case Report Bánusz R Complaints pallor fatigue loss of appetite Anamnesis the patient was coming from a rural area picageophagia ID: 793024
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Slide1
„
Eosinophil
” Kevin
case
Report
Bánusz
R.
Slide2Complaints
:
pallor, fatigue, loss of appetiteAnamnesis:the patient was coming from a rural areapica-geophagiachronic iron deficient anemia beginning at infancyPhysical examination: on admissionpale skin and mucous membranes liver 3cm enlargedseveral pea-sized lymphoglandulae in every region
K.P. – 4 Year Old Boy
2nd
Department
of
Paediatrics
Slide3Laboratory
findings
Laboratory test: iron: 3umol/l total iron binding capacity: 68umol/l ferritin: 20ng/ml LDH: 472U/l GPT: 49U/l GGT: 17U/lBlood test: Hgb: 87g/l MCV: 59,1fL MCH: 17,9pg Thr: 450G/l WBC count: 42G/lBlood smear: eosinophil segment 63% lymphocyte 15% stick forms2% granulocyte 15% monocyte
5%
Slide4Laboratory
findings
Laboratory test: iron: 3umol/l total iron binding capacity: 68umol/l ferritin: 20ng/ml LDH: 472U/l GPT: 49U/l GGT: 17U/lBlood test Hgb: 87g/l MCV: 59,1fL MCH: 17,9pg Thr: 450G/l WBC count: 42G/lBlood smear: eosinophil segment 63% lymphocyte 15% stick forms2% granulocyte 15% monocyte
5%
Slide5Laboratory
findings
Laboratory test: iron: 3umol/l total iron binding capacity: 68umol/l ferritin: 20ng/ml LDH: 472U/l GPT: 49U/l GGT: 17U/lBlood test: Hgb: 87g/l MCV: 59,1fL MCH: 17,9pg Thr: 450G/l WBC count: 42G/lBlood smear: eosinophil segment 63% lymphocyte 15% stick forms2% granulocyte 15% monocyte
5%
Slide6Laboratory
findings
Laboratory test: iron: 3umol/l total iron binding capacity: 68umol/l ferritin: 20ng/ml LDH: 472U/l GPT: 49U/l GGT: 17U/lBlood test: Hgb: 87g/l MCV: 59,1fL MCH: 17,9pg Thr: 450G/l WBC count: 42G/lBlood smear: eosinophil segment 63% lymphocyte 15% stick forms2% granulocyte 15%
monocyte
5%
Slide7Abdominal
ultrasound
: - multifocal intrahepatic lesions - hepatomegaly
Slide8Iron
deficient
anemia elevated WBC count (45G/l)marked eosinophilia (63%)multifocal intrahepatic lesions, hepatomegaly MALIGNANCY?(chronic eosinophilic leukemia)INFECTOLOGICAL ORIGIN?(parasite infection)Hepatologist’s opinion: infectological originInfectolologist’s opinion: chest, abdominal CT
Slide9multifocal
intrapulmonary lesionsmultifocal intrahepatic lesionsAbdominal, chest CT scan
Slide10Bone
marrow
aspiration&biopsy - abnormally high eosinophil count, without signs of blast production - impaired erythropoesis & myelopoesisOphtalmoscopy: normalUltrasound of the heart:: negative
Slide11Stool
microbiological
analysis: NEGATIVEResults of serologic examination Toxoplasma gondii /ELISA/: NEGATIVEToxocara IgG /ELISA/: positiveStool microbiological analysis protozoon, wormegg, larvamigrationSerologic tests for toxocariasis, toxoplasmosis
Slide12Surgeon
’s
opinion
: - laparoscopic liver biopsy Laparoscopic liver biopsyOn the diaphragmatic surface of both lobes of the liver 15-20 pea-been sized white masshistologyeosinophilic granulomarefers to parasitic infection Laparoscopic liver biopsy
Slide13Toxocara
Infection
ALBENDAZOLVISCERAL LARVA MIGRANSDiagnosis
Slide14Albendasole
Therapy
Inhibition of tubulin polimerisation Decrease of cytosceletal microtubuli Dosis: 400 mg/day per os for 5 days
Slide15Therapy
03.16.
US: complex cysta04.19. 05.17. 06.14. 07.12. US: normal08.17. CT: regression
09.20.
10.18
.
Slide16Toxocara
http://animal.discovery.com
Slide17Toxocara cati
Toxocariasis
is a systemic infection caused by ingestion of larvae of the dog tapeworm Toxocara canis or the cat tapeworm Toxocara cati.RoundwormClass: NematodaGenus Tocara cani – Toxocara cati
Size
:
female
: 5-18cm
larvae
: 0,5mm
male
: 4-10cm
Host
:
cats
,
dogs
Slide18Life cycle of toxocara
Slide19Slide20Toxocariasis
Origin
of
infection: dog, cat stoolHighest rate of occurance: 2-8 years old child (pica, contaminated toys, food )Types: immunologic reaction & number of larvaeHidden toxocariasis – light infection asymptomaticOcular larva migrans – isolated, unilateral ocular diseaseVisceral larva
migrans
–
systemic
,
inflammation
of
internal
organs
Slide21Aspecific
symptoms
:Fever- subfebrilityNo appetiteWeight loss – anorexiaNausea - vomitingfatiguesweatheadachelymphadenitisSleeping disorderschronic urticariaSymptomsOrgan specific symptoms:Liver: hepatomegaly, abdominal painLung: dypnoe, cough, pneumonia, RDSHeart:
myocarditis
CNS:
generalised
seizures
,
encephalitis
Eye
:
decreased
visus
,
periorbital
oedema
,
endophtalmitis
,
blindness
Slide22Diagnostics
:
Finding Toxocara larvae within a patient is the only definitive diagnosis for toxocariasis; (biopsy, ophtalmological examination) – Definitve!Serological examination (ELISA)Laboratory test (leukocytosis, eosinophilia, anemia hypergammaglobulinemia)Cinical manifestations (hepatomegaly, fever, organspecific symptoms)Imaging (echo, CT, MRI)Anamnesis (pets, pica)Therapy: 1. antiparasite treatment: albendasole, mebendasole 2. corticosteroid, antihistamine 3. antiparasite
treatment
of
animals
Diagnosis