Eosinophilic meningitis outbreak related to religious practice

Area of Science:

• Neurology
• Infectious Diseases
• Parasitology

Background:

• Eosinophilic meningitis (EoM) is a serious neurological condition.
• Angiostrongylus cantonensis (A. cantonensis) is a parasitic nematode causing eosinophilic meningitis, also known as angiostrongyliasis.
• Southern Brazil is an emerging region for A. cantonensis infections.

Observation:

• Three patients in Porto Alegre, Brazil, developed EoM after consuming raw mollusks in a religious ritual.
• Two patients presented with atypical symptoms including severe distal lower extremity pain and small fiber neuropathy confirmed by electroneuromyography (ENMG).
• All patients tested positive for A. cantonensis infection.

Findings:

• Successful treatment of eosinophilic meningitis caused by A. cantonensis was achieved using antihelminthic and anti-inflammatory medications.
• The study identified a rare presentation of A. cantonensis infection involving small fiber neuropathy.

Implications:

• Increased clinical awareness of A. cantonensis infection is crucial for early diagnosis and management of cerebral angiostrongyliasis.
• Public health education regarding the risks of consuming raw mollusks is essential to prevent new infections.
• This case series contributes to understanding the diverse clinical manifestations of A. cantonensis in Brazil.