İnsan toksokariyazı

Yıl 2013, Cilt: 70 Sayı: 2, 113 - 134, 01.06.2013

Mehmet Burak Selek Orhan Baylan

Öz

köpek nematodu Toxocara canis ve kedi nematodu T.cati larvalarının sindirim yoluyla alınmasıyla oluşan parazitik bir enfeksiyondur. Enfekte köpek ve kedilerin dışkılarıyla dış ortama atılan Toxocara yumurtaları içinde embriyon gelişerek enfektif hale gelirler. İnsanlar, özellikle çocuklar, embriyonlu Toxocara yumurtalarını sindirim yoluyla alarak enfekte olabilirler. İnce bağırsakta yumurtadan çıkan larvalar, ince bağırsak duvarına penetre olup kan dolaşımına geçerek vücudun diğer bölgelerine göç eder. Göç eden larvalar, doku ve organlara zarar verebilmesine ve özellikle beyin tutulumunda ciddi morbidite oluşturabilmesine rağmen hastalık genellikle iyi huylu, asemptomatik ve kendini sınırlayan bir seyir izlemektedir. Visseral larva migrans VLM önemli organlara larval migrasyonun neden olduğu sistemik bir hastalık ve oküler larva migrans OLM göz ve optik sinirlerde sınırlı bir hastalık , toksokariyazın iki temel klinik sudur. Ayrıca son zamanlarda biri çoğunlukla çocuklarda gizli toksokariyaz , diğeri daha çok yetişkinlerde yaygın toksokariyaz görülen daha hafif klinik seyirli iki sendrom daha tanımlanmıştır. Tanı, genellikle klinik belirti / bulgular, hastanın epidemiyolojik temeli ve immünolojik yöntemlerin ELISA veya Westernblot kullanımı ile konmaktadır. Öte yandan kesin tanının konması, larvaların biyopsi veya otopside gösterilmesini gerektirdiğinden oldukça güçtür. Çoğu toksokariyaz olgusu, herhangi bir tedavi gerektirmeden iyileşir. VLM, birincil olarak albendazol veya mebendazol gibi antihelmintik ilaçlarla tedavi edilmektedir. OLM tedavisi ise daha zordur ve genellikle steroidler gibi gözde ilerleyici hasar oluşumunu önleyen işlemleri kapsamaktadır. Ayrıca şiddetli olguların tedavisinde lazer fotokoagülasyon ve kriyoretinopeksi kullanılabilmektedir. T.canis enfeksiyonunun eradikasyonu, parazitin yaşam döngüsünün karmaşıklığı sebebiyle zor olduğu için her zaman toksokariyazdan korunma tercih edilir. Toxocara yumurtaları, dış ortamda uygun koşullar altında aylarca, hatta yıllarca hayatta kalmasını sağlayan güçlü bir koruyucu tabakaya sahiptir. Bu derlemede, halen önemini koruyan ve romatolojik, dermatolojik ve respiratuvar hastalıklara neden olduğundan şüphelenilen insan toksokariyazı hakkında güncel bilgiler sunulmuştur

Anahtar Kelimeler

Toksokariyaz, Toxocara canis, cati, visceral larva migrans, ocular larva migransToxocara cati, visseral larva migrans, oküler larva migrans

Human Toxocariasis

Öz

Human toxocariasis is an parasitic infection caused by the ingestion of larvae of dog nematode Toxocara canis and less frequently of cat nematode T.cati. Toxocara eggs, shed to environment by infected dogs’ and cats’ droppings, become infective by embryonation. Humans, particularly children, can be infected by accidentally ingesting embryonated Toxocara eggs. Larvae hatch in the small intestine, penetrate the intestinal wall and migrate to other parts of body via the bloodstream. It is generally a benign, asymptomatic, and self-limiting disease, although migrating larvae can cause damage to tissues and organs, especially brain involvement can cause severe morbidity. The two main clinical presentations of toxocariasis are visceral larva migrans VLM a systemic disease caused by larval migration through major organs and ocular larva migrans OLM a disease limited to the eyes and optic nerves . There are also two less-severe syndromes which have recently been described, one mainly in children covert toxocariasis and the other mainly in adults common toxocariasis . Diagnosis is usually made by clinical signs/symptoms, epidemiological background of the patient and the use of immunological methods ELISA or western-blot . On the other hand definitive diagnosis is much more challenging, since

Anahtar Kelimeler

Toxocariasis, Toxocara canis, Toxocara cati, visceral larva migrans, ocular larva migrans

Kaynakça

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