Bachtiar Arian, Auer Herbert, Finsterer Josef
Department of Otorhinolaryngology, Krankenanstalt Rudolfstiftung, Vienna, Austria.
Rev Chilena Infectol. 2012 Oct;29(5):551-3. doi: 10.4067/S0716-10182012000600015.
Toxocarosis involving cranial nerves is extremely rare and almost exclusively concerns the optic nerve. Toxocarosis involving the seventh cranial nerve has not been reported.
A 33y male developed left-sided Bell's palsy two days after left-sided otalgia 6y before. Despite extensive diagnostic work-up at that time the cause of Bell's palsy remained unknown. During the following years Bell's palsy slightly improved but retromandibular pain remained almost unchanged and he developed enlarged lymph nodes along the jugular veins, submandibularly, and in the trigonum caroticum. Re-evaluation 6y later revealed an increased titer of serum antibodies against Toxocara canis and a positive Westernblot for Toxocara canis ES-antigen. Despite absent eosinophilia in the serum, toxocarosis was diagnosed and a therapy with albendazole initiated, with benefit for retromandibular pain, but hardly for Bell's palsy or enlarged lymph nodes. CSF investigations after albendazole revealed a positive Westernblot for antibodies against toxocara but absent pleocytosis or eosinophilia, and negative PCR for Toxocara canis.
Visceral larva migrans due to Toxocara canis may be associated with Bell's palsy, retromandibular pain, and lymphadenopathy. A causal relation between Bell's palsy and the helminthosis remains speculative. Adequate therapy years after onset of the infestation may be of limited benefit.
涉及颅神经的弓蛔虫病极为罕见，几乎仅累及视神经。尚未有涉及第七颅神经的弓蛔虫病的报道。
一名33岁男性在6年前左侧耳痛两天后出现左侧贝尔麻痹。尽管当时进行了广泛的诊断检查，但贝尔麻痹的病因仍不明确。在随后的几年里，贝尔麻痹稍有改善，但下颌后疼痛几乎没有变化，并且他在颈静脉沿线、下颌下及颈动脉三角区出现了淋巴结肿大。6年后重新评估发现抗犬弓首线虫血清抗体滴度升高，犬弓首线虫ES抗原的蛋白质印迹法检测呈阳性。尽管血清中无嗜酸性粒细胞增多，但仍诊断为弓蛔虫病，并开始使用阿苯达唑治疗，下颌后疼痛有所改善，但对贝尔麻痹或淋巴结肿大几乎没有效果。使用阿苯达唑后进行的脑脊液检查显示抗弓蛔虫抗体的蛋白质印迹法检测呈阳性，但无细胞增多或嗜酸性粒细胞增多，犬弓首线虫的聚合酶链反应检测为阴性。
犬弓首线虫引起的内脏幼虫移行症可能与贝尔麻痹、下颌后疼痛和淋巴结病有关。贝尔麻痹与蠕虫病之间的因果关系仍具有推测性。感染发生多年后进行充分治疗可能效果有限。
