Diagnosefindung der Toxocariasis anhand von anamnestischen, klinischen und serologischen Parametern Einleitung: Die Infektion mit den Spulwurmarten Toxocara canis oder cati (Hunde- oder Katzenspulwurm) kann beim Menschen die sogenannte Toxocariasis auslösen. Ihr pleomorphes klinisches Bild führt dazu, dass die Helminthose häufig nicht in die Differentialdiagnose miteinbezogen wird. Sie kann beim Menschen unbemerkt verlaufen, sich in nur wenig spezifischen Allgemeinsymptomen ausdrücken aber auch schwere Organmanifestationen hervorrufen. Ziel der Studie: Erstellen eines beschreibenden Kriterienkatalogs, zusammengesetzt aus klinischer Symptomatik, Expositionsanamnese und Laborparametern, auf Grund dessen die Verdachtsdiagnose „Toxocariasis“ gestellt werden kann. Methodik: Retrospektive Auswertung von ambulanten und stationären Krankenakten von 259 Patienten mit positivem Toxocara-Antikörper-Titer aus vier tropenmedizinischen Abteilungen. Bewertet werden Symptomatik und deren Schwere, Expositionsart und –grad, Labor- und Titerverlauf, Therapieart und –ergebnis sowie Zeitraum bis zur Diagnosestellung. Der Kriterienkatalog wird mit der Höhe der Toxocara-Antikörper in Beziehung gesetzt. Ergebnisse: Es konnte kein Leitsymptom für eine Toxocariasis mittels logistischer Regression ermittelt werden, jedoch führt das gleichzeitige Auftreten von Symptomatik und Exposition gegenüber einer Toxocara-Infektionsquelle, sowie das Vorliegen einer positiven Toxocara-Serologie zur Diagnose Toxocariasis. Hierzu wurde ein Flussdiagramm zur Diagnose und Therapie der Toxocariasis für den klinischen Gebrauch erstellt. Treffen mindestens 3 Symptome (z.B. Leistungsknick, Ödemneigung, Muskelschmerzen, Schweißneigung u.a.) mit einer mindestens einfach-positiven Exposition zusammen, ist eine serologische Überprüfung medizinisch und ökonomisch mittels einer Toxocara-Antikörper-Suche geboten. Der Nachweis von Antikörper-Titern unter 25 internationalen Antikörpereinheiten (IU) verbunden mit geringer klinischer Symptomatik sollte keine Therapie nach sich ziehen. Eine deutliche klinische Symptomatik kann sowohl mit Titern unter wie über 25 Antikörpereinheiten eine Therapieindikation hervorrufen. Das Vorliegen hinführender Symptome ohne Exposition gegenüber dem Spulwurm ist keine Indikation für die Bestimmung des Toxocara-Antikörper-Titers. Tierkontakt steht unter den Expositionsarten an erster Stelle und führt zur Ausbildung von höhergradigen Antikörper-Titern. Obwohl die Toxocariasis in den Tropen häufig ist, exponieren sich Tropenreisende bei Standardreisen meist nur gering gegenüber einer Toxocara Infektionsquelle, so dass es nur zu Durchseuchungstitern kommt. In Europa erworbene Infektionen zeigen häufig ein schwereres klinisches Bild durch längeren und engen Kontakt mit infizierten Hunden oder Katzen im privaten oder beruflichen Bereich. Es handelt sich um ein additives Risiko. Die Diagnosestellung gestaltet sich häufig langwierig und meist erst nach Konsultation von verschiedenen Fachbereichen der Medizin. Schlussfolgerungen: Aus den erarbeiteten Daten und in der Literatur zeigt sich, dass die Toxocariasis bzw. das Larva migrans visceralis Syndrom keine extrem seltene Erkrankung ist und in die Differentialdiagnose bei chronischen Syndromen miteinbezogen werden sollte. Die Toxocariasis ist eine anhand von gesicherten Kriterien diagnostizierbare Erkrankung. Es stehen geeignete Medikamente mit hohem Wirkungsgrad und geringem Nebenwirkungsprofil zur Verfügung. Die Erkrankung Toxocariasis sollte vermehrt Eingang in die ärztliche Weiterbildung finden. Der öffentliche Gesundheitsdienst hat die Aufgabe, den Kontakt von Kindern zu Hunde- und Katzenkot zu begrenzen und vor allem in der Öffentlichkeit auf die Gefahr von zu engem, nicht artgerechtem Tierkontakt hinzuweisen. / Toxocariasis: pathway to diagnosis with anamnestic, clinical and serological data From infection to disease: The infection with the roundworm species toxocara canis sive cati (dog or cat roundworm) may result in clinical toxocariasis in man. Its pleomorphic clinical picture commonly leads to its neglect in differential diagnosis. It varies from inapparent infection over unspecific symptoms to severe organic disease. Aim of study: to find a clinical pathway leading to the diagnosis “toxocariasis” composed of clinical symptoms, history of exposition and laboratory data with toxocara antibodies. Methods: A retrospective study of 259 in- and outpatients with a positive toxocara-antibody-titer from four different departments of tropical medicine was undertaken. The study considers symptoms and their grading, the way and degree of exposition, labdata and toxocara-titer during observation, type and results of therapy and time span till diagnosis was established. Results: No leading symptom for toxocariasis could be isolated by logistic regression. The diagnosis toxocariasis can, however, be established if symptoms, exposition to a source of toxocara and a positive toxocara-titer are simultaneously present. A pathway to diagnosis and therapy was developed. If at least three clinical symptoms (e.g. sudden drop in performance, oedema, muscle pain, sweating) fall in line with a at least grade 1 history of exposition a screening with a toxocara antibody test is medically and economically indicated. A titer below 25 IU together with insignificant or mild clinical symptoms does not justify a therapy. Distinct clinical symptoms may indicate, however, therapy with positive antibody titers below or above 25 IU. Are there suspicious symptoms without any history of exposition to toxocara eggs, the test for antibodies is not useful. Among the ways of exposition animal contact ranks first and leads to higher toxocara antibody titres. Inspite of a high endemicity of toxocara in the tropics travellers expose themselves only marginally to toxocara sources resulting predominantly in low contact titers. Infections acquired in Europe often present with more severe clinical signs through a longstanding and close contact with infected dogs or cats in the private or professional area. It is always an additive risk. Establishing the diagnosis toxocariasis is often tedious and may be reached only after consulting various disciplines in medicine. Conclusions: The study presented as well as the literature prove that toxocariasis or the “larva migrans visceralis syndrome” is not an extremely rare disease and should be taken into account when differentiating chronic syndromes. Toxocariasis can be well diagnosed by established criteria. Appropriate medication with high efficiency and mild side effects is available. The disease toxocariasis should be more widely included into medical training. The public health service is asked to restrict the exposure of children to dog and cat droppings and intensively point out to the public the danger of too close and inappropriate animal contact.

The temporal variation of nematode communities in eight mouth stations of the Mekong River system was investigated in order to compare the change between the dry and the wet season. The nematode data was analysed by multivariate techniques such as SIMPROF, MDS, ANOSIM and SIMPER in the software PRIMER v.6 – PERMANOVA. Our results showed that average dissimi-larity between seasons of the nematode communities in each station was high. Seasonal factor did not affect strongly their distribution pattern. Dominant genera Desmodora and Oncholaimellus usually occurred in the sand stations and Parodontophora and Halalaimus were characteristic for the silty group in both seasons. The spatial variations in this estuarine area have an influence that is larger than seasonal factors. / Sự phân bố theo thời gian của quần xã tuyến trùng sống tự do vùng cửa sông Mekong được nghiên cứu nhằm đánh giá sự khác biệt của chúng trong mùa mưa và mùa khô. Dữ liệu của tuyến trùng được xử lý và phân tích đa biến như SIMPROF, MDS, ANOSIM và SIMPER bằng phần mềm PRIMER v.6 – PERMANOVA. Kết quả nghiên cứu cho thấy sự khác biệt theo mùa trong quần xã tuyến trùng tại mỗi điểm là khá lớn nhưng yếu tố mùa không ảnh hưởng gì tới mô hình phân bố của chúng. Một số giống ưu thế trong nền đáy cát như Desmodora and Oncholaimellus trong khi đó Parodontophora và Halalaimus thích nghi nền bùn sét phù sa vẫn hiễn diện trong cả 2 mùa. Kết quả nghiên cứu cũng cho thấy sự biến động trong không gian ở đây lớn hơn sự biến động về mùa vụ.

The temporal variation of nematode communities in eight mouth stations of the Mekong River system was investigated in order to compare the change between the dry and the wet season. The nematode data was analysed by multivariate techniques such as SIMPROF, MDS, ANOSIM and SIMPER in the software PRIMER v.6 – PERMANOVA. Our results showed that average dissimi-larity between seasons of the nematode communities in each station was high. Seasonal factor did not affect strongly their distribution pattern. Dominant genera Desmodora and Oncholaimellus usually occurred in the sand stations and Parodontophora and Halalaimus were characteristic for the silty group in both seasons. The spatial variations in this estuarine area have an influence that is larger than seasonal factors. / Sự phân bố theo thời gian của quần xã tuyến trùng sống tự do vùng cửa sông Mekong được nghiên cứu nhằm đánh giá sự khác biệt của chúng trong mùa mưa và mùa khô. Dữ liệu của tuyến trùng được xử lý và phân tích đa biến như SIMPROF, MDS, ANOSIM và SIMPER bằng phần mềm PRIMER v.6 – PERMANOVA. Kết quả nghiên cứu cho thấy sự khác biệt theo mùa trong quần xã tuyến trùng tại mỗi điểm là khá lớn nhưng yếu tố mùa không ảnh hưởng gì tới mô hình phân bố của chúng. Một số giống ưu thế trong nền đáy cát như Desmodora and Oncholaimellus trong khi đó Parodontophora và Halalaimus thích nghi nền bùn sét phù sa vẫn hiễn diện trong cả 2 mùa. Kết quả nghiên cứu cũng cho thấy sự biến động trong không gian ở đây lớn hơn sự biến động về mùa vụ.