Corticosteroids for parasitic eosinophilic meningitis

Area of Science:

• Neurology
• Infectious Diseases
• Pharmacology

Background:

• Eosinophilic meningitis, often caused by Angiostrongylus cantonensis, presents with inflammation due to dead parasite larvae.
• Corticosteroids are utilized to mitigate the inflammatory responses associated with this condition.

Purpose of the Study:

• To evaluate the efficacy and safety of corticosteroid treatment in patients diagnosed with eosinophilic meningitis.

Main Methods:

• A systematic search of multiple databases (CENTRAL, MEDLINE, EMBASE, Scopus, Web of Science, LILACS, CINAHL) was conducted.
• Included were randomized controlled trials (RCTs) comparing corticosteroids to placebo for eosinophilic meningitis.
• Study data extraction, quality assessment, and analysis of outcomes and adverse effects were performed by two independent reviewers.

Main Results:

• One RCT with 110 participants demonstrated that prednisolone significantly shortened headache resolution time (5 vs. 13 days) and reduced persistent headaches after two weeks (9.1% vs. 45.5%).
• Participants receiving corticosteroids showed a reduced median duration of analgesic use (10.5 vs. 25.0 days).
• No adverse effects were reported for prednisolone in the included study.

Conclusions:

• Corticosteroids provide significant headache relief for patients with eosinophilic meningitis.
• The current evidence is based on a single RCT with limitations in reporting allocation concealment and stratification.
• Further high-quality, well-designed RCTs are recommended to confirm these findings.