Nicoletti Alessandra
Department "Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
Handb Clin Neurol. 2013;114:217-28. doi: 10.1016/B978-0-444-53490-3.00016-9.
Toxocariasis is one of the most commonly reported zoonotic helminth infections in the world with a higher prevalence in tropical settings and in rural populations. It is caused by the larval stages of the ascarids Toxocara canis, the common roundworm of dogs, and probably also by the larval stages of Toxocara cati, the roundworm of cats. The clinical spectrum of toxocariasis in humans varies from asymptomatic infection to severe organ injury caused by larval migration to the major organs ("visceral larva migrans"). Clinical involvement of the nervous system in visceral larva migrans due to Toxocara is thought to be rare, although in experimental animals the larvae frequently migrate to the brain. The CNS migration leads to a variety of neurological disorders such as meningo-encephalitis, space-occupying lesion, cerebral vasculitis, epilepsy, and myelitis. Several studies have evidenced high seropositivity rates for T. canis among people with epilepsy suggesting that toxocariasis could play a role in the incidence of epilepsy in endemic areas. Diagnosis of neurotoxocariasis is based on the history; blood tests, including differential blood cell count; CSF investigations, including determination of antibodies anti-Toxocara canis; and neuroimaging. Like the visceral manifestations, neurological manifestations of toxocariasis are treated with benzimidazole components.
弓蛔虫病是世界上报告最常见的人畜共患蠕虫感染之一，在热带地区和农村人口中患病率较高。它由犬弓首蛔虫（犬常见的蛔虫）的幼虫阶段引起，可能也由猫弓首蛔虫（猫蛔虫）的幼虫阶段引起。人类弓蛔虫病的临床谱从无症状感染到幼虫迁移至主要器官（“内脏幼虫移行症”）导致的严重器官损伤不等。虽然在实验动物中幼虫经常迁移至脑部，但因弓蛔虫导致的内脏幼虫移行症累及神经系统在人类中被认为较为罕见。中枢神经系统迁移会导致多种神经疾病，如脑膜脑炎、占位性病变、脑血管炎、癫痫和脊髓炎。多项研究证明，癫痫患者中犬弓首蛔虫血清阳性率较高，这表明在流行地区弓蛔虫病可能在癫痫发病中起作用。神经弓蛔虫病的诊断基于病史、血液检查（包括血细胞分类计数）、脑脊液检查（包括检测抗犬弓首蛔虫抗体）以及神经影像学检查。与内脏表现一样，弓蛔虫病的神经表现用苯并咪唑类药物治疗。
