Albendazole therapy for eosinophilic meningitis caused by Angiostrongylus cantonensis

Jitpimolmard, Suthipun; Sawanyawisuth, Kittisak; Morakote, Nimit; Vejjajiva, Athasit; Puntumetakul, Montien; Sanchaisuriya, Kanokwan; Tassaneeyakul, Wongwiwat; Tassaneeyakul, Wichittra; Korwanich, Narumanas

doi:10.1007/s00436-006-0405-7

Cited by 83 publications

(41 citation statements)

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“…Prednisone significantly reduced the proportion of patients with persistent headaches after completion of the treatment (9.1% compared to 45.5% in the placebo group; P ϭ 0.0004), the mean duration of headache (5 days compared to 13 days; P ϭ 0.0), and the number of repeated lumbar punctures for pain relief (7 compared to 22; P ϭ 0.02) (52). The 2-week course of albendazole reduced the proportion of patients with persistent headaches from 20.6% to 40.6% in the placebo group (P ϭ 0.08), and the mean duration of headache was reduced from 8.9 to 16.2 days (P ϭ 0.05) (138). While a 2-week course of prednisolone (60 mg/day) may be recommended in meningitis caused by A. cantonensis, the value of albendazole or mebendazole therapy in conjunction with corticosteroids is not yet fully established, since most of the data come from uncontrolled studies or clinical reports of a few patients (51,127,230,281,293).…”

Section: Treatmentmentioning

confidence: 99%

Update on Eosinophilic Meningoencephalitis and Its Clinical Relevance

2009

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SUMMARY Eosinophilic meningoencephalitis is caused by a variety of helminthic infections. These worm-specific infections are named after the causative worm genera, the most common being angiostrongyliasis, gnathostomiasis, toxocariasis, cysticercosis, schistosomiasis, baylisascariasis, and paragonimiasis. Worm parasites enter an organism through ingestion of contaminated water or an intermediate host and can eventually affect the central nervous system (CNS). These infections are potentially serious events leading to sequelae or death, and diagnosis depends on currently limited molecular methods. Identification of parasites in fluids and tissues is rarely possible, while images and clinical examinations do not lead to a definitive diagnosis. Treatment usually requires the concomitant administration of corticoids and anthelminthic drugs, yet new compounds and their extensive and detailed clinical evaluation are much needed. Eosinophilia in fluids may be detected in other infectious and noninfectious conditions, such as neoplastic disease, drug use, and prosthesis reactions. Thus, distinctive identification of eosinophils in fluids is a necessary component in the etiologic diagnosis of CNS infections.

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Section: Treatmentmentioning

confidence: 99%

Update on Eosinophilic Meningoencephalitis and Its Clinical Relevance

2009

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“…A randomized controlled trial of 71 patients with eosinophilic meningitis showed a statistically significant decrease in headache duration from 16.2 to 8.9 days with albendazole treatment compared with placebo. 10 Still, other studies report exacerbations of neurologic symptoms when anti-helminthic drugs are used alone for treatment, likely due to an inflammatory response to the dying parasite. 11 Further studies to define the optimal treatment strategy are needed.…”

Section: Denouementmentioning

confidence: 99%

Eosinophilic Meningitis in a Previously Healthy 13-year-old Child

Thyssen

Mitchell²,

Qvarnström

et al. 2013

Pediatric Infectious Disease Journal

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Keywords eosinophilic meningitis; Angiostrongylus cantonensis; rat lung wormA previously healthy 13-year-old male developed acute onset of a bi-temporal headache. The headache persisted, and two weeks later, he was diagnosed with sinusitis and was given amoxicillin. On illness day 17, he experienced worsening headache, slurred speech, transient left facial droop, right hand numbness, and dizziness. At a local emergency department (ED), magnetic resonance imaging (MRI) of the brain showed no significant abnormalities, though images were obscured by artifact from his orthodontic hardware. He was discharged without a specific diagnosis after his neurologic symptoms had resolved. On illness day 19, the patient had return of hand tingling and slurred speech and presented to the Children's Hospital Colorado ED. He was diagnosed with an atypical migraine and was treated with ketorolac, diphenhydramine, and prochlorperazine. His symptoms improved, and he was discharged.On illness day 20, the patient experienced severe right eye pain and recurrence of his headache. He returned to his local ED and was hospitalized after minimal clinical improvement with treatment for migraine. At that time, his Romberg sign was abnormal, he was ataxic, and he had diplopia. On illness day 22, he underwent a lumbar puncture (LP) because of concern of pseudotumor cerebri. The cerebral spinal fluid (CSF) showed white blood cell count (WBC) of 763/mm 3 (with a differential of 80% lymphocytes, 15% monocytes, and 5% eosinophils), red blood cell count (RBC) of 2/mm 3 , protein of 49 mg/dL, and glucose of 54 mg/dL. Intravenous acyclovir was started but was discontinued when polymerase chain reaction assay (PCR) of the CSF for herpes simplex virus returned negative. Bacterial and fungal cultures of the CSF were negative. He was discharged home after a three-day hospitalization.

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“…Meningitic angiostrongyliasis can be diagnosed using clinical criteria (Chotmongkol et al 2000, Jitpimolmard et al 2007, ramirez-Avila et al 2009), including a percentage of cerebrospinal fluid eosinophils that is greater than 10% and a history of eating raw fresh-water snails or other transmission hosts. Our serologic test is very specific for meningitic angiostrongyliasis (99% specificity), but the sensitivity is 55.6%.…”

Section: Abstract: Eosinophilia -Diagnosis -Meningitis -Angiostrongymentioning

confidence: 99%

“…Blood eosinophilia has been observed in 30-80% of patients with angiostrongyliasis (Chotmongkol et al 2000, Jitpimolmard et al 2007. The aim of the present study was to evaluate the utility of blood eosinophils as a diagnostic tool for meningitic angiostrongyliasis.…”

mentioning

confidence: 99%

“…We recruited patients who were diagnosed with meningitic angiostrongyliasis at Srinagarind Hospital in Khon Kaen, Thailand, between 1996-2007. The inclusion criteria were the following: (i) a cerebrospinal fluid white blood cell count of 10 cells/mm 3 or more and the presence of 10 or more eosinophils/mm 3 in the cerebrospinal fluid, (ii) a value of at least 10% for the percentage of eosinophils in the cerebrospinal fluid leukocyte count, (iii) negative cerebrospinal fluid test results for organisms, cryptococcal antigens and cultures, (iv) a history of exposure to A. cantonensis and (v) a positive result on a test for the presence of serum antibodies to the 29 kDa antigenic polypeptide of A. cantonensis (Maleewong et al 2001).…”

mentioning

confidence: 99%

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