This study aimed to determine the status of common parasitic disease in Korea in 2019. Twelve parasitic diseases were selected: toxocariasis, anisakiasis, paragonimiasis, sparganosis, cysticercosis, toxoplasmosis, clonorchiasis, enterobiasis, trichuriasis, trichomoniasis, cryptosporidiosis, and malaria. Their biology, epidemiology, pathogenesis, symptoms and signs, diagnosis, treatment, and prognosis were evaluated. Of the parasitic diseases, toxocariasis was the most prevalent according to serological results. Anisakiasis should be considered when acute gastrointestinal symptoms occur with a recent past history of raw seafood ingestion. Paragonimiasis, sparganosis, and cysticercosis can be diagnosed using an enzyme-linked immunosorbent assay; thus, enzyme-linked immunosorbent assay needs to be performed for suspected cases. Toxoplasmosis and cryptosporidiosis are opportunistic infections. The symptoms and signs are aggravated under immunocompromised conditions. Although the egg positivity rate of Clonorchis sinensis is higher than that of other intestinal parasitic diseases, encountering patients with complaints of symptoms caused by clonorchiasis is rare because the worm burden is low. Trichomoniasis is usually managed by gynecologists; therefore, it should be included in the differential diagnoses of vaginal diseases. The annual number of malaria cases has decreased, although it remains at approximately 500 cases per year. Malaria should be suspected when symptoms such as intermittent fever, headache, and splenomegaly are noted especially when the patients reside near demilitarized zones. Although the prevalence and number of reported cases of parasitic diseases have decreased in Korea, we should consider parasitic diseases in the list of differential diagnoses.
Animals ; Anisakiasis ; Biology ; Clonorchiasis ; Clonorchis sinensis ; Cryptosporidiosis ; Cysticercosis ; Diagnosis ; Diagnosis, Differential ; Eating ; Enterobiasis ; Enzyme-Linked Immunosorbent Assay ; Epidemiology ; Fever ; Headache ; Humans ; Korea ; Malaria ; Opportunistic Infections ; Ovum ; Paragonimiasis ; Parasitic Diseases ; Prevalence ; Prognosis ; Republic of Korea ; Seafood ; Sparganosis ; Splenomegaly ; Toxocariasis ; Toxoplasmosis ; Trichuriasis ; Vaginal Diseases

Toxocara canis is an important roundworm of canids and a fearsome animal parasite of humans. Human infections can lead to syndromes called visceral larva migrans (VLM), ocular larva migrans, neurotoxocariasis, and covert toxocariasis. VLM is most commonly diagnosed in children younger than 8 years of age, but adult cases are relatively frequent among those infected by ingesting the raw tissue of paratenic hosts in East Asia. This research reports the case of a 59-year-old man with sigmoid colon cancer, who visited our institution for surgery. An intraperitoneal mass was found on preoperative computed tomography, and it was thought to be a metastatic mass from sigmoid colon cancer. A postoperative histologic examination and serum test showed eosinophilic granuloma due to toxocariasis. Diagnosis of VLM is often difficult and highly suspicious in adults. Researchers suggest, although rarely, that VLM be included in the differential diagnosis as a cause of intraperitoneal tumors.
Adult ; Animals ; Child ; Colon, Sigmoid* ; Colonic Neoplasms ; Diagnosis ; Diagnosis, Differential ; Eosinophilic Granuloma ; Far East ; Humans ; Larva Migrans ; Larva Migrans, Visceral ; Middle Aged ; Neoplasm Metastasis ; Parasites ; Research Report ; Sigmoid Neoplasms* ; Toxocara canis* ; Toxocara* ; Toxocariasis

Eosinophilic synovial effusion is rarely observed in patients with inflammatory nature of synovial fluid, and the differential diagnosis includes parasitic arthritis. Toxocariasis is the one of the most common forms of helminthiasis worldwide and has been reported as a common cause of peripheral blood eosinophilia in Korea. However, joint involvement has been rarely reported in adults with toxocariasis in the English-language literature. Here, we report the first Korean case of a female presenting with acute monoarthritis with an increased number of eosinophils in the peripheral blood and synovial fluid, who was finally diagnosed with toxocariasis.
Adult ; Arthritis ; Diagnosis, Differential ; Eosinophilia ; Eosinophils* ; Female ; Helminthiasis ; Humans ; Joints ; Korea ; Synovial Fluid ; Toxocariasis*

PURPOSE: To investigate the clinical features and treatment outcomes of ocular toxocariasis in Jeju Island using ultra-wide-field fundus photography. METHODS: We retrospectively reviewed the medical records of 40 eyes of 37 patients who were diagnosed with ocular toxocariasis based on clinical aspects and serologic tests. The quality of history-taking was assessed and peripheral blood samples were analyzed. Ocular characteristics were evaluated using ultra-wide-field fundus photography and optical coherence tomography. Changes in visual acuity and funduscopic findings after treatment were also analyzed. RESULTS: The average age of the patients was 57.9 years and the mean Toxocara canis IgG titer was 1.979 ± 0.486. The most common fundus findings were vitreous opacity (63.6%) and granuloma (60%). Granulomas that were not initially observed within the field of view of conventional fundus photography were found using ultra-wide-field imaging in 15 eyes (62.5%). Ultra-wide-field fluorescein angiography showed peripheral vascular leakage in 16 eyes (69.6%). Treatment with oral prednisolone and albendazole resulted in average vision improvements of 0.19 ± 0.07 logMAR (p = 0.031) as well as significant improvements in anterior chamber inflammation and vitreous opacity. Combination therapy led to a significantly lower recurrence rate than prednisolone monotherapy (p = 0.049). CONCLUSIONS: In Jeju Island, the mean Toxocara canis IgG titer of ocular toxocariasis was high. The incidences of vitreous opacity and granulomas were also high. Ultra-wide-field fundus imaging was useful for finding peripheral retinal lesions and peripheral vascular leakage that were not observed within the field of view of conventional fundus photography. Ultra-wide-field fundus imaging was valuable not only during clinical diagnosis, but also on follow-up evaluations of ocular toxocariasis. Treatment with oral prednisolone and albendazole effectively improved ocular inflammation and visual acuity and helped reduce the recurrence rate.
Albendazole ; Anterior Chamber ; Diagnosis ; Fluorescein Angiography ; Follow-Up Studies ; Granuloma ; Humans ; Immunoglobulin G ; Incidence ; Inflammation ; Medical Records ; Photography* ; Prednisolone ; Recurrence ; Retinaldehyde ; Retrospective Studies ; Serologic Tests ; Tomography, Optical Coherence ; Toxocara canis ; Toxocariasis* ; Uveitis ; Visual Acuity

Toxocariasis is an important cause of secondary hypereosinophilia in Korea. Here, we describe a rare case of toxocariasis presenting as transient global amnesia due to secondary hypereosinophilia. A 44-year-old male visited the Emergency Department (ED) for transient global amnesia. He ate raw cow liver and omasum 2 weeks before the ED visit. The initial peripheral blood eosinophil count was 15,250/µL and serologic test for serum specific IgG antibodies to Toxocara canis larval antigen was positive. Radiologic studies revealed multiple small embolic infarctions of brainwithout cardioembolic sources or vascular abnormalities. He was treated with systemic corticosteroid, and neither neurologic deficit nor motor deficit was left. In our current case, the patient have a history of frequently eating raw cow liver and omasum, and his total IgE level was extremely high (>5,000 IU/mL). Thus, the patient was diagnosed as having toxocariasis and secondary hypereosinophilia. Toxocariasis should be considered in the differential diagnosis in patients with eosinophilia and atypical neurologic symptoms, such as transient amnesia.
Adult ; Amnesia ; Amnesia, Transient Global* ; Antibodies ; Cerebral Infarction ; Diagnosis, Differential ; Eating ; Emergency Service, Hospital ; Eosinophilia ; Eosinophils ; Humans ; Immunoglobulin E ; Immunoglobulin G ; Infarction ; Korea ; Liver ; Male ; Neurologic Manifestations ; Omasum ; Serologic Tests ; Toxocara canis ; Toxocariasis*

PURPOSE: To report a case of macular hole secondary to presumptive infectious posterior uveitis involving the fovea that spontaneously resolved after medical treatment. CASE SUMMARY: A 33-year-old male visited our clinic for decreased visual acuity in his left eye. He was treated with immunosuppressive therapy including steroid after bone marrow transplantation. Best corrected visual acuity (BCVA) was 0.05 in the left eye. Slit lamp examination showed mild anterior vitritis, and fundus examination showed a macular hole with surrounding whitish infiltration at the fovea. Spectral domain optical coherence tomography (SD-OCT) revealed a full thickness macular hole with surrounding hyper-reflective masses with an infiltration-like appearance involving all retinal layers. Serum anti-toxocara IgG was positive (ELISA), and eosinophil count and immunoglobulin E was elevated. Under diagnosis of presumptive ocular toxocariasis, the patient was treated with albendazole. After medical treatment for toxocariasis, the whitish foveal infiltration became smaller and more discrete. SD-OCT revealed spontaneous closure of the macular hole, and BCVA was improved to 0.4 after a 4-month follow-up. CONCLUSIONS: We report a macular hole complicated by presumptive infectious posterior uveitis that experienced spontaneous closure after medical treatment for underlying infection.
Adult ; Albendazole ; Bone Marrow Transplantation ; Diagnosis ; Eosinophils ; Follow-Up Studies ; Humans ; Immunoglobulin E ; Immunoglobulin G ; Immunoglobulins ; Male ; Retinal Perforations* ; Retinaldehyde ; Tomography, Optical Coherence ; Toxocariasis ; Uveitis, Posterior* ; Visual Acuity

PURPOSE: This study evaluated the prevalence of ocular toxocariasis (OT) in patients with uveitis of unknown etiology who visited a tertiary hospital in South Korea and assessed the success of serum anti-Toxocara immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) as a diagnostic test for OT. METHODS: The records of consecutive patients with intraocular inflammation of unknown etiology were reviewed. All participants underwent clinical and laboratory investigations, including ELISA for serum anti-Toxocara IgG. OT was diagnosed based on typical clinical findings. Clinical characteristics, seropositivity, and IgG titers were compared between patients diagnosed with OT and non-OT uveitis. The seropositivity and the diagnostic value of anti-Toxocara IgG was investigated among patients with different types of uveitis. RESULTS: Of 238 patients with uveitis of unknown etiology, 71 (29.8%) were diagnosed with OT, and 80 (33.6%) had positive ELISA results for serum anti-Toxocara IgG. The sensitivity and specificity of the ELISA test were 91.5% (65 / 71) and 91.0% (152 / 167), respectively. The positive predictive value of the serum anti-Toxocara IgG assay was 81.3%. Among patients with anterior, intermediate, posterior, and panuveitis, the prevalence rates of OT were 8.3%, 47.1%, 44.8%, and 7.1%, respectively; the seropositivity percentages were 18.1%, 47.1%, 43.7%, and 17.9%; and the positive predictive values were 38.5%, 95.8%, 92.1%, and 40.0%. The serum anti-Toxocara IgG titer also significantly decreased following albendazole treatment. CONCLUSIONS: OT is a common cause of intraocular inflammation in the tertiary hospital setting. Considering that OT is more prevalent in intermediate and posterior uveitis, and that the positive predictive value of the anti-Toxocara IgG assay is high, a routine test for anti-Toxocara IgG might be necessary for Korean patients with intermediate and posterior uveitis.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Animals ; Antibodies, Anti-Idiotypic/*blood ; Aqueous Humor/parasitology ; Child ; Enzyme-Linked Immunosorbent Assay ; Eye Infections, Parasitic/*diagnosis/epidemiology/parasitology ; Female ; Follow-Up Studies ; Humans ; Immunoglobulin G/blood/*immunology ; Incidence ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Retrospective Studies ; *Tertiary Care Centers ; Toxocara canis/*immunology/isolation & purification ; Toxocariasis ; Uveitis/*diagnosis/epidemiology/parasitology ; Young Adult

Systemic infections that are caused by various types of pathogenic organisms can be spread to the eyes as well as to other solid organs. Bacteria, parasites, and viruses can invade the eyes via the bloodstream. Despite advances in the diagnosis and treatment of systemic infections, many patients still suffer from endogenous ocular infections; this is particularly due to an increase in the number of immunosuppressed patients such as those with human immunodeficiency virus infection, those who have had organ transplantations, and those being administered systemic chemotherapeutic and immunomodulating agents, which may increase the chance of ocular involvement. In this review, we clinically evaluated posterior segment manifestations in the eye caused by hematogenous penetration of systemic infections. We focused on the conditions that ophthalmologists encounter most often and that require cooperation with other medical specialists. Posterior segment manifestations and clinical characteristics of cytomegalovirus retinitis, endogenous endophthalmitis, toxoplasmosis, toxocariasis, and ocular syphilis are included in this brief review.
Bacteria ; Cytomegalovirus Retinitis ; Diagnosis ; Endophthalmitis ; Eye Infections ; HIV ; Humans ; Inflammation* ; Organ Transplantation ; Parasites ; Specialization ; Syphilis ; Toxocariasis ; Toxoplasmosis ; Toxoplasmosis, Ocular ; Transplants

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.
Adult* ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia ; Eosinophils ; Humans ; Korea ; Liver ; Lung ; Male ; Prevalence* ; Prospective Studies ; Seroepidemiologic Studies ; Serologic Tests* ; Thorax ; Toxocara ; Toxocara canis ; Toxocariasis*

Roundworms of Toxocara canis and Toxascaris leonina are common gastrointestinal helminths of canids over the world. Humans are infected with T. canis larvae through ingestion of infective eggs in contaminated environments or larvae by consumption of raw or uncooked meat or livers. Recently, patients of clinically diagnosed toxocariasis are increasing and require correct diagnosis in Korea. The present study investigated serological cross-reactivity between crude antigens of T. canis (TCLA) and T. leonina (TLLA) larvae. We collected serum specimens from 177 toxocariasis patients who were clinically suspected in the Seoul National University Hospital and 115 healthy controls. An ELISA method for toxocariasis was used to evaluate diagnostic efficacy of TLLA for serodiagnosis of human toxocariasis. The IgG ELISA using TLLA gave 14 (14.3%) positives of 98 TCLA positive specimens among 177 suspected toxocariasis patients. Most of them showed high absorbances with TCLA. In conclusion, there is a partial cross reaction between serum specimens of toxocariasis and TLLA.
Animals ; Antibodies, Helminth/blood ; Antigens, Helminth/*immunology ; Cross Reactions ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin G/blood ; Larva/immunology/metabolism ; Toxascaris/growth & development/*immunology/isolation & purification ; Toxocara canis/growth & development/*immunology/isolation & purification ; Toxocariasis/*diagnosis/parasitology