Human toxocariasis and the visceral larva migrans syndrome: correlative immunopathology

Effects of metformin on parasitological, pathological changes in the brain and liver and immunological aspects during visceral toxocariasis in mice

There are currently insufficient anthelmintic medications available for the treatment of toxocariasis. For instance, Albendazole (ABZ) is the preferred medication, but its effectiveness against tissue-dwelling parasites is limited. In addition, Metformin (MTF) is a widely used oral antidiabetic medication that is considered to be safe for treatment. This study aimed to investigate any potential effects of MTF, alone or in combination with ABZ, on mice infections caused by Toxocara canis (T. canis). The efficacy of the treatment was assessed in the acute and chronic phases of the infection by larval recovery and histopathological, immunohistochemical, and biochemical studies. The results showed that combined therapy significantly reduced larval counts in the liver, brain, and muscles and ameliorated hepatic and brain pathology. It reduced oxidative stress and TGF-β mRNA expression and increased FGF21 levels in the liver. It decreased TNF-α levels and MMP-9 expression in the brain. In addition, it increased serum levels of IL-12 and IFN-γ and decreased serum levels of IL-4 and IL-10. In the acute and chronic phases of the infection, the combined treatment was more effective than ABZ alone. In conclusion, this study highlights the potential role of MTF as an adjuvant in the treatment of experimental T. canis infection when administered with ABZ.

Matrix metalloproteinases activation in Toxocara canis induced pulmonary pathogenesis

BACKGROUND

Toxocara canis, a source of visceral larva migrans, causes toxocariasis and induces respiratory symptoms. The reasons by which the pulmonary pathological alteration in the lungs infected with T. canis remain unclear.

METHODS

The involvement of the pulmonary pathological alteration by histology, enzyme activity, and Western blot analysis in the lungs of BALB/c mice after the infection of 2000 embryonated eggs.

RESULTS

The pathological effects gradually increased after the infection culminated in severe leukocyte infiltration and hemorrhage from days 4-14 post-inoculation. Gelatin zymography using substrate showed that the relative activity of matrix metalloproteinase (MMP) -9 and MMP-2 significantly increased in T. canis-infected mice. Western blot analysis indicated that the MMPs protein level of fibronectin monomer significantly increased in T. canis-infected mice compared with that in uninfected control. T. canis larvae mainly initiated leukocyte infiltration and hemorrhage in the lungs.

CONCLUSION

These phenomena subsequently induced the activities of MMPs in parallel with the pathological changes in early stage pulmonary inflammation. In conclusion, T. canis larval migration activated the MMPs and caused pulmonary pathogenesis.

Mesenchymal stem cells combined with albendazole as a novel therapeutic approach for experimental neurotoxocariasis

Neurotoxocariasis (NT) is a serious condition that has been linked to reduced cognitive function, behavioural alterations and neurodegenerative diseases. Unfortunately, the available drugs to treat toxocariasis are limited with unsatisfactory results, because of the initiation of treatment at late chronic stages after the occurrence of tissue damage and scars. Therefore, searching for a new therapy for this important disease is an urgent necessity. In this context, cytotherapy is a novel therapeutic approach for the treatment of many diseases and tissue damages through the introduction of new cells into the damaged sites. They exert therapeutic effects by their capability of renewal, differentiation into specialized cells, and being powerful immunomodulators. The most popular cell type utilized in cytotherapy is the mesenchymal stem cells (MSCs) type. In the current study, the efficacy of MSCs alone or combined with albendazole was evaluated against chronic brain insults induced by Toxocara canis infection in an experimental mouse model. Interestingly, MSCs combined with albendazole demonstrated a healing effect on brain inflammation, gliosis, apoptosis and significantly reduced brain damage biomarkers (S100B and GFAP) and T. canis DNA. Thus, MSCs would be protective against the development of subsequent neurodegenerative diseases with chronic NT.

Assessment of the diagnostic value of specific anti-Toxocara IgA in Slovakian patients suspected to have toxocarosis

Human toxocarosis is one of the most widespread and prevalent helminthic zoonosis in many countries, including Slovakia. The aim was to evaluate the usefulness of IgA anti-Toxocara antibody detection in the serodiagnosis of toxocarosis. The levels of specific IgA antibodies were determined by excretory-secretory (ES)-enzyme-linked immunosorbent assay (ELISA). The IgA seropositivity in IgG anti-Toxocara seropositive patients (n = 52) was 32.7% and found to be highest in the oldest age groups (P = 0.026). The presence of IgA in suspected patients for toxocarosis were evaluated in respect to some characteristics of examined persons. Substantially higher IgA seropositivity was detected in patients with increased total IgE (44.8%) than in subjects with a normal level of IgE (17.4%; P = 0.036). No associations (P > 0.05) were found between IgA seropositivity and sex, level of specific IgG antibodies, avidity of IgG, eosinophilia, domicile, geophagia, traveling abroad, dog/cat ownership, or clinical symptoms. The IgA-ELISA showed sensitivity of 57.1% and specificity of 100%. Mild correlations (r = 0.302, r = 0.305, r = - 0.409) were observed between the levels of anti-Toxocara IgA antibodies and age, the amounts of eosinophils and IgA antibody levels, the amounts of eosinophils, and the values of IgG avidity, respectively. The presence of anti-Toxocara IgA may facilitate the diagnosis of toxocarosis and may well be useful for the determination of acute Toxocara infection. Moreover, this test should be accompanied by other immunological markers of examined patients (e.g., increased total IgE, eosinophilia, and low-avidity IgG antibodies).

Treatment-resistant neuromyelitis optica spectrum disorders associated with Toxocara canis infection: A case report

A 53-year-old woman was admitted to the department of neurology in Tenri Hospital because of progressive thoracic myelitis a month after she had eaten uncooked bovine liver. A previous episode of right optic neuritis and a positive test for serum anti-aquaporin-4 antibodies indicated a diagnosis of neuromyelitis optica spectrum disorders. Although the patient initially recovered with the reduction of anti-aquaporin-4 antibodies during treatment with intravenous methylprednisolone infusion and plasma exchange, her neurological symptoms deteriorated soon after the completion of plasma exchange. Western blotting analysis detected anti-Toxocara canis antibodies in the serum; thus, the patient underwent oral albendazole treatment. This resulted in the alleviation of her symptoms. We therefore consider that rigorous investigation should be encouraged to detect rare pathogens including parasites in cases of treatment-resistant neuromyelitis optica spectrum disorders.

Cerebral Toxocariasis: Silent Progression to Neurodegenerative Disorders?

Toxocara canis and T. cati are highly prevalent nematode infections of the intestines of dogs and cats. In paratenic hosts, larvae do not mature in the intestine but instead migrate through the somatic tissues and organs of the body. The presence of these migrating larvae can contribute to pathology. Toxocara larvae can invade the brains of humans, and while case descriptions of cerebral toxocariasis are historically rare, improved diagnosis and greater awareness have contributed to increased detection. Despite this, cerebral or neurological toxocariasis (NT) remains a poorly understood phenomenon. Furthermore, our understanding of cognitive deficits due to toxocariasis in human populations remains particularly deficient. Recent data describe an enhanced expression of biomarkers associated with brain injury, such as GFAP, AβPP, transforming growth factor β1 (TGF-β1), NF-L, S100B, tTG, and p-tau, in mice receiving even low doses of Toxocara ova. Finally, this review outlines a hypothesis to explore the relationship between the presence of T. canis larvae in the brain and the progression of Alzheimer's disease (AD) due to enhanced AD-associated neurodegenerative biomarker expression.

Larval migration of the ascarid nematode Toxocara canis following infection and re-infection in the gerbil Meriones unguiculatus

A morphological and immunohistochemical study of larval migration patterns was performed in gerbils that were infected once (primary infected group) or twice (secondary infected group) with 1500 eggs of Toxocara canis. Animals from the primary infected and the re-infected group were killed at different times after infection, and larvae were counted in the intestines, liver, lungs and brain. Fragments of all organs were formalin fixed and paraffin embedded for histology and immunohistochemistry analyses (using polyclonal anti-Toxocara serum raised in rabbits infected with T. canis). In the primary infected group, larvae were more abundant in the intestine at 24 h, in the liver and lungs between 24 and 72 h and in the brain after 96 h; larvae predominated in the brain for up to 60 days after infection. In the re-infected group, an increase in the number of larvae in the liver and a reduction in the number of larvae in the brain was observed up to 60 days after re-infection. Inflammatory reactions were absent or limited. Eosinophils and loose granulomata were observed around the larvae and their antigens in the primary infected group and were more severe. Many eosinophils and typical epithelioid granulomata were observed around larvae in the re-infected group. These results demonstrate that the migration pattern of T. canis larvae in gerbils is similar to that in mice and rats, exhibiting a late neurotropic stage. In the re-infected group, there was histological evidence of an adaptive T-helper 2 (Th-2) response, and larvae were apparently retained within granulomata in the liver, without obvious signs of destruction.

Molecular mechanism of serine/threonine protein phosphatase 1 (PP1cα-PP1r7) in spermatogenesis of Toxocara canis

Toxocariasis is one of the most important, but neglected, zoonoses, which is mainly caused by Toxocara canis. To better understand the role of serine/threonine protein phosphatase 1 (PP1) in reproductive processes of male adult T. canis, differential expression analysis was used to reveal the profiles of PP1 catalytic subunit α (PP1cα) gene Tc-stp-1 and PP1 regulatory subunit 7 (PP1r7) gene TcM-1309. Indirect fluorescence immunocytochemistry was carried out to determine the subcellular distribution of PP1cα. Double-stranded RNA interference (RNAi) assays were employed to illustrate the function and mechanism of PP1cα in male adult reproduction. Real-time quantitative PCR (qPCR) showed transcriptional consistency of Tc-stp-1 and TcM-1309 in sperm-producing germline tissues and localization research showed cytoplasmic distribution of PP1cα in sf9 cells, which indicated relevant involvements of PP1cα and PP1r7 in spermatogenesis. Moreover, spatiotemporal transcriptional differences of Tc-stp-1 were determined by gene knockdown analysis, which revealed abnormal morphologies and blocked meiotic divisions of spermatocytes by phenotypic aberration scanning, thereby highlighting the crucial involvement of PP1cα in spermatogenesis. These results revealed a PP1cα-PP1r7 mechanism by which PP1 regulates kinetochore-microtubule interactions in spermatogenesis and provided important clues to identify novel drug or vaccine targets for toxocariasis control.

An alternative method for producing Toxocara canis second stage larvae from a paratenic host (pigeon) for mRNA extraction purpose

Toxocara canis is a prevalent zoonotic parasite which can cause serious disease in puppies and humans. Excretory-secretory and coating antigens of the second stage larvae (L2) are the best targets for performing immunodiagnostic and also immunoprophylactic tests. Various hatching methods have been described to bring out L2 from the resistant infective egg shell; but these methods are difficult to do and have had different results when performed by different practitioners. In this study, second stage larvae were obtained from the viscera of pigeons (a paratenic host) which were infected with infective eggs. Infective Toxocara canis eggs were given to ten pigeons and live larvae were recovered from their excised livers and lungs by using the Baermann's apparatus in the next days. Two in vitro methods for larvae hatching were also performed including a so-called physiological hatching method according to Ponce-Macotela et al. (J Parasitol 175:382-385, 2010), and a mechanical hatching method according to Alcântara-Neves and Santos (J Exp Parasitol 119:349-351, 2008) and their results were compared with the in-vivo method. Results show that averagely 36.2 % of fed larvae recovered from livers and 0.15 % from lungs. Average larvae recovery in the first day after infection (24.2 %) was significantly lower than subsequent days (39 %). Maximum larvae recovered in day 3 (55 %). In-vitro methods we carried out did not have acceptable results and only a few larvae did hatch using these methods.

Eosinophilic pneumonias

This review starts with discussions of several infectious causes of eosinophilic pneumonia, which are almost exclusively parasitic in nature. Pulmonary infections due specifically to Ascaris, hookworms, Strongyloides, Paragonimus, filariasis, and Toxocara are considered in detail. The discussion then moves to noninfectious causes of eosinophilic pulmonary infiltration, including allergic sensitization to Aspergillus, acute and chronic eosinophilic pneumonias, Churg-Strauss syndrome, hypereosinophilic syndromes, and pulmonary eosinophilia due to exposure to specific medications or toxins.

Therapeutic battle against larval toxocariasis: are we still far behind?

Toxocariasis is a widespread zoonotic helminthic disease. Human infection is acquired by ingestion of embryonated eggs of Toxocara which reach the environment via stools of dogs and cats. In paratenic hosts, such as humans and mice, the hatched larvae migrate systematically in the body and could reach critical sites such as the eye and the central nervous system. The clinical expression of toxocariasis includes two main forms of varying intensity: visceral and ocular, as well as several organ-specific clinical manifestations. The issue of treatment is a matter of great controversy not only because of limited efficacy of anthelmintic drugs in terms of parasite eradication, but also because of doubts about the benefits of therapy as most Toxocara infections are self-limiting. Many animal studies were conducted employing different drugs and regimens, yet the results were variable and inconsistent. On the other hand, experience in human therapy is unfortunately limited due to paucity of clinical trials. Herein, the problems and pitfalls of treatment of toxocariasis are addressed, and new trends in therapy are discussed.

Parasitic liver disease in travelers

Liver disease is an important source of morbidity among ill returning travelers. Jaundice is one of the most common and obvious symptoms of liver disease, the differential diagnosis of which is extensive, especially in travelers. Jaundice in travelers can arise from both infectious and noninfectious causes. We herein summarize the most common parasitic etiologies that may lead to jaundice in the returned traveler, visitors of friends and relatives, or new immigrants, and describe the etiology, epidemiology, and pathogenesis of clinical features of each.

Visceral larva migrans associated with earthworm and gecko ingestion: a case report

Introduction

Visceral larva migrans is a syndrome caused by an infection with larval helminths, which may result in partial or general pathological changes in host tissues. Due to the difficulty in finding the causative parasites, the diagnosis of visceral larva migrans is generally based on compatible clinical signs, epidemic history, marked eosinophilia and pathological examination, especially positive serological test results and the disappearance of symptoms after specific treatment.

Case presentation

We report here the case of a 21-year-old Chinese man who, having ingested living earthworms and geckos at a witch’s suggestion, presented with fatigue and wordlessness lasting for one year along with elevated transaminase levels for one month. Clinical examination showed eosinophilia, elevated transaminase levels, nodular lesions in his liver and typical pathological characteristics of hepatic visceral larva migrans. After four courses of anthelmintic therapy, our patient presented with sustaining improvement of clinical manifestations and normalization of laboratory data.

Conclusions

Because of the difficulty in making a definite diagnosis, anthelmintic therapy should be performed in patients with a suspected diagnosis of visceral larva migrans based on their epidemic history and presence of typical manifestations, especially when the serological test results are negative. Furthermore, patients with severe parasite infection may require multiple anthelmintic therapies in order to eliminate the parasites.

Association between contamination of public squares and seropositivity for Toxocara spp. in children

A concomitant study was carried out, of the association of positive serology for Toxocara spp. in 90 children who played in public squares used for leisure, with the frequency with which each child used these areas, and the presence of eggs of Toxocara spp. in the sand or grass in these locations. The sand and grass of their peridomiciles and school playgrounds, as well as the feces of their dogs were also analyzed for Toxocara. Serum samples were tested for IgG antibodies to Toxocara canis excreted-secreted larval antigens by ELISA, and blood samples for eosinophilia. The water-sedimentation technique was used to evaluate the presence of parasite eggs in the sand and grass turfs, and in feces of the dogs that also frequented these locations. 16/90 (17.8%) of the children were seropositive for Toxocara spp. There was a positive association between seropositivity in children who played in the public squares six or seven times a week, with a parasite load above 1.1 eggs/g of sand, as well as with contamination of the peridomicile, even at less than 1.0 egg/g of sand. Eosinophilia, the habit of geophagy, age from one to four years, and the presence of parasitized pet dogs were also positively correlated with seropositivity in the children. Eggs were found in 15/15 (100%) of the public squares, 17/90 (18.9%) of the peridomiciles, 3/13 (23.1%) of the schools, and 12/41 (29.3%) of the dogs living in the peridomiciles investigated.

Evaluation of the immunosuppressive effect of cyclophosphamide and dexamethasone in mice with visceral toxocariasis

Visceral toxocariasis is a serious public health problem with a cosmopolitan distribution. Children are susceptible due to their immature immune system and high risks of infection. Nevertheless, the few completed studies about immunosuppression have had controversial results. To evaluate the effect of two immunosuppressive drugs on the larval burden of Toxocara canis, four groups of ten Swiss strain mice each were inoculated on day 0 with 1,200 embryonated T. canis eggs. Fifteen days before the experimental infection, group 1 (control) was treated via intraperitoneal injection (IP) with sterile distilled water and groups 2 and 3 were treated with dexamethasone (DEX) at 1 and 5 mg/kg/day, respectively. Additionally, group 4 was treated IP with cyclophosphamide (CY) at 50 mg/kg at two times per week for 2 weeks. Sixty days following infection, the mice were euthanised to recover the larvae by means of the tissue digestion technique. The levels of antibodies detected by indirect ELISA were not associated with the larval burden. Administration of CY (50 mg/kg) and DEX (5 mg/kg) resulted in an increase of the larval burden of 162.1% and 50.8%, respectively, in relation to the control group. These two treatments, especially CY (50 mg/kg), promoted immunosuppression and the establishment of a significant larval burden, supporting its further utilisation in studies related to immunosuppression in visceral toxocariasis.

Kinetics of Foxp3-expressing regulatory cells in experimental Toxocara canis infection

Foxp3-expressing cells have recently been recognized as a cornerstone for the homeostasis of the immune system, and as key cells in many infectious diseases. Moreover, they have been found to contribute to the regulation of parasite-induced immunopathology in many parasitic infections. However, their role in Toxocara-induced immunopathology has not yet been investigated. The aim of this study is to assess the kinetics of Foxp3-expressing regulatory cells during the course of experimental infection by Toxocara canis (T. canis). Foxp3+ cells were identified in the liver by immunohistochemistry, and splenic Foxp3 gene expression was evaluated. We found significantly progressive increase in Foxp3-expressing cell counts in the liver starting from 5 weeks p.i. These cells were detected within and around Toxocara-induced granulomas as well as in isolated inflammatory foci in the portal tracts or within the hepatic parenchyma. Likewise, expression of Foxp3 mRNA in the spleen significantly increased at 5 and 16 weeks p.i. Furthermore, immunization of mice with Toxocara excretory-secretory antigen prior to experimental infection caused earlier mobilization and recruitment of Foxp3+ cells to the liver and enhanced splenic expression of Foxp3 transcripts. These results suggest a potential role of Foxp3-expressing regulatory cells in the evolution of the immunopathological events during infection by T. canis.

Catastrophic aortic thrombosis due to Toxocara infection

Toxocariasis, a common helminthozoonosis with a worldwide prevalence, usually manifests as 'visceral larva migrans' (VLM). Among its wide range of clinical presentations, large vessel thrombosis has never been described before. We report a case of aortic thrombosis caused by Toxocara canis infection in a young male who was successfully treated with albendazole.

The co-occurrence of Toxocaraocular and visceral larva migrans syndrome: a case series

Introduction

Ocular toxocarosis associated with high peripheral eosinophilia and together with systemic signs of visceral damage has been reported sporadically. Eye infections caused by numerous migrating larvae of Toxocara parasites, probably due to re-invasion or delayed reactivation, and leading to a progressive loss of vision is relatively rare. We report three atypical cases of toxocarosis with the co-existence of ocular larva migrans syndrome and generalized signs of Toxocara infection in schoolboys.

Case presentation

Two children aged 8 and 14 years respectively, with symptomatic ocular and visceral larva migrans syndromes, and one 16-year-old adolescent with chronic multifocal eye invasion, characterized by severe granulomatous retinochoroiditis with unilateral blindness, chronic abdominal pain and generalized synthesis of total immunoglobulin E antibody are described. The three patients, heavily infected with Toxocara species were boys of Polish origin. Ocular location of the parasite was confirmed by the detection of intraocular synthesis of specific anti-Toxocara immunoglobulin G antibody in aqueous humour samples from the affected eyes. Immunological parameters of tissue eosinophilia, allergy or hypersensitivity reactions to the presence of the migrating Toxocara parasites were analysed. Irreversible eye complications were observed in the patients with high level of exposure to Toxocara species in a contaminated environment, with a suggestion of possible re-activation or re-infection by different species or strains of the parasite.

Conclusions

Wide promotion of sanitary education is strongly justified in children and adolescents in Toxocara endemic areas in order to reduce the potential risk of primary invasion or re-infection with the parasites, which can lead to a severe course or progression of the disease. A long-term clinical follow-up and more intensive anti-parasitic treatment is recommended in patients with subclinical and overt forms of toxocarosis to prevent later reactivation of the migrating larvae in tissues.

The co-occurrence of Toxocara ocular and visceral larva migrans syndrome: a case series

INTRODUCTION

Ocular toxocarosis associated with high peripheral eosinophilia and together with systemic signs of visceral damage has been reported sporadically. Eye infections caused by numerous migrating larvae of Toxocara parasites, probably due to re-invasion or delayed reactivation, and leading to a progressive loss of vision is relatively rare. We report three atypical cases of toxocarosis with the co-existence of ocular larva migrans syndrome and generalized signs of Toxocara infection in schoolboys.

CASE PRESENTATION

Two children aged 8 and 14 years respectively, with symptomatic ocular and visceral larva migrans syndromes, and one 16-year-old adolescent with chronic multifocal eye invasion, characterized by severe granulomatous retinochoroiditis with unilateral blindness, chronic abdominal pain and generalized synthesis of total immunoglobulin E antibody are described. The three patients, heavily infected with Toxocara species were boys of Polish origin. Ocular location of the parasite was confirmed by the detection of intraocular synthesis of specific anti-Toxocara immunoglobulin G antibody in aqueous humour samples from the affected eyes. Immunological parameters of tissue eosinophilia, allergy or hypersensitivity reactions to the presence of the migrating Toxocara parasites were analysed. Irreversible eye complications were observed in the patients with high level of exposure to Toxocara species in a contaminated environment, with a suggestion of possible re-activation or re-infection by different species or strains of the parasite.

CONCLUSIONS

Wide promotion of sanitary education is strongly justified in children and adolescents in Toxocara endemic areas in order to reduce the potential risk of primary invasion or re-infection with the parasites, which can lead to a severe course or progression of the disease. A long-term clinical follow-up and more intensive anti-parasitic treatment is recommended in patients with subclinical and overt forms of toxocarosis to prevent later reactivation of the migrating larvae in tissues.

The mitochondrial genome of Toxocara canis

Toxocara canis (Ascaridida: Nematoda), which parasitizes (at the adult stage) the small intestine of canids, can be transmitted to a range of other mammals, including humans, and can cause the disease toxocariasis. Despite its significance as a pathogen, the genetics, epidemiology and biology of this parasite remain poorly understood. In addition, the zoonotic potential of related species of Toxocara, such as T. cati and T. malaysiensis, is not well known. Mitochondrial DNA is known to provide genetic markers for investigations in these areas, but complete mitochondrial genomic data have been lacking for T. canis and its congeners. In the present study, the mitochondrial genome of T. canis was amplified by long-range polymerase chain reaction (long PCR) and sequenced using a primer-walking strategy. This circular mitochondrial genome was 14162 bp and contained 12 protein-coding, 22 transfer RNA, and 2 ribosomal RNA genes consistent for secementean nematodes, including Ascaris suum and Anisakis simplex (Ascaridida). The mitochondrial genome of T. canis provides genetic markers for studies into the systematics, population genetics and epidemiology of this zoonotic parasite and its congeners. Such markers can now be used in prospecting for cryptic species and for exploring host specificity and zoonotic potential, thus underpinning the prevention and control of toxocariasis in humans and other hosts.

An improved method to obtain antigen-excreting Toxocara canis larvae

Toxocara canis is a dog helminth which causes visceral larva migrans (VLM) when infecting humans as a larva. The infection is demonstrated by detecting IgG antibodies against excretory-secretory larval antigens (ESLA) in serum by ELISA. The production of ESLA involves the collection of adult worms from dog puppy stools, the separation of eggs from dissected uteri, and the in vitro growing of egg-derived larvae, following the time-consuming and laborious protocol described by De Savigny [De Savigny, D.H., 1975. In vitro maintenance of T. canis larvae and a simple method for the production of Toxocara ES antigen for the uses in serodiagnostic tests for visceral larva migrans. Journal of Parasitology 61, 781-782]. In this work, an improved protocol for obtaining T. canis larvae is described. The modifications proposed improved the efficiency of the original De Savigny method in three ways: (i) increasing the parasite yield up to five fold, (ii) improving the larval purity, and (iii) markedly reducing the execution time of the protocol.

Enhanced expression of transforming growth factor-beta 1 in inflammatory cells, alpha-smooth muscle actin in stellate cells, and collagen accumulation in experimental granulomatous hepatitis caused by Toxocara canis in mice

Although toxocaral granulomatous hepatitis (TGH) characterized with a dominant-Th2 type immune response is a self-limiting disease, little is known concerning the role of fibrosis-related cytokine transforming growth factor-beta 1 (TGF-beta 1) in pathogenesis of TGH. A detailed histological and quantitatively immunohistochemical analysis of TGF-beta 1, alpha-smooth muscle actins (alpha-SMA), and collagen was performed on the liver tissues from mice infected with Toxocara canis as assessed between day 1 and 42 weeks post-infection (DPI or WPI). TGF-beta1 was detected mainly in infiltrating leukocytes in lesions with strong expressions from 4 to 16 WPI. Larvae per se also exhibited strong TGF-beta 1-like molecule expressions in the trial. Alpha-SMA was detected predominantly in hepatic stellate cells (HSC) which surrounded the lesions with moderate expressions largely throughout the period of the entire experiment. Collagen was observed to accumulate in inflammatory lesions and biliary basement with moderate to strong expressions from 1 WPI onwards in the trial. Since many evidences have indicated that leukocytes have the potential to influence HSC by producing TGF-beta 1 which can affect HSC to increase collagen synthesis in various liver diseases, we may propose that persistently elevated TGF-beta 1 expression in infiltrating leukocytes and active HSC with marked alpha-SMA expressions may contribute to healing of injured sites through up-stimulation of collagen deposition; in contrast, abnormally persistent collagen accumulation may cause irreversible fibrotic injury in the TGH.

Experimental toxocariosis in BALB/c mice: effect of the inoculation dose on brain and eye involvement

Ocular toxocarosis (OT) is a well-established disease. However, our understanding of the migratory route, time and circumstances that produce ocular invasion are not clear. To improve our knowledge of factors related to ocular invasion, BALB/c mice were inoculated with simple doses (SD) of 6, 12, 50, 100, 200 and 1000 embryonated eggs (EE) and multiple doses (MD) of 200 and 1000 EE. Brains and eyes were studied for the presence of larvae in animals sacrificed on days 3, 5, 7, 9, 11, 13, 15, 17, 19, 40, 80 and 120 in SD and on days 28, 30, 32, 34, 36, 38, 40, 42, 46, 87 and 127 in MD. The humoral immune responses were studied by ELISA using excretory-secretory antigen. Due to the considerable number of days tested, results showed are based on one set of experiments. However, each point studied represents the result obtained from a group of five mice. We have shown that the eye involvement with Toxocara canis larvae is a phenomenon mainly produced once larvae have reached the brain. There is a direct relationship between the parasitic load and the number of ocular larvae. Moreover, the arrival of larvae to the eye is an independent event, unrelated to the kind of administered dose (SD, MD), although the number of the brain larvae was higher in the cases of MD. High levels of specific antibodies were observed but they did not prevent the arrival of the larvae to the brain and the eye.

Prevalence and intensity ofToxocara canis(Werner, 1782) in dogs and its potential public health significance in Ile-Ife, Nigeria

A study on the prevalence and intensity ofToxocara canis(Werner, 1782) in dogs was carried out in Ile-Ife, Nigeria. Faecal samples were collected from 269 dogs between January and December 2004, processed by the Kato–Katz technique and then examined forT. caniseggs. The prevalence ofT. canisobtained was 33.8%. The intensity of infection, measured as mean egg count per gram of faeces ( ± SEM) was 393.8 ± 83.4. The prevalence and intensity ofT. canisin dogs aged 0–6 months were significantly higher (P < 0.05) than older age groups. The prevalence and intensity ofT. canisinfection were significantly higher in males than in female dogs (P < 0.05). SinceT. canisis known to cause visceral larva migrans (VLM) in young children, there is the possibility that the high prevalence ofT. canisinfection obtained in this study might constitute an important risk factor for transmission to humans. Therefore, there is the need to educate the residents of Ile-Ife on the danger of close association of their children with household pets.

The effect of an indirect anthelmintic treatment on parasites and breeding success of free-living pheasantsPhasianus colchicus

In Great Britain free-living common pheasantsPhasianus colchicusare often managed at high densities owing to their popularity as a quarry species. They are prone to infection by a range of parasite species includingHeterakis gallinarum,Capillariaspp. andSyngamus trachea. In 1995 the efficacy of an indirect anthelmintic technique for controlling parasitic worm burdens of pheasants was determined in a pilot study on a shooting estate in the south of England. Between 2000 and 2003 a large-scale field experiment was conducted on nine estates in eastern England to determine the effect of the technique on parasite burden and pheasant breeding success. In the absence of anthelmintic treatment worm burdens increased rapidly through March and April, whereas birds given anthelmintic-treated grain had lower worm burdens during the same period. The breeding success of pheasants was significantly higher on plots provided with anthelmintic treatment, although no long-term increases in population densities were observed. The burdens of the most common parasiteH. gallinarumwere significantly lower in pheasants from treatment plots six weeks after the anthelmintic treatment had ceased, but spring treatment did not influence parasite burden in the following winter.

Eosinophil cationic protein, specific IgE and IgG4 in human toxocariasis

Among 67 French patients presenting a toxocaral infection, various demographic, environmental, clinical and laboratory parameters (blood eosinophil count, eosinophil cationic protein (ECP), serum total IgE, specific IgE against common inhalant allergens, specific IgE and IgG4 againstToxocaraexcretory-secretory antigens) were investigated. Correlation studies and logistic regression analyses were conducted, testing elevated levels of ECP, specific anti-ToxocaraIgE or IgG4 as outcome variables An elevated ECP level was significantly associated with both cough and rhinitis, a high level of specific anti-ToxocaraIgE with itchy rashes and possible atopic status, and an increase of specific anti-ToxocaraIgG4 with rural residence.

Toxocara canis: effect of inoculum size on pulmonary pathology and cytokine expression in BALB/c mice

Infection of mice with Toxocara canis results in pulmonary inflammation and the induction of a Th2 type of immune response. The aim of this study was to determine whether the effect of infection with this nematode depends on the inoculum size. Results indicate that mice infected with either a high or a low inoculum size showed, in a dose-dependent manner, pulmonary inflammation with eosinophil infiltration, increased levels of total IgE, and Toxocara-specific IgG1 that persisted up to 60 days p.i. Relative quantification of cytokine expression in lungs of mice infected with different doses showed proportional increased expression of the IL-4, IL-5, and IL-10 transcripts, whereas the expression of the IFN-gamma transcript was not different from that of uninfected controls. These results indicate that infection of BALB/c mice with T. canis results in chronic pulmonary inflammation and a dominant Th2 type of immune response, independent of the inoculum size.

Persistent airway hyper-responsiveness and inflammation in Toxocara canis-infected BALB/c mice

BACKGROUND

Infection with Toxocara canis, the roundworm of dogs, has been associated with asthmatic manifestations. Clinical symptoms such as wheezing, coughing and episodic airflow obstruction have been described for patients infected with this helminth.

OBJECTIVE

In order to characterize the effect of T. canis infection on the lungs, we monitored immune responses, pulmonary pathology and lung function over a period of 60 days in BALB/c mice.

METHODS

Infection was performed by a single oral administration of 1000 T. canis embryonated eggs. Airway responsiveness was measured in conscious, unrestrained mice at 7, 14, 30 and 60 days post-infection (p.i.).

RESULTS

Infection of mice resulted in airway hyper-responsiveness (AHR) that persisted up to 30 days p.i. Pulmonary inflammation as well as increased levels of IgE and eosinophils in bronchoalveolar lavage (BAL) persisted up to 60 days p.i. Cytokine analysis in BAL indicated increased levels of IL-5 at day 7 and 14 p.i., whereas the levels of IL-2, IFN-gamma, IL-4 and IL-10 did not differ from those of uninfected controls. Toxocara-specific stimulation of spleen cells using recombinant TES-70 protein resulted in the induction of IL-5 at day 7 and 14 p.i. and IL-10 at day 14 p.i. Production of all other cytokines did not differ from that of uninfected controls. Evaluation of larval burden revealed that T. canis was still present in the lungs of infected mice at 60 days p.i.

CONCLUSION

The presence of Toxocara larva in the lungs at 60 days p.i. following a single infection could explain the persistent pulmonary inflammation, airway hyper-reactivity, eosinophilia and increased IgE production observed in T. canis-infected BALB/c mice.

Influence of Toxocara canis infection during pregnancy on offspring resistance towards re-infection

The impact of Toxocara canis infection of Balb/c mice mothers on the future immune response of their offspring towards reinfection with the same parasite was studied. Two groups of offspring, the first originating from the mothers infected with a single dose of 1000 Toxocara canis eggs and the second from non-infected mothers, were both challenged with 500 T. canis eggs per animal at 6 weeks of age. The proportions of spleen CD4+ and CD8+ T lymphocytes, the level of serum cytokines IFN-gamma and IL-5, eosinophilia in peripheral blood, the production of specific antibodies and the number of migrating larvae were monitored. In both groups of offspring, the challenge infection resulted in an increase in CD4+ T-cell subtype in comparison with the non-infected healthy control, although after an initial decline a subsequent increase in CD8+ was observed. The immunoregulation index (CD4+/CD8+) was lower in the group of mice originating from infected mothers throughout the whole experiment compared to the offspring of non-infected mothers as well as in healthy control mice of the same age. In the offspring of infected mothers mainly, a reduced production of IFN-gamma and of IL-5, suppressed eosinophilia and a higher level of protective antibodies was detected, compared to the control second group, in which the INF-gamma concentration significantly increased after day 42 p.i. In the first group of offspring before challenge, 12.7 +/- 2.5 larvae in the brains and 32 +/- 2.1 larvae in the muscles transmitted from the infected mothers were detected. There was a significant reduction in larval recovery from brain on days 42 and 49 p.i. (56.7 and 56.8%, respectively), while from muscles in the same time there was a reduction of 46.7 and 39%, respectively, compared to the offspring of non-infected mothers. These results indicate a significant protective memory of immune mechanisms against T. canis induced in offspring of Toxocara-infected mother mice.

Leukocytosis and blood eosinophilia in a polyparasitised population in north-eastern Brazil

It has long been known that leukocytosis and blood eosinophilia are common in the tropical environment, but data derived from population-based studies are scarce. A study was undertaken in a fishing village in north-east Brazil where both intestinal helminthiases and parasitic skin diseases are common. Of 409 individuals studied, 128 (31.3%) were infected with one intestinal helminth or ectoparasite species, 93 (22.7%) with two, 61 (14.9%) with three, 25 (6.1%) with four and 11 (2.7%) with more than four species; no parasites were found in 91 (22.2%) individuals. Leukocyte counts ranged between 3,300 cells/microl and 16,100 cells/microl (median, 7,200 cells/microl) and eosinophil counts between 40 cells/microl and 5,460 cells/microl (median, 455 cells/microl). Eosinophilia (>500/microl) was detected in 44.7% of the individuals, and hypereosinophilia (>1,000/microl) in 12.9%. Thirty-six (8.8%) individuals showed leukocytosis. While 75% of individuals with normal eosinophil counts were considered parasite-free, only 14% with eosinophilia and 11% with hypereosinophilia did not have enteroparasites or ectoparasites. Multivariate regression showed that the probability of eosinophilia and hypereosinophilia, but not of leukocytosis, increased with the number of parasite species present. The data show that eosinophilia occurs in almost one-half of the individuals from a resource-poor setting and that it is significantly associated with the presence of intestinal helminths, but not with the presence of ectoparasites.

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.

Influence of murine Toxocara canis infection on plasma and bronchoalveolar lavage fluid eosinophil numbers and its correlation with cytokine levels

Toxocara canis is a nematode of the Ascaridae family that normally parasites the small intestine of canid species. Humans are accidentally infected upon ingestion of embryonated eggs, and can manifest several clinical alterations such as fever, hepatomegaly, splenomegaly, respiratory symptoms, muscle pain and anorexia. In the present work, we investigated the kinetics of tissue distribution of L2 larva in lungs, liver, kidney, brain, skeletal muscle and myocardium. Also, we analyzed the blood and bronchoalveolar lavage fluid (BAL) for levels of IL-6, IFN-gamma, eotaxin and Regulated on Activation Normal T Cell Expressed and Secreted (RANTES) in experimental murine T. canis infection. We observed liver, lung and kidney lesions correlated to larva migration as early as the first day of infection. After the seventh post-infection day, larva could also be detected in brain, skeletal muscle and heart, as an indicator of biphasic migration pattern. Increased inflammatory activity was detected in BAL and plasma of infected animals, as was an intense eosinophil migration associated with an increase in the levels of all the cytokines studied. In conclusion, our results establish a tight correlation between tissue lesions caused by larva migration and increased plasma levels of pro-inflammatory and eosinophil chemotactic cytokines. Thus, murine T. canis infection may prove to be useful in understanding the role of cytokines in infection.

[Systemic vasculitis during parasitosis]

A RARE EVENTUALITY: Although parasite infections are frequent, observations of vasculitis related to parasitosis are, however, very rare. REGARDING THE MECHANISM: The simultaneous occurrence of a parasitosis and vasculitis may be the consequence of either the direct implication of a parasite observed in the histological lesions in the onset of alteration in the vascular wall, or of immunopathological phenomena occuring during the anti-parasite immune response, or a fortuitous association. THE HUMAN PARASITOSIS IMPLIED: In most cases, vasculitis associated with parasitosis is an isolated event with varied clinical aspects. Such cases have been reported in toxoplasmosis, trichinosis, strongyliasis, ascaridiosis, sarcocystosis, amibiasis, leishmaniosis and toxocarosis.

Enhanced inducible nitric oxide synthase expression and nitrotyrosine accumulation in experimental granulomatous hepatitis caused by Toxocara canis in mice

The involvement of inducible nitric oxide synthase (iNOS) and nitrotyrosine (NT) in pathogenesis of toxocaral granulomatous hepatitis (TGH) in a murine host was quantitatively determined by biochemical, parasitological, pathological, and immunohistochemical assessments in a 42-week investigation. Mice were sacrificed for serum collection and histological processing as well as acid-pepsin digestion of the liver in a larval recovery study. Significantly increased levels of total serum NO were found in the trial, indirectly suggesting iNOS activation in the liver. iNOS reactivity was predominantly observed in infiltrating leucocytes in lesions and normal and apocrine-like cholangiocytes; in contrast, hepatocytes and multinucleated giant cells showed negative cytoplasmic staining in TGH. Strong iNOS-like reactivity was also detected on the body wall of larvae. The locations of NT reactivity were nearly identical to those of iNOS expression; infiltrating leucocytes or cholangiocytes stained for iNOS were also stained for NT in TGH. Enhanced iNOS expression, but not invading larvae (r = 0.256, P = 0.211), seemed to play a certain role in pathological damage in TGH due to a significant correlation between iNOS expression and serum alanine aminotransferase (ALT) levels (r =0.593, P = 0.021) in the trial. Our present results indicate a potential therapeutic strategy for treatment of GH caused by other nematodes through manipulation of iNOS expression.

Zoonotic risk of Toxocara canis infection through consumption of pig or poultry viscera

The potential zoonotic risk of Toxocara canis infections from consumption of swine or poultry viscera containing larvae was assessed using a pig model. Two groups of six pigs were fed either fresh swine viscera (group FS) or poultry viscera (FP) containing around 3500 Toxocara larvae. Another two groups of six pigs were fed swine viscera (PS) or poultry viscera (PP) preserved at 4 degrees C for 1 week. All pigs were necropsied 14 days after the exposure. Liver white spots were counted and T. canis specific IgG antibodies were measured by ELISA. Larval burdens were assessed in the mesenteric lymph nodes, liver, lungs, brain, tongue, and eyes. All recipient pigs exhibited several white spots on the liver surface and detectable antibody levels. Larvae were recovered predominantly from the lungs, but also from the mesenteric lymph nodes and the liver, a few larvae were found in the brain and tongue of the pigs. Two larvae were found in the eyes of two pigs in group FS. Mean percentages of total larval recoveries in groups FS, FP, PS, and PP were 75.3, 63.6, 42.6, and 18.8%, respectively. Significantly higher numbers of larvae were recovered from pigs given swine viscera than pigs given poultry viscera. The preservation at 4 degrees C for 1 week caused a significant reduction in the larval infectivity overall, nevertheless, the recoveries remained substantial. The fact that larvae migrating in swine or poultry organs and tissues have high infectivity in pigs even after preservation at 4 degrees C for 1 week, suggests that human infection with T. canis might easily occur following consumption of raw or undercooked dishes, either fresh or refrigerated, prepared from swine or poultry organs and tissues harbouring T. canis larvae.

In vivo inhibition of inducible nitric oxide synthase decreases lung injury induced by Toxocara canis in experimentally infected rats

The direct effect of nitric oxide (NO) on the viability of Toxocara canis larvae was studied. We observed that the nitric oxide donors, SIN-1 and SNOG, exert no cytotoxic effect on the in vitro viability of T. canis larvae. In addition, we developed a model in rats to elucidate the role of NO during T. canis infection. We evaluated different indicators in four experimental groups: morphological parameters, the total number cells and cell types recovered, nitrite and protein concentration, lactate dehydrogenase and alkaline phosphatase enzymatic activity in the bronchoalveolar lavage fluid, lung index and detection of anti-T. canis specific antibodies. We observed significant differences between non-infected and infected groups. The infected animals treated with the inducible nitric oxide synthase (iNOS) inhibitor aminoguanidine were less damaged than infected, non-treated animals. Our results suggest that the in vivo inhibition of the synthesis of NO triggered by iNOS diminishes the deleterious effects of the parasite upon the host, especially the vascular alterations in the lungs. We could show that in vivo production of NO induced by infection with T. canis results in direct host damage. Thus, this induction may constitute an evasion/adaptation mechanism of the parasite.

Immunologic aspects of tropical lung disease

Respiratory tract infections are a major cause of morbidity and mortality in adults and children worldwide. Because of its anatomical features, which allow gaseous exchange, the respiratory tract is constantly exposed to the outer environment and to the systemic and pulmonary circulation, which may allow infectious microbes, toxins, allergens, dust, and other antigens to enter the lung. The human host is a perpetual battleground between the body's immune system and invading antigens, whether they are microorganisms, chemicals, or cancer cells. Although a vast amount of literature is accumulating on the subject of immune responses to pathogens, the mechanisms underlying specific immunity to many organisms remain unknown. Paradoxically, while the immune response has evolved to confer protection against invading antigens, much human pathology arises when the immune responses are evoked.