Toxocariasis in dogs and cats in Vietnam: Clinical symptoms and treatment guidelines according to Decision 1385/QD-BYT?
- The agent, the source of the disease, and the mode of transmission of Toxocariasis in dogs/cats in Vietnam?
- Clinical symptoms according to guidelines for diagnosis, treatment and prevention of toxocariasis in dogs/cats in Vietnam?
- Treat the disease according to the guidelines for diagnosis, treatment and prevention of toxocariasis in dogs/cats in Vietnam?
The agent, the source of the disease, and the mode of transmission of Toxocariasis in dogs/cats in Vietnam?
Section 1.1; 1.2; 1.3 Guidelines for diagnosis, treatment and prevention of canine/cat ascariasis, promulgated under Decision 1385/QD-BYT in 2022 by the Minister of Health, stipulating the causative agent, source and mode of transmission such as: after:
The causative agent of the disease is the larvae of dog/cat roundworm (Toxocara canis/ Toxocara cati).
There are three modes of transmission including:
- People who eat food and drinking water contaminated with eggs of dog/cat roundworms;
- People who eat offal or raw/undercooked meat of a host of pathogens such as chickens, ducks, buffaloes, cows, sheep, rabbits;
The disease is not transmitted directly from person to person.
The main source or reservoir is dogs and cats infected with worms Toxocara spp., especially puppies are the reservoir of the highest risk for humans. In addition, some other animals (chickens, ducks, buffaloes, cows, sheep, rabbits) may carry the disease at a lower rate.
Clinical symptoms according to guidelines for diagnosis, treatment and prevention of toxocariasis in dogs/cats in Vietnam?
Section 2 Guidelines for diagnosis, treatment and prevention of toxocariasis in dogs/cats promulgated under Decision 1385/QD-BYT in 2022 of the Minister of Health, prescribes clinical symptoms as follows:
"2. CLINICAL SYMPTOMS
2.1. Common form: Symptoms are not too prominent, can be seen as
- Itching, rash;
- Headache;
- Stomachache;
- A cough;
- Sleep disorders;
- Change behavior.
2.2. The larval form moves in the eye: The ophthalmic form is uncommon, usually in one eye. Symptoms include:
- Decreased vision;
- Granuloma: posterior polar granuloma, peripheral granuloma;
- endophthalmitis,
- Damage to the retina, conjunctivitis, uveitis
- Total loss of vision.
2.3. The larval body moves the internal organs
The larvae can migrate to various organs such as the heart, lungs and liver. Visceral form is more common in children under 7 years of age. The clinical symptoms are quite diverse depending on the number and location of the affected organs, the most common are:
- Chronic abdominal pain, hepatomegaly, diarrhea, vomiting;
- Bronchial asthma: Wheezing, dry cough, difficulty breathing;
- Chest tightness;
- Fever, headache, fatigue, weight loss;
- Itching, rash.
2.4. Larvae migrate to the nervous system
This is a dangerous disease compared to other forms. Symptoms are not specific, the degree of manifestation depends on the location of the lesion in the nervous system such as:
- Fever;
- Headache;
- Convulsions.
3. Subclinical
3.1. Test
- ELISA: Detects IgG antibodies against secreted antigens of Toxocara spp. in serum or intraocular fluid.
- Complete blood count: Blood eosinophils increased > 7% (or > 500 cells/µl blood).
- Erythrocyte sedimentation test: increased
- CRP (C Reaction Protein): increase
- Quantitative IgE test: increase
- Stool test: look for other parasites to diagnose and rule out.
- Biopsy: Determine histopathology of lesions infected with canine/cat ascariasis or identify larvae, often with eosinophilic infiltrates.
- Molecular biology: Detecting specific gene segments of dog/cat ascaris larvae in biopsies.
3.2. Image analysation
- Chest X-ray: There are pictures of lung parenchymal lesions, lung infiltrates.
- Computed tomography (CT scanner): There is a density change image corresponding to the lesion area.
- MRI scan of suspected lesions: detect signal changes corresponding to damaged areas.
- Abdominal ultrasound, superficial transducer ultrasound: Detecting damage to abdominal viscera or subcutaneous soft tissue. Visceral lesions in the form of nodules < 3cm, hypoechoic, heterogeneous, may have hyperechoic dots without internal shadow, lesions are fairly regular, well demarcated, without angiogenesis, with thin fibrous she around. Under the skin are infiltrative lesions, which can be localized depending on the stage.
- Ophthalmoscopy: Signs of retinal fibrosis, "spin" marks, can see the image of larvae at the bottom of the eye."
Toxocariasis in dogs/cats in Vietnam: Clinical symptoms and treatment guidelines according to Decision 1385/QD-BYT in 2022?
Treat the disease according to the guidelines for diagnosis, treatment and prevention of toxocariasis in dogs/cats in Vietnam?
- DecSection 5 Guidelines for diagnosis, treatment and prevention of toxocariasis in dogs/cats in Vietnam promulgated under Decision 1385/QD-BYT in 2022 of the Minister of Health, prescribes treatment as follows:
“5. TREATMENT
5.1. The principles of treatment
Treatment of specific drugs in combination with symptomatic treatment.
5.2. Specific treatment
Use one of the drugs in the following order of preference:
5.2.1. Regimen 1: Albendazol (200mg and 400mg tablets)
a) Dosage
- Adults 800mg/day/person, divided into 2 times/day.
- Children > 1 year old: 10-15mg/kg/day (maximum 800mg), divided into 2 times/day.
b) Treatment according to disease type
- For normal form: 14 days each time
- For visceral, ocular and neurological bodies: every 21 days. For the eye, the patient can be examined by an ophthalmologist for surgery as indicated.
c) Contraindications of albendazol
- People with a history of hypersensitivity to benzimidazole.
- Pregnant or lactating women.
- Children < 1 year old.
- People with a history of bone marrow toxicity.
d) Notes
- Be careful when using albendazol with liver failure, kidney failure.
- Undesirable effects of albendazole, including granulocytopenia, agranulocytosis, decrease in platelet types and affect liver function with prolonged use. Therefore, complete blood count and liver function tests (transaminases) should be performed at the start of each treatment cycle and at least every 2 weeks during treatment. If liver enzymes are greatly increased, albendazol should be discontinued. Treatment can then be continued if liver enzymes return to pre-treatment levels, but more frequent testing is required upon re-treatment.
5.2.2. Regimen 2: Thiabendazol (500 mg tablet)
a) Dosage: 2 times/day x 7 days, according to the patient's weight (see table)
b) Treatment according to disease type: applied to visceral body and normal body.
c) Contraindications: hypersensitivity to the components of the drug.
d) Be careful
- People with liver failure, kidney failure;
- Women who are pregnant in the first 3 months and are breastfeeding;
- Do not use drugs when operating machinery, driving trains or vehicles;
- Children under 12 months old or under 13.6 kg body weight.
5.2.3. Regimen 3: Ivermectin (3mg and 6mg tablets)
a) Dosage: adults and children ≥ 5 years old: 0.2mg/kg x 01 dose/day x 1-2 days;
b) Treatment according to disease type
+ For larval forms due to transfer in the skin and soft tissues, the drug responds well to the recommended dose and can be repeated (if not cured).
+ For larva migrating in the eye, viscera should consider treatment with ivermectin. Can be used after or concurrently with anti-inflammatory corticosteroids to reduce the clinical condition of the patient exacerbation. Combined symptomatic treatment.
c) Contraindications
+ Patients with hypersensitivity to any ingredient of the drug.
The patient has meningitis.
+ Pregnant women, or women who are breastfeeding.
Children under 5 years old or weighing < 15 kg.
d) Pay attention when taking medicine
+ The drug is taken away from meals, 1-2 hours before or after meals;
Use caution when driving or operating machinery.
+ Some side effects when using ivermectin include fever, itching, skin erythema, joint pain, muscle pain, lymphadenopathy, tachycardia,...
5.3. Symptomatic treatment
Depending on the clinical symptoms to prescribe the appropriate treatment drugs:
- Itching, urticaria: use antihistamines until the symptoms are gone;
- Fever: antipyretic and mechanical antipyretic;
- Supportive drugs: probiotics, vitamins synthetic, liver tonic, iron tablets depending on symptoms.
5.4. Surgical treatment
In the case of larva migrans in the skin, soft tissue, in the eye, surgery may be indicated.
5.5. Follow-up after treatment
Organize treatment for patients up to 3 times, each session is 1 month apart. After each course, it is necessary to re-evaluate the following indicators: clinical symptoms, ELISA, blood count, liver and kidney function. If there is a clear improvement, treatment can be stopped. If not, continue the 2nd, 3rd sessions with the same dosage as the 1st course. After three courses of treatment, if the symptoms still do not improve, it is necessary to review the diagnosis, do more or repeat tests to guide the diagnosis and other treatment is more appropriate”.reased vision;
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