlargement that was isointense on T1-weighted images and hyperintense on T2-weighted images. Nodular enhancement was seen after gadolinium injection. Treatment with albendazole, with or without steroids, resulted in marked neurologic improvement and normalization of the MRI in all patients.The finding of a single inflammatory MRI lesion in the spinal cord with positive Toxocara canis serology in the blood and CSF in cases of subacute or chronic myelitis suggests the diagnosis of Toxocara myelitis, irrespective of the presence of eosinophilia. Antihelminthic treatment is associated with a good outcome.

Toxocara and Ascaris seropositivity among patients suspected of visceral and ocular larva migrans in the Netherlands: trends from 1998 to 2009

Toxocara canis, Toxocara cati and Ascaris suum are roundworms of dogs, cats and pigs, respectively, that can also infect humans. These zoonotic helminths have a worldwide distribution and are also endemic in the Netherlands. Infection with Toxocara sp. may result in visceral larva migrans (VLM) or ocular larva migrans (OLM) caused by the migrating larvae. Although A. suum has been reported to occasionally mature to the adult stage in humans, clinical cases of VLM suspected to be caused by A. suum have been described. Diagnosis of these helminth infections relies mainly on serology. Here we analyse the results from the Toxocara and Ascaris IgG-ELISA from a total of 2,838 serum samples from VLM and OLM suspected patients that were sent to our institution from 1998 to 2009. Results indicate that for each year the Ascaris seropositivity is significantly higher compared to the Toxocara seropositivity. Furthermore, while Toxocara seropositivity has decreased over time, the Ascaris seropositivity has not significantly changed for the past 12 years. The Ascaris and Toxocara seropositivity was also shown to increases with age and, while gender has no influence on the Ascaris seropositivity, males showed higher Toxocara seropositivity.

Characterization of a Toxocara canis species-specific excretory-secretory antigen (TcES-57) and development of a double sandwich ELISA for diagnosis of visceral larva migrans

This study describes the isolation of a Toxocara canis species-specific excretory-secretory (ES) antigen and the development of an enzyme-linked immunosorbent assay (ELISA) based on this antigen. Analysis of the ES antigens of T. canis, Toxocara vitulorum, Ascaris lumbricoides and Necator americanus larval antigen was performed by SDS-PAGE followed by western blotting. A 57 kDa T. canis-specific antibody fraction (TcES-57) was identified by western blotting and labelling with anti-Toxocara antibodies (from experimental rabbits and human patients) and tracing with anti-human or anti-rabbit peroxidase conjugate. No protein fraction of 57 kDa was detected in ES or larval antigens collected from T. canis, T. vitulorum, A. lumbricoides and N. americanus. Using TcES-57, a specific antiserum was produced in rabbits and a double sandwich ELISA was developed. This test was validated using known seropositive sera from toxocariasis patients, sera from A. lumbricoides or N. americanus patients, and 50 serum samples from cats. These tests revealed that TcES-57 antigen is specific to T. canis infection and does not cross react with sera of other related infections. Thus, ELISA based on TcES-57 antigen was proven to be an effective tool in the diagnosis of toxocariasis and studies on the role of T. canis in the epidemiology of human toxocariasis.

Seroprevalence of Toxocara canis in sheep in Wales

Antibody levels to Toxocara canis L2 excretory/secretory antigens were examined by ELISA in 400 serum samples from sheep in Powys and Gwent, Wales. A positive OD value was set at the mean +/-3S.D. of 45 control samples. Seroprevalence increased with age. Seven percent and 13% of 6-month-old sheep showed positive OD values as did 16% of 10-month-old, 27% and 31% of 15-month-old and 47% of cull ewes. Analysis of variance showed a significant increase in ELISA OD values among the seropositive sheep with increasing age of sheep.

Toxocara canis infection induces antigen-specific IL-10 and IFNγ production in pregnant dogs and their puppies

Toxocara canis (T. canis) is originally a parasite of canine bitches and their pups. The pathogenicity of T. canis infection is enhanced during pregnancy and puppyhood. The aim of this study was to investigate if modification of IFNgamma and IL-10 secretion occurs during infection in pregnant dogs and puppies. Analysis of cytokines secreted could let us hypothesize a role for IL-10 and/or IFNgamma in T. canis infection. We tested T. canis-specific production of IFNgamma and IL-10 by lymphocytes of pregnant dogs and their puppies after in vitro re-exposure to purified excretory/secretory antigen (ESAg) from T. canis. Blood mononuclear cells (BMC) isolated from pregnant dogs and their puppies were cultured in the presence of ESAg. Cultures' supernatants were tested for cytokine levels by ELISA. Results obtained showed that IL-10 concentrations increased during pregnancy in infected animals and in the meantime IFNgamma production decreased. In puppyhood, we observed that, IL-10 concentration decreased with the age of puppies mainly in infected animals while IFNgamma increased. In conclusion, our data suggests that BMC of infected dogs have a particular modification of IL-10 and IFNgamma synthesis. These data could be the basis to design immunotherapeutic approaches.

Immunological and hematological response in experimental Toxocara canis-infected pigs

The relationship between the immunological and hematological response to infection was studied in pigs inoculated experimentally with Toxocara canis. Two groups of four pigs were infected with doses of 1000 and 2000 infective eggs, respectively. Two uninfected animals were used as negative controls. Blood samples were collected from each pig once a week. Serological examination by ELISA to determine antibody levels against T. canis L2/L3 excretory-secretory (ES) antigens showed values higher than the positive cut-off point (1:32) for both the infected groups. These values increased from day 7 p.i. and remained high during the experimental period until day 56. Significant differences were recorded for the two inoculating doses (p</=0.01) from day 14 to 42 p.i. Western blots run on day 7 p.i. with serum from the 2000 eggs group showed two polypeptide bands of 70 and 55kDa. These same bands were observed for both infected groups from day 15 p.i. until the end of the experiment. Eosinophil counts were significantly higher (p</=0.05) for both inoculated groups between weeks 2 and 7 p.i. as compared with the control group. No significant changes were observed for other blood parameters. The pig is a useful animal model since T. canis induces an early immunological response and ELISA can detect the presence of these antibodies against T. canis L(2)/L(3) ES antigens in animals inoculated with low doses of Toxocara eggs.

Toxocarosis as zoonosis. A review of literature and the prevalence of Toxocara canis antibodies in 511 serum samples

A total of 511 serum samples from children aged between 6 months to 15 years old, with different clinical signs-living in the region of Northern Greece - were tested by ELISA (enzyme links immunosorbent assay) technique, for the detection of specific IgG and IgM antibodies against T. canis antigen. The reason IgM was detected was because IgM levels are elevated in the acute phase of toxocara infection, in spite of their notorious non-specificity. In this seroepidemiologic survey of children, a remarkably high percentage (12.5&#x0025;) reacted positively to this method. Sixteen (3.1&#x0025;) out of 511 sera showed IgG antibodies, 43 (8.4&#x0025;) showed IgM, while 5 (1&#x0025;) showed both IgG and IgM antibodies against T. canis E/S (excretory - secretory) antigen. Females were significantly more infected than males. Seropositivity rate was highest in children over the age of 10.

Incidence of patent Toxocara canis infection in bitches during the oestrous cycle

The incidence of patent Toxocara canis infection as result of reactivation of somatic larvae with subsequent tracheal migration was investigated by faecal examination during 23 oestrous cycles of 15 bitches. Blood samples were collected for determination of total and differential leukocyte counts, prolactin concentration, and Toxocara titre. Five pregnant dogs were used as controls. In the cyclic dogs there were no alterations in white blood cell counts or prolactin concentration, in contrast with the pregnant dogs, in which both variables increased, starting 10 days after onset of the luteal phase. The difference was significant at day 40 and day 60 (both p < 0.005). No significant differences were observed in the number of eosinophils or in the Toxocara antibody titre. T. canis eggs were only found in the faeces of three 1-year-old, cyclic dogs at 1, 60, and 140 days, respectively, after the onset of the luteal phase. It is concluded that cyclic beagle bitches, in which prolactin levels increase in the second half of the luteal phase, are unlikely to be at higher risk for patent T. canis infection than in other phases.

Aspects of Toxocara epidemiology: human toxocarosis

Toxocarosis is the clinical disease in man caused by infection of zoonotic roundworms of dogs and cats, Toxocara canis and T. cati. In this review the mode of transmission to the human by oral ingestion of Toxocara eggs from the environment is discussed. T. cati seems to play a more important role than generally suggested. Direct contact with animals is not considered a potential risk because embryonation of excreted Toxocara ova requires a minimum of 2 weeks. For the same reason there is no relationship expected between infection and exposure to dogs and cats in the household. Children more frequently have clinical symptoms because of the closer contact with contaminated soil in yards and sandpits, the lack of hygiene, and because of eating dirt. Toxocara larval migration in the body can cause various clinical syndromes. Visceral larva migrans, ocular larva migrans, and covert toxocarosis are described. Serodiagnostic techniques are reliable tools to detect antibodies or antigens. Systemic treatment with anthelmintics is described but can result in hypersensitivity reactions caused by dying larvae. For ocular lesions, laser photocoagulation and corticosteroid therapy are described. Preventive measures consist of preventing contamination of the environment with Toxocara eggs and for education of pet owners and non-pet owners to increase awareness about potential zoonotic hazards. Veterinary practitioners, general practitioners, and public health agencies should therefore provide sufficient information and advice.

Aetiology of uveitis in Sierra Leone, west Africa

BACKGROUND

In 1992, non-onchocercal uveitis caused 9% of blindness, 8% of visual impairment, and 11% of uniocular blindness among patients visiting an eye hospital in Sierra Leone, west Africa. The aim of this study was to determine the aetiology of uveitis in this population.

METHODS

General and ophthalmic examination complemented by serum and aqueous humour analyses for various infectious agents was performed for 93 uveitis patients and compared with serum (n = 100) and aqueous humour (n = 9) analysis of endemic controls.

RESULTS

At the initial examination, 45 patients (48%) proved to be severely visually handicapped. After clinical and laboratory analyses, an aetiological diagnosis was established for 49 patients (52%). Toxoplasma gondii was the most important cause of uveitis (40/93; 43%). Anti-toxoplasma IgM antibodies were detected in serum samples of seven of 93 patients (8%) compared with one of 100 controls (1%, p < 0.05). At least six patients (15%) with ocular toxoplasmosis had acquired the disease postnatally. Antibodies against Treponema pallidum were detected in 18 of 92 patients (20%) and in 21 controls (21%). Other causes of uveitis were varicella zoster virus (one patient), herpes simplex virus (two patients), and HLA-B27 positive acute anterior uveitis with ankylosing spondylitis (one patient), while one patient had presumed HTLV-I uveitis.

CONCLUSIONS

In a hospital population in Sierra Leone, west Africa, uveitis was associated with severe visual handicap and infectious diseases. Toxoplasmosis proved to be the most important cause of the uveitis. Although the distribution of congenital versus acquired toxoplasmosis in this population could not be determined, the results indicate an important role of postnatally acquired disease. The results further suggested minor roles for HIV, tuberculosis, toxocariasis, and sarcoidosis as causes of uveitis in this population.

Effect of various doses of infective Toxocara canis and Toxocara cati eggs on the humoral response and distribution of larvae in mice

The effect of 5-2,500 infective Toxocara canis and 5-1,000 T. cati eggs on the humoral immune response and on the distribution of larvae in the organism was studied in paratenic hosts--inbred C57BL6/J mice. With each dose of T. canis eggs the maximal antibody level was recorded on day 56 post infection and was followed by a moderate decline that lasted until day 154 of the experiment. A correlation between the antibody level and the egg count was observed only with the infective dose of 5-50 eggs. A more rapid occurrence of antibodies was recorded in mice infected with a high dose of eggs. In those given 5 and 7 T. cati eggs the antibody level exceeded the extinction threshold value only from day 21 to day 84. Low doses of T. canis (n = 5) and T. cati (n = 7) eggs caused a comparable distribution of larvae in mice, and the larval recoveries on day 70 post infection ranged between 10.00% and 25.74%. Following a dose of 500 T. cati eggs, 22.28% of the larvae were recovered, although only 1.08% were localized in the brain. A dose of 1,000 T. canis eggs yielded 36.37% of the larvae, with as much as 28.13% being found in the brain.

A seroepidemiological study of human Toxocara infection in the Slovak Republic

Sera of 908 blood donors, average age 35 years, living in towns and villages of the Slovak Republic were tested for Toxocara canis antibodies using an ELISA-IgG test. The seroprevalence in the healthy population was estimated at 13.65%. Antibodies were predominantly demonstrated in the sera from persons living in rural communities (17.09%) compared to the sera investigated from urban communities (11.82%). Women had a significantly higher seropositivity than men. The serological response in 2703 sera from patients suspected of toxocarosis was compared with their clinical manifestation, sex and age. Toxocara antibodies were found in 27.41% of suspected patients. Although the seroprevalence in adults was significantly higher among women than men, in children, boys had a higher seroprevalence than girls. The main clinical manifestations were leucocytosis and eosinophilia (46%), ocular disorders (36%), lung, liver and neurological disorders (26%). The most severe forms of this disease were observed in 2 to 5-year-old children with geophagy.

Epidemiology of Toxocara canis in red foxes (Vulpes vulpes) from urban areas of Bristol

A descriptive epidemiological survey was undertaken of the ascarid nematode Toxocara canis in 521 red foxes (Vulpes vulpes) during the period January 1986 to July 1990. Age-prevalence and age-intensity profiles show that worm burdens are significantly higher in cubs than in subadult or adult foxes and higher in subadult than in adult foxes. Seasonal variations in worm burdens occur, with the highest prevalences and intensities being found during the spring, when cubs are born, and in the summer months. Prevalences and intensities then decrease during the autumn and winter months in both subadult and adult foxes, but, during this period, prevalences are significantly higher in male than in female foxes. Variations in worm burdens in the fox population are likely to be related to the reproductive cycle of the fox, with a high proportion of cubs becoming infected in utero. The role of the fox in the transmission of T. canis in the urban environment is discussed.

Comparable seropositivity for ascariasis and toxocariasis in tropical slum children

The seropositivities for infection by Ascaris lumbricoides and Toxocara canis were determined in children (1-15 years old) of a slum area of Caracas, Venezuela, and the levels that indicate the presence of active infection were defined. In children aged from 1 to 3 years, approximately 10% were positive for either parasite, and this figure increased to about 30% in 4- to 6-year-olds. For toxocariasis, the percentage of positivity remained at this level up to the age of 15 years. Whilst the positivity in children 10-15 years of age was comparable for Ascaris and Toxocara, a peak of positivity (50%) was found for Ascaris at 7-9 years of age. These results indicate that for these urban slum children, infection by Toxocara is essentially as common as that by Ascaris and, thus, that toxocariasis represents a potential public health problem in the tropical environment that is largely overlooked.

Toxocara antibodies in patients with visceral or ocular disorder in Slovenia

The incidence of Toxocara antibodies was determined in 319 sera from patients suspected of having Toxocara infection. Serological responses were compared with clinical manifestations and age of the patients. A seropositive reaction was found in 24% of the patients. Highly positive results (OD 0.510-1.000 and OD > 1.000) by ELISA were obtained significantly more frequently in younger patients than in older ones (p < 0.005). The percentage of seropositive patients with visceral disorder was found to decrease with age, whereas the proportion of seropositive patients with ocular disorder increased with age. Serologically confirmed Toxocara infection in Slovenia alerted us to the fact that this health issue should be given due attention in the future.

Comparison of isolates and species of Toxocara and Toxascaris by biosynthetic labelling of somatic and ES proteins from infective larvae

Infective-stage larvae of three different isolates of Toxocara canis were intrinsically ([35S]methionine) labelled in culture, to determine the presence of similarities or differences in the somatic and ES antigens expressed between larvae derived from different hosts and different geographical regions. Two other closely related ascaridids, Toxascaris leonina which infects cats and dogs, and Toxocara vitulorum (Neoascaris vitulorum) which infects cattle, were also compared to T. canis larvae by this method. Overall comparisons were made by 1- and 2-dimensional electrophoresis, while immunological cross-reactivities between the different species were analysed by radio-immunoprecipitation. Our results show that extensive physicochemical characteristics are shared between T. canis isolates, both from different hosts and different geographical locations. A substantial overlap was revealed when T. canis and T. vitulorum antigens were compared, whereas Toxascaris was found to produce a distinct antigen profile: this result was independent of whether methionine- or Iodogen-labelled products were being considered. Antigen recognition by polyclonal antibodies raised to all three species and to the cat ascaridid Toxocara cati, revealed considerable cross-reactivities. The cross-reactions were especially prominent between the Toxocara species, a fact further substantiated when reactivity of T. canis ES-specific monoclonal antibodies were tested against T. leonina and T. vitulorum antigens. The ES antigens of T. leonina were not recognized by the T. canis monoclonals, whereas the majority of these antibodies precipitated antigens of T. vitulorum. One which did not react with T. vitulorum was monoclonal antibody Tcn 2, indicating its species-specific reactivity and therefore its potential for the specific diagnosis of human toxocariasis.

Immunodiagnosis of toxocarosis in humans: evaluation of a new enzyme-linked immunosorbent assay kit

Excretory/secretory (E/S) antigen derived from second-stage larvae of Toxocara canis maintained in defined medium in vitro has been well established worldwide for the immunodiagnosis of human toxocarosis by enzyme-linked immunosorbent assay. Such an enzyme-linked immunosorbent assay, based on the detection of human anti-T. canis (E/S antigen) serum immunoglobulin G, has recently been commercialized by Biokema-Affinity Products (Crissier-Lausanne, Switzerland). This commercial test kit was evaluated with regard to its application in a routine diagnostic laboratory and the reliability of the results. Of 78 patients with suspected clinical toxocarosis, 71 had anti-T. canis antibodies (positive serological result) corresponding to a diagnostic sensitivity of 91%; 14% of serum samples (n = 199) from patients with protozoan or with helminthic infections also showed positive reactions mainly related to infections with Trichinella, Strongyloides, and Fasciola species. An epidemiological study with 1,000 serum samples from randomly selected healthy blood donors and children in Switzerland demonstrated a seroprevalence of 2.7%. The test kit under evaluation had an overall diagnostic sensitivity of 91% and a relative specificity of 86%, the latter being related to some protozoan and helminthic infections. Because of the scarcity of such infections, potential cross-reactivity does not play a major role under the conditions found in the middle part of Europe. In conclusion, the application of the test kit provided for use in this study can be recommended for routine diagnostic use.

Application of the western blotting procedure for the immunodiagnosis of human toxocariasis

To improve the immunodiagnosis of human toxocaral disease, a sensitive and specific assay using the Western blotting procedure (WB) with excretory-secretory antigens from Toxocara canis larvae (TES) was developed and compared with the standard enzyme-linked immunosorbent assay method (TES-ELISA) using the same antigens. We tested groups of sera from laboratory animals or patients presenting with toxocariasis or other helminthic diseases and a group of sera from people dwelling in an area endemic for toxocariasis who exhibited hypereosinophilia. Statistically, the WB assay correlated well with TES-ELISA, but the former was more specific for banding patterns corresponding to low-molecular-weight fractions, thus avoiding problems of cross-reactivity with sera infected with other helminthic diseases.

Evaluation of chemotherapy in experimental toxocarosis by determination of specific immune complexes

Parasitism by the larval phase of Toxocara canis is a chronic process in which the larvae survive in the tissues, resulting in the constant stimulation of the immune system. As a result, the detection of specific antibodies may not reflect the active state of the parasite. We have studied the dynamics of the production of specific immune complexes by ELISA with the monoclonal antibody TC-1 in rabbits inoculated with single and multiple doses of T. canis eggs. We also compared this with the production of specific antibodies and their possible modification after treatment with mebendazole. The specific antibodies against excretory-secretory antigen were detected with peaks at 10 and 12 weeks depending on the dose and remained positive during the entire experiment (62 weeks). Treatment caused an increase in the level of detectable antibodies dropping to similar levels to the controls. Specific immune complexes were detected only in multiple doses, and were then positive during the entire experiment. From the beginning of treatment the values of immune complexes fell quickly, remaining at undetectable levels during the rest of the experiment. For this reason the detection of specific immune complexes is a valid technique for monitoring the efficiency of treatment.

Visceral larva migrans: a seroepidemiological survey in five municipalities of São Paulo state, Brazil

An enzyme-linked immunosorbent assay (ELISA), employing antigens from Toxocara canis larvae and the absortion of suspected sera with Ascaris lumbricoides extracts was used in a seroepidemiological study performed in five municipalities of São Paulo State, Brazil (São Paulo, Campinas, Santos, Marília and Presidente Prudente) in order to determine the frequency of antibodies to Toxocara. In 2,025 blood samples collected, 806 proceeded from male subjects and 1,219 from females; 483 samples were collected from subjects under 15 years of age and the remaining 1,542 from subjects aged 15 years or over. Among the 2,025 sera investigated, 3.60% had antibodies to Toxocara at significant levels. A moderate predominance of infection with Toxocara among male subjects (3.72%) was observed, although the difference was not statistically significant when this rate was compared with that for female (3.28%). Related to age, a higher frequency of positive results was detected among subjects under 15 years (6.41%) against the older group (2.53%). A trend of more elevated rates of infection was observed in municipalities with high demographic densities (São Paulo, Campinas and Santos). Nevertheless, such findings only appeared to be statistically significant in subjects younger than 15 years.

A serological survey of toxocariasis in patients and healthy donors in Barcelona (Spain)

The ELISA test, using excretory-secretory antigen from larvae II of Toxocara canis, was applied on 1018 sera (793 from adults and 225 from pediatrics) distributed in: A) patients with an hypereosinophilia where the ethiological agent was undetermined (99); B) patients with ocular complaints compatible with an ocular toxocariasis (116); C) patients with hidatidosis (97); D) patient with other non-toxocaral helminthiasis (34); E) patients with other clinical features (468) and F) healthy donors (204). Over 3,6% of sera showed elevated levels of antibodies reacting with T. canis antigen. The prevalence of seropositivity was statistically higher in patients with eosinophilia (14,1%) (a less than 0,001) and ocular complaints (6%) (0,025 greater than alpha greater than 0,01) than in the control group (1%). In the overall seropositivity from pediatrics did not differ from that of the adults.

An epidemiological and serological study of toxocara infection in Sweden

The serological prevalence of toxocara infection was determined in 323 sera from statistically selected healthy individuals from different geographical areas of Sweden. The serological response in 175 sera from patients suspected of having contracted toxocariasis was compared with their clinical manifestation and age. The sera were analysed by ELISA using excretory/secretory antigens. The serological prevalence in young adults was estimated to 7%, indicating that subclinical toxocariasis occurs in healthy Swedes. The prevalence figure is not contrasting with reports from other countries. Antibodies were predominantly demonstrated in sera from men living in a rural community compared to sera from the other areas investigated (p less than 0.01). 91% of the sera from patients were obtained from patients greater than 5 years old. The clinical manifestations were ocular disorder (46%), eosinophilia (32%), lung, liver, neurological disorders (14%). The disorders were equally distributed between the age groups. A seropositive reaction was noted in 25% of the patients and the various clinical manifestations and age groups were equally represented among the seropositives. However, the percentage of seropositive patients with ocular disorders increased with growing age, whereas the opposite was observed in patients with eosinophilia. The results indicate that clinically apparent toxocariasis exists in Sweden.

A critical look at the importance, prevalence and control of toxocariasis and the possibilities of immunological control

The visceral infection of humans with Toxocara canis is particularly prevalent in children and may cause a variety of symptoms that commonly persist for 6-24 months. The ocular infection usually causes permanent loss of visual acuity. Human infection is acquired by ingestion of embryonated T. canis eggs with contaminated dirt. Review of recent reports indicates that patent T. canis infection is widely prevalent in the general population of dogs all over the world (3-81%) and results in a substantial contamination of the ground (0.3-87%). The results of sensitive and specific serological tests suggest that about 7% of the clinically healthy human population of the United States, about 5% of that of Canada, and about 4% of that in Great Britain is infected with the parasite. Control of transmission of the parasite to man is often attempted by eliminating the infection in dogs, reducing the population of dogs and the environmental contamination with their feces, and educating the public about the zoonotic potential of toxocariasis. The evidence reviewed indicates that these methods are only marginally effective. Because T. canis relies on congenital and lactogenic transmission to persist in nature, only a procedure that effects the sustained killing of the reservoir larvae in the tissues of the bitch, or of newly-acquired parasites, is expected to be successful. Research with mice, rabbits and dogs demonstrated that prior infections of the host induce the development of protective immunity to reinfections. This procedure, however, leaves remnant populations of larvae from the immunizing infections that are resistant to anthelmintics and to the effect of prior irradiation. Hyperimmunization with partially-purified extracts of T. canis larvae induced 37% resistance to a challenge in mice when the extract was administered alone, and 76% resistance when administered with lipopolysaccharide adjuvant. Production of complete resistance, however, will probably require the prior control of the immunosuppression induced by the parasite. T. canis infections inhibit the production of homologous protective immunity and antibody responses to heterologous antigens, probably by interfering with the activity of helper T-cells, competing with protective antigens, and suppressing antibody synthesis. The evidence indicates, however, that an anti-T. canis vaccine to eliminate the parasite in dogs is feasible.

Specificity of Toxocara ELISA in tropical populations

The diagnosis of human infection by Toxocara canis relies heavily upon serological tests, the specificity of which can be inadequate in regions of endemic helminthiasis. When different population groups of tropical Venezuela were evaluated using ELISA based upon Toxocara excretory-secretory antigen (TcESA), solid-phase adsorption of the sera with extracts of a wide variety of non-homologous parasites revealed the existence of significant cross-reactivity. This was effectively and conveniently overcome when the test sera were incubated in the presence of the soluble parasite extracts in a competitive inhibition ELISA. The mean reduction of ELISA values caused by pre-adsorption of the sera tested was 32.2%, and that caused by competitive inhibition was 42.3%, the effects of these two procedures being strongly correlated (r = 0.83). The magnitude of the reduction was inversely proportional to the actual ELISA value (r = -0.55), and ranged from a mean of 68.0% in sera from apparently healthy individuals of medium-high socio-economic level, down to 28.1% in heavily parasitized Amazon indians. Ascaris showed the greatest degree of cross-reactivity in these tests, although under conditions of competitive inhibition even sera with high levels of antibody against this parasite could be negative in Toxocara ELISA. Western blotting revealed a major 81,400 D component that was shared between Ascaris and TcESA. Our results indicate that the competitive inhibition of cross-reactivity by soluble non-homologous parasite extracts provides a convenient and economical means of increasing the specificity of ELISA for the determination of the seroprevalence of toxocariasis in tropical populations.

Seroprevalence of Toxocara canis infection in tropical Venezuela

An enzyme-linked immunosorbent assay (ELISA) was used to determine the seroprevalence of Toxocara canis infection in different socio-economic groups of the tropical population of Venezuela. The lack of definitive independent diagnostic criteria for toxocariasis required the establishment of operational upper limits of normality for Toxocara ELISA values, based upon their log-normalized distribution in a presumptive "non-toxocariasis" sub-population. Only 1.8% of urban subjects of medium-high socio-economic level were considered to be clearly positive in Toxocara ELISA, compared to 20.0% of urban slum dwellers, 25.6% rural subsistence farmers and 34.9% Amazon Indians. As the test was performed using excretory-secretory antigen, and under conditions of competitive inhibition by soluble extracts of non-homologous parasites, co-infection by common intestinal helminths, protozoa or other organisms did not give rise to false positive results. However, strong cross-reactivity with Onchocerca volvulus may have influenced the prevalence figure obtained for the Amazon Indians. These results indicate that T. canis is yet another parasite that is widely distributed in economically underprivileged tropical populations.

Morphology of the alimentary tract of Trichinella spiralis muscle larvae with emphasis on the esophagus

This study was designed to provide a comprehensive description of the ultrastructure of the esophagus of Trichinella spiralis muscle larvae. Although the esophagus exhibited basically the same structure throughout its entire length, being composed of a single cell-layered epithelium, the basal lamina, and the cuticle, some morphological diversity was observed, depending on the level of sectioning. The upper esophagus, devoid of a muscular sheath, was equipped with myofilamentous cytoplasm and a thick cuticle. The middle and lower esophagus was surrounded by the muscular sheath on the basal side and thin cuticle on the luminal side. The cytoplasm usually contained glycogen, ribosomes, and mitochondria. The presence of an amorphous substance in the lumen of the esophagus is reported for the first time. It was completely homogeneous or finely granular and always devoid of any substructure.

Excretory-secretory products of helminth parasites: effects on host immune responses

Parasitic helminths excrete or secrete (ES) a variety of molecules into their mammalian hosts. The effects of these ES products on the host's immune responses are reviewed. Investigations into the source of antigenic or immunoregulatory ES products have identified the cuticular and tegumental surfaces of some nematodes and trematodes respectively as being important sources of ES products; other ES molecules are released through specialized excretory or secretory organs. It is proposed that the active shedding of surface antigens may serve as an important source of parasite antigens available to the immune system in a form in which they can be taken up and processed by antigen-presenting dendritic cells, macrophages and certain B cells for presentation to T helper cells. The ES products of nematodes, trematodes and cestodes contribute to immune evasion strategies of the parasites through mechanisms including shedding of surface-bound ligands and cells, alteration of lymphocyte, macrophage and granulocyte functions and modulation of complement and other host inflammatory responses. Immunopathology may be induced by ES products as in the development of granulomas around entrapped schistosome eggs. In some host-parasite systems ES antigens may induce host-protective immune responses and this source of protective antigens has been utilized in the successful vaccination against helminth infections, particularly against infection with trichurid nematodes and the metacestode stage of cestode parasites. The use of ES antigens in immunodiagnosis of helminth infection is also briefly discussed.

The morphology of Trichinella spiralis: ultrastructural study of the mid- and hindgut of the muscle larvae

The ultrastructure of the gut of Trichinella spiralis muscle larvae is comprehensively described, based on extensive observations. The mid-gut was composed of a single cell layer of epithelium over the basal lamina, the brush border, the septate junction, prominent glycogen aggregates, and other common cell organelles. The epithelial cells of the midgut were basically uniform, but the lumen presented a remarkably diversified appearance. In the ampullar portion, the midgut accommodated an amorphous substance of medium electron density, the middle portion was collapsed, and the terminal portion again dilated, but without any particular contents. The mid- and hindgut were devoid of muscle cells that could be responsible for the peristaltic movement of the gut.

Comparative study of assays detecting circulating immune complexes and specific antibodies in patients infected with Toxocara canis

A sandwich ELISA method using previously described E/S antigen-specific monoclonal antibodies has been developed to detect circulating immune complexes in patients infected with Toxocara canis. This technique could be used for the study of the dynamics of the parasite-host relationship, as we believe the detection of immune complexes and/or soluble antigen to be an improvement over detection of antibodies only. In this parasitosis, antibodies may be present in residual levels for prolonged periods after active infection.

Species-specific and common epitopes on the secreted and surface antigens of Toxocara cati and Toxocara canis infective larvae

It is widely accepted that the major cause of visceral larva migrans (VLM) in man is Toxocara canis infection. This has been largely based on the detection of antibodies to this species. We have compared the antigens of T. canis and Toxocara cati in order to establish whether assay for the former might be compromised by infection with the latter. Comparisons were made by radioiodination of the surface and excretory/secretory (ES) glycoproteins of the infective larvae of both species, immunoprecipitation with poly- and monoclonal reagents, and SDS-PAGE. The SDS-PAGE profiles of surface antigens of the two species showed few similarities, whereas that of the ES material indicated considerable homology. Serum from infected animals and a human VLM patient exhibited complete cross reactivity, although there was evidence in the mouse of a specific response to one of the components of T. cati ES. Testing of ES against a panel of monoclonal antibodies (MoAbs) confirmed the similarity; all but one of the MoAbs recognized several of the components of both sources of ES. The only exception was MoAb Tcn-2, which did not react with T. cati surface, somatic or ES antigens. This antibody is known to recognize a carbohydrate determinant which is widespread on T. canis glycoproteins. This species-specific determinant, therefore, represents a reversal of the consensus that peptide determinants tend to be the more specific. Finally, the MoAbs were used to examine the exposure of shared epitopes on the surface of intact larvae of T. cati. Again, fine differences in binding by anti-carbohydrate monoclonals were observed when the two species of Toxocara were compared, reflecting a distinction in exposure or orientation of surface molecules on these nematodes. Moreover, these epitopes were absent or variably present on the surface of freshly hatched larvae, and full exposure did not occur until about 24 h post-hatching. This delay in the presentation of epitopes might have implications for the process of infection in sensitized hosts. In conclusion, it is probable that the serological response in man to T. canis is, by current serological methods, indistinguishable in specificity from that induced by T. cati infection, and that the MoAb which we describe could be used to permit discrimination.

Improvements in the serodiagnosis of helminthic zoonoses

Remarkable progress has been achieved in developing improved serodiagnostic assays for a group of diseases for which other diagnostic methods are often lacking. Toxocariasis, trichinellosis, dirofilariasis, Taenia solium cysticercosis and the cystic and alveolar forms of hydatid disease are occult infections in humans and sometimes in lower animal hosts. Although Strongyloides stercoralis achieves patency in humans, parasitologic diagnosis is often very difficult. Efforts to develop reliable immunodiagnostic methods have spanned several decades but progress had been slow until recently. The complexity and nonspecificity of helminth antigens were major problems which prevented the full realization of the benefits of the highly sensitive assay systems now available. Modern immunologic methods including hybridoma technology, immunoaffinity chromatography and immunoblotting, however, have yielded improved reagents and the means to characterize their nature and function. The outcome of this research has been more sensitive and specific serologic tests based on measurement of both circulating antigens and antibodies as well as improved understanding of the nature of host-parasite interactions. Although much remains to be done, many improved immunodiagnostic procedures are already being applied in clinical diagnosis, epidemiologic studies and control programs directed against the helminthic zoonoses.

Zoonotic visceral and ocular larva migrans

Infection of children with the larval stage of the dog roundworm Toxocara canis usually produces few, if any, clinical signs. In some children, however, the disease may be severe, with permanent ocular or neurologic sequelae. Because the prevalence of infection may exceed 10 per cent in some population subgroups, it is important to understand the modes of transmission and risk factors for infection. The clinical presentations of toxocariasis as well as recommendations for their prevention are described.

Cryopreservation and long-term in vitro maintenance of second-stage larvae of Toxocara canis

Second stage larvae of Toxocara canis were isolated from developed eggs, frozen in Eagle's Minimal Essential Medium with 5% dimethyl sulfoxide or 10% glycerol as cryoprotectants according to two cooling schedules and maintained in liquid nitrogen for 1 week. After thawing, the previously frozen larvae (FL) and unfrozen controls (CL) were maintained in a chemically defined medium in vitro for 35 weeks. While CL had motility rates around 95% to 97% throughout the experiment, previously frozen larvae (FL) exhibited rates of 48%-58% at the beginning and of 19%-39% at the end of the 35 week in vitro maintenance period. The surviving FL and CL larvae proved to be infective for mice. Excretory/secretory (ES) antigens isolated from several batches of culture medium in which FL and CL had been maintained reacted in the ELISA with human sera containing antibodies against Toxocara. Antigens from FL and CL separated by SDS-PAGE and silver-stained showed some differences in polypeptide patterns. Western-blot analysis revealed that these differences were not related to antigenic polypeptides but were most likely caused by substances without antigenic properties originating from dead and/or degenerating larvae. It can be concluded that ES antigens produced by previously frozen larvae are essentially the same as those derived from unfrozen controls. The value of cryopreservation of T. canis larvae for routine production of ES antigens will be further evaluated.

Biosynthetic labelling of the excretory and secretory antigens of Toxocara canis larvae

Toxocara canis larvae were cultured in vitro in medium containing [35S-]methionine for six days. The medium and the larval tissues were analysed for biosynthetically labelled polypeptides by sodium dodecyl sulphate polyacrylamide gel electrophoresis and autoradiography. Immunoprecipitates with positive and negative human antiserum were similarly analysed, using Staphylococcus aureus to absorb immunocomplexes. The larvae secrete biosynthetically labelled polypeptides into the medium, with three major polypeptides of molecular weights between 99 and 110 X 10(3) the major constituents. Both of these react strongly with human IgG in human positive sera. Many polypeptides become labelled in the larval tissue, but only one polypeptide with similar molecular weight to the ES antigens, strongly reacted with human IgG.

Characterization of surface and excretory-secretory antigens of Toxocara canis infective larvae

The surface antigens of Toxocara canis infective larvae have been identified by radio-iodination and compared with the excretory-secretory (ES) products released by the larvae in vitro. Common antigens, of molecular weight 32 000 and 120 000 are found on the larval surface, in the ES material and in culture supernatant following surface iodination of living T. canis larvae. The 120 000 antigens consist of three closely migrating bands in each of these preparations. However, one prominent ES component, of molecular weight 400 000, is not found on the larval surface. Additional molecules of 55 000 and 70 000 are present in the ES material, but while these may be discerned in surface preparations there appears to be more heterogeneity of surface molecules in this size range. Both sets of molecules are antigens to infected patients and experimental animals. A comparison of characterized human sera show that a radio-immunoprecipitation assay correlates with the established ELISA test (r = 0.89), and that all labelled molecules are antigenic to the infected host.