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Angiostrongylus (Parastrongylus) eosinophilic meningitis
1Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu.
Abstract:
Angiostrongylus (Parastrongylus) cantonensis is the commonest cause of eosinophilic meningitis in the world. Infective third-stage larvae develop in slugs and snails. Humans are infected primarily in the central nervous system after ingesting an infected intermediate host. Damage by motile worms, inflammatory responses to foreign bodies, and possible toxicity of worm substances work in concert to produce the pathologic and clinical picture of neurologic angiostrongyliasis. This disease manifests itself by headache, paresthesias, generalized weakness, and occasionally visual disturbances and extraocular muscular paralysis. Eosinophilic pleocytosis is the major laboratory finding. Although the diagnosis of neurologic angiostrongyliasis is usually made clinically, serologic methods such as ELISA (enzyme-linked immunosorbent assay) can be helpful. Occasionally, living larvae can be identified histologically in the CSF, eye, or other tissue. There is no specific treatment for this disease. Corticosteroids may be useful to relieve increased intracranial pressure. The role of anthelmintic drugs, such as thiabendazole and ivermectin, is not yet known. The prognosis of neurologic angiostrongyliasis is usually good; however, fatal and chronic cases do occur. Appropriate preparation of food, control of mollusks and planarians, and elimination of rodents are important measures in limiting the further spread of eosinophilic meningitis caused by A. cantonensis.
Insights
Angiostrongylus cantonensis causes eosinophilic meningitis globally, primarily affecting the central nervous system. Prevention involves food preparation and controlling intermediate hosts like slugs and snails.
Area of Science:
- Neurology
- Infectious Diseases
- Parasitology
Background:
- Angiostrongylus cantonensis is the leading global cause of eosinophilic meningitis.
- Infective larvae develop in slugs and snails, with human infection occurring via ingestion of these intermediate hosts.
- Neurologic angiostrongyliasis results from larval migration and host inflammatory responses within the central nervous system.
Purpose of the Study:
- To describe the pathology, clinical presentation, diagnosis, and management of eosinophilic meningitis caused by Angiostrongylus cantonensis.
- To highlight diagnostic challenges and current treatment limitations for this parasitic meningitis.
Main Methods:
- Clinical case review and analysis of diagnostic findings.
- Review of existing literature on Angiostrongylus cantonensis infections.
- Serologic methods like ELISA and histological examination of CSF or tissue for larvae.
Main Results:
- The disease presents with headache, paresthesias, weakness, and neurological deficits.
- Eosinophilic pleocytosis in cerebrospinal fluid is a key laboratory finding.
- Diagnosis is often clinical, supported by serology (ELISA) or larval identification.
Conclusions:
- While usually self-limiting, Angiostrongylus cantonensis can cause severe or fatal neurologic disease.
- No specific treatment exists; corticosteroids may manage intracranial pressure.
- Prevention strategies include proper food handling and controlling intermediate hosts (mollusks, planarians) and rodent populations.