Corticosteroids for parasitic eosinophilic meningitis

Area of Science:

• Neurology
• Infectious Diseases
• Pharmacology

Background:

• Angiostrongylus cantonensis (A. cantonensis) is a primary cause of infectious eosinophilic meningitis.
• Inflammation and meningitis symptoms are exacerbated by dead parasite larvae.
• Corticosteroids are utilized to mitigate parasite-induced inflammation.

Purpose of the Study:

• To evaluate the efficacy and safety of corticosteroid treatment for eosinophilic meningitis.

Main Methods:

• A systematic literature search was conducted across multiple databases (CENTRAL, MEDLINE, EMBASE, Scopus, Web of Science, LILACS, CINAHL) up to December 2014.
• Randomized controlled trials (RCTs) comparing corticosteroids with placebo for eosinophilic meningitis were included.
• Study data were independently collected and analyzed by two reviewers, with methodological quality assessment.

Main Results:

• One RCT with 110 participants met the inclusion criteria.
• Corticosteroids (prednisolone) significantly shortened headache resolution time (5 vs. 13 days, P < 0.0001).
• Fewer participants receiving corticosteroids experienced persistent headaches (9.1% vs. 45.5%, P < 0.0001), required repeat lumbar puncture (12.7% vs. 40%, P = 0.002), or used analgesics (median 10.5 vs. 25.0 days, P = 0.038).
• No adverse effects were reported for prednisolone.

Conclusions:

• Corticosteroids demonstrate significant efficacy in alleviating headaches in patients with eosinophilic meningitis (pain score ≥ 4).
• The supporting evidence comes from a single RCT of moderate quality, with limitations in reporting allocation concealment and stratification.
• Further well-designed RCTs are warranted to confirm these findings.