Case Report: Abdominal Angiostrongyliasis in the Amazon of Ecuador

Abdominal angiostrongyliasis, a foodborne parasitic disease, caused by the zoonotic nematode Angiostrongylus costaricensis, is a rarely reported human eosinophilic enteritis, only been diagnosed in the America continent. The adult worm invades arteries, most frequently those in the right ileocolic region, and causes abdominal symptoms. Currently, the only definitive diagnosis is by identifying the parasite in surgical specimens. By observing adult worms of A. costaricensis inside the mesenteric arteries, we diagnosed and treated the first known case from the Amazon region of Ecuador. A 2-year-old indigenous Shuar, who during the previous 2 months had been diagnosed with having dysentery, typhoid fever, and appendicitis; presented with fever, painful distended abdomen, a palpable abdominal mass on the right flank, and bloody diarrhea, accompanied by leukocytosis with eosinophilia of 20.6%. The child completely recovered after partial surgical resection of the transverse and descending colon, and treatment with mebendazole. This case substantiates that not only the existence of the parasite, but also active transmission of the disease is occurring in Ecuador. Physicians, travelers, as well as decision-making authorities should be alerted to the importance of this foodborne zoonosis and of the need for research to determine the geographical distribution and possible prevention strategies.