PDF(Pubmed)
Abstract：
Toxocariasis is a zoonosis transmitted by the nematode Toxocara spp. Immunocompromised hosts are more susceptible than general population to bacterial, viral, fungal and parasitic infections. In this population toxocariasis may present as exacerbation or reactivation and could have severe or atypical manifestations being a diagnostic challenge for healthcare providers. We report a case of a presumptive pulmonary toxocariasis during chemotherapy in a patient affected by acute myeloid leukaemia (AML) and Hodgkin lymphoma and we summarize current evidence of pulmonary involvement in immunocompromised population with Toxocara spp infection in a narrative review. The aim of this work is also to revise the current literature on pulmonary involvement during Toxocara spp infection in immunocompromised hosts to improve knowledge on clinical presentation, treatment and outcome. A 66 years old man who had undergone to a cytarabine and idarubicin chemotherapy induction scheme for AML, complained of febrile neutropenia and dry cought. At the chest computed tomography (CT) there were multiple nodular pulmonary lesions with subpleural consolidations. The lung biopsy revealed inflammatory infiltration with diffuse small granulomas with minor eosinophil component. The laboratory analysis showed high immunoglobulin E (IgE) count with normal peripherical eosinophils, among the extended parasitological analysis, Toxocara immunoblot assay resulted positive. In the most accepted hypothesis of a polmunary toxocariasis infection, the patient was treated with a combination of albendazole plus corticosteroids for four weeks, with a positive outcome. Infection complications during chemotherapy are not uncommon, however, this is the first reported case of pulmonary toxocariasis during cytarabine and idarubicin treatment in AML. The revised literature shows male gender and younger age as possible risk factors, nevertheless the majority of cases of seropositivity for Toxocara was reported in solid organ malignancies. In this case, the suspect was mainly based on laboratory total elevated IgE, confirmed by serological, anatomo-pathological and radiological findings. Hypereosinophilia is often not present in chronic infection. In conclusion, pulmonary toxocariasis should be ruled out in patients with pulmonary involvement and high IgE titre, with or without peripheral eosinophilia, especially in those with known immunocompromised status.
摘要：
弓形虫病是由线虫弓形虫属传播的人畜共患病。免疫功能低下的宿主比普通人群更容易受到细菌的影响，病毒，真菌和寄生虫感染。在该人群中，弓形虫病可能表现为恶化或重新激活，并且可能具有严重或非典型的表现，这对医疗保健提供者来说是诊断挑战。我们报告了一例受急性髓性白血病（AML）和霍奇金淋巴瘤影响的患者在化疗期间发生的肺弓形虫病，并在叙述性综述中总结了免疫受损人群中肺部受累的最新证据。这项工作的目的还在于修改当前有关免疫功能低下的宿主弓形虫感染期间肺部受累的文献，以提高对临床表现的认识。治疗和结果。一名66岁的男子接受了阿糖胞苷和伊达比星的AML化疗诱导方案，主诉发热性中性粒细胞减少和干咳。在胸部计算机断层扫描（CT）中，有多个结节性肺部病变伴胸膜下合并。肺活检显示炎性浸润，弥漫性小肉芽肿伴少量嗜酸性粒细胞成分。实验室分析显示高免疫球蛋白E（IgE）计数与正常外周嗜酸性粒细胞，在扩展的寄生虫学分析中，弓形虫免疫印迹试验结果为阳性。在最受认可的波兰弓形虫感染假说中，患者接受阿苯达唑联合糖皮质激素治疗4周,一个积极的结果。化疗期间的感染并发症并不少见，然而,这是在阿糖胞苷和伊达比星治疗AML期间报告的首例肺弓形虫病病例.修订后的文献显示，男性性别和年轻年龄是可能的危险因素，然而，大多数弓形虫血清阳性病例报告发生在实体器官恶性肿瘤中。在这种情况下,疑犯主要基于实验室总IgE升高,通过血清学证实，解剖病理学和放射学发现。在慢性感染中通常不存在嗜酸性粒细胞增多。总之,肺部受累和高IgE滴度的患者应排除肺弓形虫病，伴有或不伴有外周嗜酸性粒细胞增多，尤其是那些已知免疫功能低下的人。
