Review of Toxocariasis at a Children's Hospital Prompting Need for Public Health Interventions

Authors

Mary B Fortini
Timothy A Erickson
Lauren M Leining
Karina M Robinson
Megan N Carey
Sarah J Smith
Brendan Sullivan
Alisa R Nelson
Sarah M Gunter
Jill E Weatherhead

Publication Date

10-1-2023

Journal

The Pediatric Infectious Disease Journal

DOI

10.1097/INF.0000000000004042

PMID

37625080

PMCID

PMC10754417

PubMedCentral® Posted Date

10-1-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

United States, Humans, Child, Animals, Cats, Dogs, Public Health, Toxocariasis, Cat Diseases, Hospitals, Pediatric, Seroepidemiologic Studies, Dog Diseases, Zoonoses, Toxocara, eosinophilia, epidemiology, public health

Abstract

BACKGROUND: Toxocariasis, caused the by dog and cat roundworm, is one of the most common zoonotic helminth infections in the United States and can lead to severe lifelong morbidity in children. Although historical seroprevalence studies have identified a high frequency of toxocariasis regionally in the United States, there are few studies linking epidemiology and clinical disease in children. The study objective was to examine the contemporary epidemiology of pediatric toxocariasis within an endemic US region.

METHODS: We conducted an epidemiologic study analyzing children diagnosed with toxocariasis presenting to a tertiary pediatric hospital in Texas from 2010 to 2021. We examined risk factors and performed a geospatial analysis, including a comparative analysis of human cases and locations of surrendered infected stray animals in the same region.

RESULTS: Children diagnosed with toxocariasis were most commonly of Hispanic/Latino ethnicity (30/46; 65%), white race (41/45; 91%) and receiving Medicaid (34/44, 77%). Many infected children had contact with dogs or cats. Ocular toxocariasis was associated with a lack of peripheral eosinophilia ( P < 0.001). No other Toxocara syndromes were associated with defined absolute eosinophil count levels. Post-treatment resolution of eosinophilia was variable, ranging from 1 to 172 weeks. A Toxocara hotspot was identified in northeast Houston, comprising one of the lowest median household incomes in the region.

CONCLUSIONS: Toxocariasis is a devastating zoonotic infection in children living in the US. As it is not a reportable disease, the true burden remains unknown. It is critical to increase awareness of toxocariasis to direct public health interventions and ultimately reduce Toxocara -induced morbidity in US children.