Visceral Larva Migrans Associated With Gecko Ingestion

Abstract and Introduction

Abstract

Introduction Visceral larva migrans is a syndrome caused by an infection with larval helminths, which may result in partial or general pathological changes in host tissues. Due to the difficulty in finding the causative parasites, the diagnosis of visceral larva migrans is generally based on compatible clinical signs, epidemic history, marked eosinophilia and pathological examination, especially positive serological test results and the disappearance of symptoms after specific treatment.
Case presentation We report here the case of a 21-year-old Chinese man who, having ingested living earthworms and geckos at a witch's suggestion, presented with fatigue and wordlessness lasting for one year along with elevated transaminase levels for one month. Clinical examination showed eosinophilia, elevated transaminase levels, nodular lesions in his liver and typical pathological characteristics of hepatic visceral larva migrans. After four courses of anthelmintic therapy, our patient presented with sustaining improvement of clinical manifestations and normalization of laboratory data.
Conclusions Because of the difficulty in making a definite diagnosis, anthelmintic therapy should be performed in patients with a suspected diagnosis of visceral larva migrans based on their epidemic history and presence of typical manifestations, especially when the serological test results are negative. Furthermore, patients with severe parasite infection may require multiple anthelmintic therapies in order to eliminate the parasites.

Introduction

Visceral larva migrans (VLM) is a syndrome caused by an infection with larval helminths. They invade aberrant hosts, such as human beings, but instead of developing into adult worms, they migrate through host tissues, resulting in partial or general pathological changes. A cause of zoonosis, the parasites can finish their natural life cycles in free-living form, which is vital for maintaining their infection capability. While VLM has a worldwide distribution, it is most commonly seen in the tropical and developing countries, where the sanitary and hygienic conditions are poor.

The clinical manifestations of VLM are varied, depending on which organs are involved. Common clinical manifestations are marked eosinophilia and hyperglobulinemia, caused by the host immune response to the larval helminths.^[1] Due to the difficulty in finding the causative parasites, the diagnosis of VLM is generally based on compatible clinical signs, epidemic history, marked eosinophilia and pathological examination, especially positive serological test results and the disappearance of symptoms after specific treatment.^[2] Here, we report a case in which the patient was suspected of VLM associated with more than one kind of parasitic infection, caused by the ingestion of earthworms and geckos.