Toxoplasma, Toxocara and Tuberculosis co-infection in a four year old child

This case report describes a co-infection of Toxoplasma gondii, Toxocara spp and tuberculosis in a child with chronic lymphadenopathy and eosinophilia.The case report highlights two important points. First is the diagnostic challenges that are encountered by clinicians in tropical countries such as Sri Lanka, where lymphadenopathy and eosinophilia with a positive serology commonly point towards a parasitic infection. Secondly the importance of proper history taking and performing the Mantoux test as a first line investigation in a country where the incidence of tuberculosis is low, even in the absence of a positive contact history.Tuberculosis. toxocariasis and toxoplasmosis are among the common infectious causes of lymphadenitis in children [1]. Approximately 250,000 children worldwide develop tuberculosis, a larger proportion being reported from the South East Asian region [2,3]. Extra-pulmonary tuberculosis is more common in children, the most common form being lymphatic disease accounting for about two thirds of the cases of extra-pulmonary tuberculosis [4-6].Toxoplasma gondii and Toxocara spp. infections are cosmopolitan zoonotic diseases which may cause systemic and ocular diseases in humans [7-9]. Few publications exist regarding Toxoplasma and Toxocara co-infection [10,11].This case report describes a child with chronic lymphadenopathy and eosinophilia who was seropositive for both Toxoplasma gondii and Toxocara spp, together with a positive Mantoux test and lymph node histology suggesting tuberculosis.A 4 year-old, previously healthy boy was admitted to the surgical unit of the Colombo South Teaching Hospital, Sri Lanka with an abscess in the left big toe. No fever or local lymphadenopathy was present at initial presentation. The abscess was drained, treated with antibiotics and the child was discharged. Two weeks later the child was re-admitted with an infection at the site of original abscess and left sided inguinal lymphadenopathy. Full blood count (FBC)