2.  Complaints: pallor, fatigue, loss of appetite  Anamnesis:  the patient was coming from a rural area  pica-geophagia  chronic iron deficient anemia beginning at infancy  Physical examination: on admission  pale skin and mucous membranes  liver 3cm enlarged  several pea-sized lymphoglandulae in every region

3.  Laboratory test: iron: 3umol/l total iron binding capacity: 68umol/l ferritin: 20ng/ml LDH: 472U/l GPT: 49U/l GGT: 17U/l  Blood test: Hgb : 87g/l MCV: 59,1fL MCH: 17,9pg Thr: 450G/l WBC count: 42G/l Blood smear: eosinophil segment 63% lymphocyte 15% stick forms2% granulocyte 15% monocyte 5%

4.  Laboratory test: iron: 3umol/l total iron binding capacity: 68umol/l ferritin: 20ng/ml LDH: 472U/l GPT: 49U/l GGT: 17U/l  Blood test Hgb: 87g/l MCV: 59,1fL MCH: 17,9pg Thr: 450G/l WBC count: 42G/l Blood smear: eosinophil segment 63% lymphocyte 15% stick forms2% granulocyte 15% monocyte 5%

5.  Laboratory test: iron: 3umol/l total iron binding capacity: 68umol/l ferritin: 20ng/ml LDH: 472U/l GPT: 49U/l GGT: 17U/l  Blood test: Hgb: 87g/l MCV: 59,1fL MCH: 17,9pg Thr: 450G/l WBC count: 42G/l Blood smear: eosinophil segment 63% lymphocyte 15% stick forms2% granulocyte 15% monocyte 5%

6.  Laboratory test: iron: 3umol/l total iron binding capacity: 68umol/l ferritin: 20ng/ml LDH: 472U/l GPT: 49U/l GGT: 17U/l  Blood test: Hgb: 87g/l MCV: 59,1fL MCH: 17,9pg Thr: 450G/l WBC count: 42G/l Blood smear: eosinophil segment 63% lymphocyte 15% stick forms2% granulocyte 15% monocyte 5%

7.  Abdominal ultrasound: - multifocal intrahepatic lesions - hepatomegaly

9. multifocal intrapulmonary lesions multifocal intrahepatic lesions

10.  Bone marrow aspiration&biopsy - abnormally high eosinophil count, without signs of blast production - impaired erythropoesis & myelopoesis  Ophtalmoscopy: normal  Ultrasound of the heart:: negative

11.  Stool microbiological analysis: NEGATIVE  Results of serologic examination  Toxoplasma gondii /ELISA/: NEGATIVE  Toxocara IgG /ELISA/: positive Stool microbiological analysis protozoon, wormegg, larvamigration Serologic tests for toxocariasis, toxoplasmosis

12.  Surgeon’s opinion: - laparoscopic liver biopsy  Laparoscopic liver biopsy ▪ On the diaphragmatic surface of both lobes of the liver 15-20 pea-been sized white mass  histology ▪ eosinophilic granuloma ▪ refers to parasitic infection

14. Albendasole  Inhibition of tubulin polimerisation Decrease of cytosceletal microtubuli  Dosis: 400 mg/day per os for 5 days

15. 1. 03.16. US: complex cysta 2. 04.19. 3. 05.17. 4. 06.14. 5. 07.12. US: normal 6. 08.17. CT: regression 7. 09.20. 8. 10.18.

16. http://animal.discovery.com

17.  Toxocariasis is a systemic infection caused by ingestion of larvae of the dog tapeworm Toxocara canis or the cat tapeworm Toxocara cati.  Roundworm  Class: Nematoda  Genus Tocara cani – Toxocara cati  Size: female: 5-18cm larvae: 0,5mm male: 4-10cm Host: cats, dogs

20. Origin of infection: dog, cat stool Highest rate of occurance : 2-8 years old child (pica, contaminated toys, food ) Types: immunologic reaction & number of larvae 1.Hidden toxocariasis – light infection asymptomatic 2.Ocular larva migrans – isolated, unilateral ocular disease 3.Visceral larva migrans – systemic, inflammation of internal organs

21. Aspecific symptoms:  Fever- subfebrility  No appetite  Weight loss – anorexia  Nausea - vomiting  fatigue  sweat  headache  lymphadenitis  Sleeping disorders  chronic urticaria Organ specific symptoms:  Liver: hepatomegaly, abdominal pain  Lung: dypnoe, cough, pneumonia, RDS  Heart: myocarditis  CNS: generalised seizures, encephalitis  Eye: decreased visus, periorbital oedema, endophtalmitis, blindness

22.  Diagnostics: 1. Finding Toxocara larvae within a patient is the only definitive diagnosis for toxocariasis; (biopsy, ophtalmological examination) – Definitve! 2. Serological examination (ELISA) 3. Laboratory test (leukocytosis, eosinophilia, anemia hypergammaglobulinemia) 4. Cinical manifestations (hepatomegaly, fever, organspecific symptoms) 5. Imaging (echo, CT, MRI) 6. Anamnesis (pets, pica)  Therapy: 1. antiparasite treatment: albendasole, mebendasole 2. corticosteroid, antihistamine 3. antiparasite treatment of animals