Clinical manifestations of eosinophilic memingitis due to Angiostrongylus cantonensis

Between 1959 and 1976, 34 patients were seen in Hawaii with eosinophilic meningitis. Angiostrongylus cantonensis was recovered from two of these patients. The remaining cases were presumed to be due to this parasite because of clinical and epidemiologic findings. The most likely source of infection for eight patients was ingesting raw terrestrial snails or slugs, and for six patients eating raw or poorly cooked crustaceans. Patients typically presented with severe headache; neck stiffness and fever were usually mild or absent. Paresthesias were noted by most adults. The cerebrospinal fluid (CSF) cell count ranged from 150 to 1500 leukocytes per cubic millimeter, with a mean eosinophil percentage of 38. CSF IgE levels were not abnormal in four patients so studied. Although two deaths occurred, the illness was typically self-limited, resolving completely with no specific treatment.