Trudności w diagnostyce i leczeniu toksokarozy ocznej – opis przypadku
Ocular Toxocarosis, Diagnostic and Therapeutic Difficulties – Case Study
Monika Modrzejewska1, Agnieszka Krukar2, Wojciech Lubiński1
1 Katedra i Klinika Okulistyki Pomorskiego Uniwersytetu Medycznego w Szczecinie
Kierownik: dr hab. n. med. Wojciech Lubiński, prof. PUM, FEBO
Samodzielny Publiczny Szpital Kliniczny nr 2 w Szczecinie
2 Specjalistyczny Szpital im. prof. Alfreda Sokołowskiego w Szczecinie
Summary: Toxocariasis is an infection transmitted from animals to humans caused by invasion of either the dog roundworm (Toxocara canis) or the cat roundworm (Toxocara cati). The lack of eosynophila and slightly expressed serological ranges for Toxocariasis antibodies are typical for the ocular form of this infection coexisting with diagnostic difficulties of the disease.
The aim of this paper is to present diagnostic difficulties in ocular Toxocariasis in a child with a negative ELISA test.
Results: A 14-year old child with ocular toxocariasis was described. The girl was hospitalized because of sudden deterioration of vision in the left eye (VOL 1/50). The initial diagnosis was Toxoplasmatic maculitis. The presence of inflammatory retinal foci was confirmed in eye fundus indirect examination and in fluorescein angiography. In the panel of multiple serological tests, Toxoplasmosis has been ruled out and the only deviation was positive cytomegalovirus IgG (cytomegalovirus) but their high avidity excluded a primary infection with this pathogen. ELISA test for Toxocariasis was also negative. With the lack of positive values of inflammation indices idiopathic focal chorioretinitis was diagnosed. A significant and recurrent worsening of visual acuity caused by macula lesions required intravenous steroid therapy, which only brought temporary improvement. Further deterioration of vision and reappearance of new inflammatory choroidal and retinal foci with involvement of macula (VOL z 1,0 to 1/50) was the indication to bacteriological, mycological and parasitological tests. Western-blot method revealed a positive immunological profile of specific IgG antibodies against Toxocara canis. Antihelmintic therapy with continuation of systemic and local steroids was applied.
Conclusions: Negative result of ELISA serological test does not allow to rule out toxocariasis. Western-blot method is a more specific and sensitive test which may detect low levels of antibodies in Toxocara canis ocular form.
Słowa kluczowe: toksokaroza, narząd wzroku, objawy kliniczne, leczenie.
Keywords: Toxocariasis, visual organ, clinical symptoms, treatment.