Toxocara canis (Larva migrans visceralis) aus ophthalmologischer Sicht

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Abstract
Visceral larva migrans [VLM] (T. canis) is usually a relatively benign disease which is caused by infective 2nd-stage larvae of the common cosmopolitan ascarid of dogs, characterized chiefly by sustained eosinophilia, pulmonary symptoms and hepatomegaly. Its severity varies with the number of larvae in the tissue and the immune or allergic state of the infected individual. The most important aspect of the neurotropic larvae perhaps is its potential as a facilitating agent, for instance, for viral or Toxoplasma gondii invasion of the CNS by destroying the blood-brain barrier. Ocular invasion characteristically occurs after primary infestation, seldom bilaterally. Larvae may present 3 different ocular lesions: a granulomatosis at the posterior pole (solitary granuloma), a chronic endophthalmitis or peripheral retinal lesions with proliferation. Prognosis regarding visual acuity depends on early diagnosis and larval localization. Successful therapy with a combination of antibiotics, sulfonamides, prednisolone and vermifuge is reported. The microprecipitation test on living larvae is considered superior all serological tests at present, but a negative result (at first) does not exclude T. canis invasion VLM syndrome should not be ruled out if the patient suffers from cerebral spasms of uncertain etiology.