Human angiostrongyliasis: the past, present, and future

Human angiostrongyliasis is an emerging foodborne zoonosis caused predominantly by Angiostrongylus cantonensis and Angiostrongylus costaricensis, which produce distinct neurological and abdominal forms of disease, respectively. Human infection occurs primarily through ingestion of raw or undercooked gastropod intermediate hosts, paratenic hosts such as freshwater prawns and crabs, or fresh produce contaminated with infective third-stage larvae (L3). A. cantonensis is the principal cause of neuroangiostrongyliasis and eosinophilic meningitis, whereas A. costaricensis causes abdominal angiostrongyliasis, characterized by eosinophilic inflammation involving the intestinal wall and mesenteric vasculature. Although historically concentrated in tropical and subtropical regions, A. cantonensis has expanded its geographic range, while A. costaricensis remains predominantly distributed in Latin America. This changing epidemiology is influenced by climate and environmental change, host redistribution, globalisation, urbanisation, and dietary practices. Diagnosis remains challenging and requires integration of epidemiological exposure, clinical findings, and laboratory and imaging results. For neuroangiostrongyliasis, cerebrospinal fluid (CSF) eosinophilia, serological testing, and molecular assays, including increasingly sensitive real-time PCR approaches, provide important diagnostic evidence, whereas abdominal angiostrongyliasis frequently requires imaging, histopathology, and, where available, molecular or serological confirmation. Treatment of neuroangiostrongyliasis remains centred on corticosteroids and management of intracranial pressure, while the role of albendazole has historically been controversial but is increasingly supported as adjunctive therapy when administered with corticosteroids. In abdominal angiostrongyliasis, surgical management remains an important component of diagnosis and treatment, particularly in patients with intestinal complications. Emerging molecular diagnostics, host-directed therapies, novel anthelmintic strategies, and improved surveillance approaches offer promising opportunities for future disease control. Continued progress will require an integrated One Health approach combining epidemiological surveillance, improved diagnostic capacity, evidence-based clinical management, food-safety education, and ecological monitoring of transmission.