Cianferoni Antonella, Schneider Lynda, Schantz Peter M, Brown Daniel, Fox LeAnne M
Division of Immunology, Children's Hospital, Boston, MA 02115, USA.
Pediatrics. 2006 Feb;117(2):e336-9. doi: 10.1542/peds.2005-1596.
A 16-year-old girl developed a cough, hypereosinophilia (absolute eosinophil count: 32000/mm3), hypergammaglobulinemia, and multiple noncavitary pulmonary nodules 1 month after having ingested an earthworm on a dare. Spirometry revealed moderate restriction and reduced gas diffusion. Parabronchial biopsy demonstrated eosinophilic organizing pneumonitis with multiple eosinophilic microabscesses, and Toxocara titers were elevated (>1:4096). Ophthalmologic examination ruled out ocular larva migrans. The patient received a 10-day course of albendazole (400 mg orally twice daily) and demonstrated significant clinical improvement with resolution of cough and pulmonary function abnormalities. Her white blood cell count and hypergammaglobulinemia normalized within 20 days, yet eosinophils (absolute eosinophil count: 1780/mm3) and Toxocara serologies (>1:4096) remained elevated 3 months after completing antihelminthic therapy. In this instance, the ingested earthworm served as the paratenic carrier of Toxocara larvae from the soil to the patient. This case highlights the clinical evolution of pulmonary visceral larva migrans infection caused by Toxocara spp. associated with a discrete ingestion in an adolescent patient. In addition, it provides a rare opportunity to define the incubation period of visceral larva migrans and emphasizes the importance of education regarding sources of Toxocara infection.
一名16岁女孩在因受激而吞食蚯蚓1个月后，出现咳嗽、嗜酸性粒细胞增多（绝对嗜酸性粒细胞计数：32000/mm³）、高球蛋白血症和多个非空洞性肺结节。肺功能测定显示中度受限和气体扩散降低。支气管旁活检显示嗜酸性粒细胞性机化性肺炎伴多个嗜酸性粒细胞微脓肿，弓蛔虫滴度升高（>1:4096）。眼科检查排除了眼幼虫移行症。患者接受了为期10天的阿苯达唑治疗（口服400mg，每日两次），咳嗽和肺功能异常得到明显改善。她的白细胞计数和高球蛋白血症在20天内恢复正常，但在完成抗蠕虫治疗3个月后，嗜酸性粒细胞（绝对嗜酸性粒细胞计数：1780/mm³）和弓蛔虫血清学（>1:4096）仍居高不下。在这种情况下，摄入的蚯蚓充当了弓蛔虫幼虫从土壤到患者的转续宿主。该病例突出了由弓蛔虫属引起的肺内脏幼虫移行症感染在一名青少年患者中与一次特定摄入相关的临床演变。此外，它提供了一个难得的机会来确定内脏幼虫移行症的潜伏期，并强调了关于弓蛔虫感染源教育的重要性。
