The Prevalence of Toxocariasis and Diagnostic Value of Serologic Tests in Asymptomatic Korean Adults

이진영,양문희,황정해,강미라,팽재원,이병재,최동철,윤세효 대한천식알레르기학회 2015 Allergy, Asthma & Immunology Research Vol.7 No.5

Purpose: Toxocariasis is the most common cause of peripheral blood eosinophilia in Korea and produces eosinophilic infiltration in various organs, including the lung. However, the prevalence of toxocariasis in the general population is rarely reported. Methods: We investigated the seroprevalence of Toxocara larval antibody among asymptomatic people who attended Samsung Medical Center for a health checkup, including low-dose chest computed tomography (CT) between March 2012 and December 2013. A total of 633 people (400 men and 233 women) were prospectively recruited. Results: The Toxocara-seropositive rate was 51.2% using the current cutoff value based on Toxocara enzyme-linked immunosorbent assay (ELISA) (67.0% for men and 24.0% for women). In the multivariate-adjusted model, age (odds ratio [OR], 1.08; 95% confidence intervals [CI], 1.04- 1.11), male sex (OR, 3.47; 95% CI, 2.26-5.33), rural residence (OR, 1.55; 95% CI, 1.05-2.30), and history of raw liver intake (OR, 8.52; 95% CI, 3.61- 20.11) were significantly associated with Toxocara seropositivity. When subjects were divided into 3 groups using cutoff values base on weak positive and strong positive control optical densities (ODs), the ORs for peripheral blood eosinophilia and serum hyperIgEaemia were 0.31 (95% CI, 0.02- 2.89) in the weakpositive group and 36.64 (95% CI, 11.73-111.42) in the strong positive group compared to the seronegative group. Similarly, ORs for the solid nodule with surrounding halo were 2.54 (95% CI, 0.60-10.84) in the weak positive group and 15.08 (95 CI 4.09-55.56) in the strong positive group compared to the seronegative group. Conclusions: The study indicated that the Toxocara-seropositive rate obtained by using the current cutoff value based on ELISA was high in the asymptomatic population in Korea. The results of this study suggest that active toxocariasis may be more frequently seen in the Toxocara-strong positive group than in the Toxocara-weak positive group.

포항 지역의 톡소카라증의 임상적, 혈청학적 특징에 관한 연구: 포항의 톡소카라증의 특징

류병한 ( Byung Han Ryu ),박준석 ( Jun Seok Park ),정여진 ( Yeo Jin Jung ),강수경 ( Soo Kyoung Kang ),이승희 ( Seung Hee Lee ),최성진 ( Sung Jin Choi ) 대한내과학회 2013 대한내과학회지 Vol.84 No.2

목적: 톡소카라증은 개회충 또는 고양이회충의 충란을 섭취함으로써 발생하는 질환이며 원충에 대한 여러 가지 알레르기 반응을 통한 다양한 증상을 일으킨다. 저자들은 포항 지역의 톡소카라증의 임상적, 혈청학적 특징을 연구하여 호산구증가증 환자에서 톡소카라증을 더 의심할 수 있게 하는 소견을 알아보고자 본 연구를 시행하였다. 방법: 2008년 8월부터 2011년 5월까지 말초 호산구증가증으로 본 병원에 방문한 145명의 환자들을 대상으로 하였다. Toxocara ELISA 양성군 90명 및 음성군 55명으로 환자군을 분류하였고 나이, 성별, 알레르기 천식, 비염, 폐 또는 간의 호산구 침착 같은 임상양상뿐만 아니라 Immuno-CAP 방법을 사용하여 혈청 총 IgE, 집먼지진드기에 대한 특이 IgE와 같은 혈청학적 양상을 비교 분석하였다. 결과: 전체 대상 환자 145명 중 Toxocara ELISA 양성 90예 (62.1%) 음성 55예 (37.9%)였다. Toxocara ELISA 양성군에서 평균연령은 54.8±14.5세, 음성군에서 49.2± 20.5세로 두 군 간에 연령의 유의한 차이는 없었다(p=0.081). Toxocara ELISA 양성군에서 남성의 비율은 76.7%, 음성군에서 47.3%로 양성군에서 유의하게 높았다(p<0.01). 혈청 총 호산구수(cells/μL)는 Toxocara ELISA 양성군 2,325±361, 음성군 1,407±249로 양성군이 유의하게 많았고 (p=0.038), 총 IgE(IU/mL)는 Toxocara ELISA 양성군 2,089±196, 음성군 984±199로 양성군이 유의하게 높았다(p<0.01). Df 양성률은 Toxocara ELISA 양성군 82.3%, 음성군 44.2%로 양성군이 유의하게 높았으며(p<0.01) Dp 양성률은 Toxocara ELISA 양성군 53.2%, 음성군 42.3%로 두 군 간에 유의한 차이는 없었다(p=0.224). 폐(p<0.01)와 간(p<0.01)의 호산구 침착 및 익히지 않은 소의 간 또는 고기를 섭취한 비율(p<0.01)은 Toxocara ELISA 양성군에서 높았다. 그러나 폐와 간 침범 사이의 상관관계는 없었다(p=0.272). 알레르기 천식(p<0.01)과 비염(p<0.01) 환자의 비율은 Toxocara ELISA 음성군에서 높았다. 아토피는 Toxocara ELISA 양성군에서 유의하게 많았다(p<0.01). 그리고 Toxocara ELISA의 흡광도와 총 IgE (r=0.502, p<0.01), Toxocara ELISA의 흡광도와 총 호산구 수(r=0.256, p=0.015)간에 양의 상관관계가 있었다. 그리고 Df에 대한 특이 IgE가 Dp보다 의미있게 높은 점은(p<0.01) 포항 지역의 톡소카라 증에서 개회충 항원과 Df항원 간의 유사성이 Dp 보다 클 것이라는 것을 시사하고 있다. 결론: 포항 지역의 톡소카라증은 알레르기 천식 또는 비염이 없는 경우가 더 많고 집먼지진드기 중 Df항원에 대한 특이 IgE가 Dp보다 의미있게 높다는 특징을 보이고 있다. 이러한 특징들은 향후 호산구증가증 환자에서 톡소카라증을 진단함에 있어서 유용한 임상적, 혈청학적 소견이 될 수 있을 것으로 생각된다. Background/Aims: This study was performed to investigate the clinical and serological characteristics of toxocariasis in the Pohang region. Methods: A total of 145 patients with peripheral eosinophilia (>450 cells/μL) were enrolled and divided into two groups based on Toxocara excretory-secretory IgG enzyme-linked immunosorbent assay (ELISA) positivity, and the clinical features and serologic markers were compared between the two groups. Results: The seropositive rate of Toxocara was 62.1%. The serum total eosinophils (p=0.038), total IgE level (p<0.01), Dermatophagoides farinae (Df) seropositivity rate (p<0.01), frequency of eosinophilic tissue infiltration in the lung or liver (p<0.01), and ingestion of raw cow meat or liver (p<0.01) were higher in seropositive patients than in seronegative patients. However, the presence of asthma and rhinitis (p<0.01) were more frequent in seronegative patients. Among seropositive patients, positive correlations were observed between serum total IgE, total eosinophils, and the optical density value of the Toxocara IgG ELISA (p<0.01; p=0.015, respectively). The specific IgE to Df was significantly higher (p<0.01) than that to Dermatophagoides pteronyssinus (Dp), suggesting a cross reaction between the Df antigen and the Toxocara antigen. Conclusions: Patients who have elevated serum total IgE and have eosinophilia without allergic disease might have toxocariasis. The lower frequency of asthma or rhinitis and a tendency for higher specific IgE to Df than that to Dp could be useful findings for the diagnosis of toxocariasis in patients with eosinophilia. (Korean J Med 2013;84:203-210)

Morphological and Molecular Characterization of Toxocara apodemi (Nematoda: Ascarididae) from Striped Field Mice, Apodemus agrarius, in Korea

Hyeon-Cheol Kim,Eui-Ju Hong,류시윤,Jinho Park,Jeong Gon Cho,유도현,채준석,Kyoung-Seong Choi,박배근 대한기생충학ㆍ열대의학회 2020 The Korean Journal of Parasitology Vol.58 No.4

Adult ascarid worms from the field mice, Apodemus agrarius, were observed with a light and scanning electron microscope, and molecularly analized with 18S rRNA gene. In the scanning electron microscope, 3 prominent labia were present in the anterior end of male and female worms, but the interlabia and gubernaculum were absent. Scanning electron micrographs showed cervical alae as vestigial organs that looked like a slightly uplifted superficial sewing stitch. Total 6 pairs of post-cloacal papillae were observed on the tail of the male worms. The tail of female worms was blunt and conical shape with a spine-like structure, mucron. The eggs were sub-globular, coated with the albuminous layer and 73 by 82 μm in average size. The superficial pits of T. apodemi egg (mean 8.6×6.7 μm) are obviously bigger than those of Toxocara spp. The partial sequence of 18S rRNA showed the sequence homology of Toxocara canis(99.6%), Toxocara cati (99.4%), Toxascaris leonina (99.4%), and Toxocara vitulorum (99.2%). Conclusively, it was confirmed that ascarid nematodes, Toxocara apodemi, recovered from striped field mice in Korea are taxonomically conspecific relationship with genus Toxocara and genetic divergence from other Toxocara species.

Prevalence of Toxocara spp. eggs in sands of educational facilities and public playground in Seoul in 2012

( Jeong Yeon Kwak ),( Neung Hee Kim ),( Yong Il Kang ),( Bang Woo Shin ) 한국예방수의학회 2013 예방수의학회지 Vol.37 No.3

Visceral larva migrans (VLM) is a clinical syndrome caused by the migration of certain larval nematodes through the tissues of an aberrant host. VLM in humans is most frequently associated with Toxocara canis, the common roundworm of dogs. To demonstrate the prevalence of Toxocara spp. eggs in public playgrounds in Seoul city, soil samples collected from April to December in 2012 were examined. Eggs of parasite were found 4 of 1,174 in soil samples from public playgrounds and educational facilities in Seoul. Of the 1,174 soil samples examined, 0.34% of samples were found th be positive ova of Toxocara canis. Soil samples in educational facilities were more contaminated (0.57%) with the eggs than those in public playground area (0%). Most Toxocara canis eggs in sands were found in the autumn.

Prevalence of Toxocara spp. eggs in sands of educational facilities and public playground in Seoul in 2012

곽정연,김능희,강영일,신방우 한국예방수의학회 2013 예방수의학회지 Vol.37 No.3

Visceral larva migrans (VLM) is a clinical syndrome caused by the migration of certain larval nematodes through the tissues of an aberrant host. VLM in humans is most frequently associated with Toxocara canis, the common roundworm of dogs. To demonstrate the prevalence of Toxocara spp. eggs in public playgrounds in Seoul city, soil samples collected from April to December in 2012 were examined. Eggs of parasite were found 4 of 1174 in soil samples from public playgrounds and educational facilities in Seoul. Of the 1174 soil samples examined, 0.34% of samples were found th be positive ova of Toxocara canis. Soil samples in educational facilities were more contaminated(0.57%) with the eggs than those in public playground area(0%). Most Toxocara canis eggs in sands were found in th autumn.

Case report : Case report of Toxocara canis migration to canine brain

( Moon Young Rhyoo ),( Kyung Hyun Lee ),( Ji Youl Jung ),( You Chan Bae ),( Hyun Kyoung Lee ),( Woo Hee Park ),( Soon Seek Yoon ),( Oun Kyung Moon ),( Myoung Heon Lee ) 한국예방수의학회 2013 예방수의학회지 Vol.37 No.2

Toxocara canis is a gastrointestinal helminthes of dogs found all over the world. When dogs ingest the infectious eggs of Toxocara canis, the eggs hatch and larvae penetrate the intestinal wall carried by migration to a wide variety of tis-sues. Despite its zoonotic effects, there have been few reports on dogs diagnosed as canine ascaridiasis in Korea. In this report, we present a case of canine toxocariasis by histopathologic finding and PCR assay. H&E stain showed granulomatous inflammation and intralesional larva in organs and even the cortex of the cerebellum. Toxocara canis was confirmed in the PCR assay where DNZ was extracted from heart, liver and cerebellum.

타조 생간 섭취 후 발생한 개회충증에 의한 심한 호산구증가증

강성윤 ( Sung Yoon Kang ),강민규 ( Min Kyu Kang ),김미영 ( Mi Yeong Kim ),이서영 ( Suh Young Lee ),김태완 ( Tae Wan Kim ),이소희 ( So Hee Lee ),김세훈 ( Sae Hoon Kim ),강혜련 ( Hye Ryun Kang ),박흥우 ( Heung Woo Park ),장윤석 ( Yo 대한천식알레르기학회 2011 천식 및 알레르기 Vol.31 No.2

Toxocariasis is an infection in a human host caused by Toxocara canis. Most human infections occur in younger persons who eat dirt containing embryonated eggs or larvae in raw or uncooked foods, particularly raw liver. Toxocariasis can produce various clinical manifestations associated with hypereosinophila and eosinophilic infiltration into the internal organs in the form of abscess or granuloma. We report the case of a 63-year-old man with hypereosinophilia caused by Toxocara infection, who had a history to eat raw ostrich liver 6 months before. He had general weakness and weight loss after ingestion of raw ostrich liver and was then referred to our hospital for the evaluation of hematologic malignancies because he had hypereosinophilia, anemia and a reversed albumin-globulin (A/G) ratio. Toxocara infection was confirmed by enzyme-linked immunosorbent assay for Toxocara canis. He was treated with albendazole for 2 weeks and was discharged from the hospital without any complications. At the 4 month and 1 year follow-up visits, his clinical symptoms improved, the total eosinophil counts were markedly reduced, and the A/G ratio. (Korean J Asthma Allergy Clin Immunol 2011;31:144-147)

實驗的 犬蛔蟲症 診斷에 있어서 여러가지 抗原의 效用性

홍재훈,주종윤 啓明大學校 醫科大學 1999 계명의대학술지 Vol.18 No.2

Toxocariasis is produced by the migration of the Toxocara canis larvae in extra-intestinal tissues in unnatural hosts or under suitable conditions in natural hosts. Serodiagnosis and treatment may be difficult. The present study was performed to observe the specific reacting antigenic bands of crude extract Toxocara canis adult and larval worm and excretory-secretory matirials. Its reaction to the serum IgG antibody obtained from experimentally infected mice. For adult antigen, after homogenization with adult worm, the homogenate was extracted at 4℃ for 2 days and centrifuged at 20,000 g for 1 hr. The supernatant was used as adult antigen. For larval antigen, after homogenization with larvae using ultrasonic homogenizer. the homogenate was handled by same method as adult antigen. The supernatant was used as larval antigen. ES antigen was collected excretory-secretory materials of Toxocara canis larvae cultured in RPMI 1640. Infected sera were obtained from mice infected with Toxocara canis embryonated eggs (A group : infected with 100 embryonated eggs ; B group 500 embryonated eggs). The control sera were obtained from non-infected mice. Serum levels of IgG antibody by ELISA using crude antigen increased from 14 day after infection in adult antigen and ES antigen. But it was not observed the difference between infected sera and non-infected sera in larval antigen. And it was observed very little difference of A group and B group. The best result extressed as positive/negative ratio could be obtained when ES antigen was used. So ES antigen will be able to represent a antigen. By SDS-PAGE in 4-20% linear gel, it was showed to difference of each other antigens. By immunoblot, serum antibody was recognized in ES antigen ; major protein bands with molecular weight of 65.6, 51, 33, 27 and 24.5 kDa bands respectively. Among them 24.5 kDa band reacted even in non-infected control sera. The result of reaction was similar between adult and larval antigen, but intensity of reaction was very weak. These results suggest that Toxocara canis ES antigen will be able to represent a antigen that can be used in the diagnosis of toxocariasis.

여서도패총 출토 분석(糞石)에 관한 연구

안덕임(An, DeogIm),서민(Seo, Min),김건수(Kim, GeonSu) 한국상고사학회 2008 한국상고사학보 Vol.60 No.-

본 연구에서는 선사시대의 식생활, 질병, 고환경 복원 등에 연구목적을 두고 신석기시대의 여서도패총에서 발견된 분석(糞石)에 관한 기생충분석이 시도되었다. 기생충 분석 결과 간흡충(Clonorchis sinensis), 회충(Ascaris lumbricoides), 회충류(Toxocara sp.) 3종의 기생충란이 검출되었다. 시료에서 검출된 기생충란과 시료의 고고학적인 배경을 고려할 때 분석시료는 사람 또는 개의 것으로 판단된다. 회충, Toxocara sp. 충란의 검출로 미루어 당시 위생상태가 그다지 좋지 않았음을 추정할 수 있다. 분석에서 검출된 간흡층란을 통하여 당시의 식습관을 추정하였다. 간흡충란의 감염경로를 고려할 때 분석을 남긴 사람 또는 개는 감염된 민물고기를 날것으로 먹었거나 불완전하게 조리된 상태에서 먹었을 것으로 판단된다. 개가 이러한 먹이를 먹게 된 것은 당시 사람들의 식습관과 관련이 있을 것이다. 개는 사람들이 먹는 음식이나 그 찌꺼기로 사육되며 또 사람들이 버린 음식물 쓰레기 더미를 뒤지고 먹는 습성이 있기 때문이다. 이로 미루어 당시 사람들이 민물고기를 날로 먹는 습속을 가지고 있었을 가능성이 있으며 이로 인해 사람들 사이에 간흡층이 유행하였을 가능성이 있을 것으로 추정된다. 회충류는 비교적 오랜 시간에 걸쳐 전 세계적으로 분표한 기생충이다. 이에 비하여 간흡층은 검출 연대가 늦은데 현재까지 자료에 의하면 본 여서도패총에서 발견된 간흡충란이 고고학적 유적에서 발견된 간흡층란 가운데 세계적으로 가장 오래된 자료일 것이다. In this study, a coprolite from the Neolithic Yoseodo shell midden, Korea, was analyzed to reconstruct palaeodiet, diseases, palaeoenvironment, etc. As a result, the eggs of Clonorchis sinensis, Ascaris lumbricoides and Toxocara sp. were found. On the basis of parasitic and archaeological evidence, it is likely that the coprolite resulted from a man or a dog. From the eggs of Ascaris lumbricoides and Toxocara sp., it can be assumed that sanitary conditions in the past were somewhat poor. The eggs of Clonorchis sinensis can help to infer dietary habits at that time. Considering the infection route of Clonorchis sinensis, the man or the dog that excreted the coprolite ate raw or undercooked freshwater fish, or was fed with them. This might be related with dietary habits of people. Because people feel leftovers of their meals, and because dogs scavenge around refuse heaps, people and dog diets may considerably overlap. Therefore, it is possible that people at that time might have dietary habit of eating raw or undercooked freshwater fish and as a result, Clonorchis sinensis infection might be widespread among people. The eggs of Ascaris lumbricoides and Toxocara sp. habe been recorded worldwide for a relatively long period of time. The eggs of Clonorchis sinensis have been detected for short period of time compared to those of the species, and this is so far the first record of Clonorchis sinensis eggs from archaeological sites in the world.

개회충 척수염의 다양한 자기공명영상 소견

박선영,박경석,이영준,이준우,배윤정,강유선,AHN JOONG MO,강흥식 대한영상의학회 2020 대한영상의학회지 Vol.81 No.1

Purpose To describe magnetic resonance imaging (MRI) findings in 10 cases of Toxocara canis myelitis and to analyze these findings to aid in the diagnosis of this condition. Materials and Methods From June 2015 to March 2018, we retrospectively analyzed the electronic medical records and MR images of patients who were diagnosed with Toxocara canis myelitis. The analysis of the MR images was based on a discussion between an experienced spinal radiologist and a radiology resident. Results This study classified MRI findings into the following two types. Type 1 was defined as central and diffuse T2 high signal intensity on the axial plane, which was observed in 50% of all cases. All lesions showed avid enhancement, mostly in the posterolateral or posterior region (4 cases, 80%). Type 2 was defined as wedge-shaped or focal T2 high signal intensity in the posterolateral or posterior region and corresponded to the remaining 50% of the cases. In this case, the extent of the lesion was relatively small and contrast enhancement was observed in only one case. Conclusion This study revealed that various imaging findings could be observed in cases of Toxocara canis myelitis, and the findings were classified into two types. 목적 개회충 척수염의 자기공명영상 10예를 보고하고, 개회충 척수염 진단에 도움이 되는 다양한 영상 소견을 분석하고자 한다. 대상과 방법 2015년 6월부터 2018년 3월까지 본원에서 개회충 척수염으로 진단받은 환자들을 대상으로 의무기록과 촬영한 척추 자기공명영상 소견을 척추영상 전문의 1명과 영상의학과 전공의 1명이 후향적으로 분석하였다. 결과 본 연구는 개회충 척수염의 자기공명영상 소견을 다음 두 가지로 분류하였다. 먼저 type 1은 축상면에서 중심부, 미만성 T2 고신호강도가 보이는 경우로 50%가 해당되며 모든 환자에서 병변의 뚜렷한 조영증강이 있었으며 대부분의 경우(4예, 80%)에서 후외측 또는 후방의결절성 조영증강을 보였다. Type 2는 후외측 혹은 후방에서 쐐기 모양 또는 국소적 T2 고신호강도의 병변이 보이는 경우로 분류하였으며, 50%에 해당한다. 이 경우 병변의 범위가 상대적으로 작았고 조영증강은 1예에서만 관찰되었다. 결론 개회충 척수염의 자기공명영상이 다양한 소견으로 나타날 수 있음을 확인하였고 이를통해 개회충 척수염의 자기공명영상 소견을 2가지로 분류하여 제시하였다.