Angiostrongylus cantonensis Infection on Mayotte Island, Indian Ocean, 2007-2012

Abstract

IntroductionHuman angiostrongyliasis (HA) is a neurological helminthic disease caused by the lung worm Angiostrongylus cantonensis. It is suspected in the combination of travel or a residence in an endemic area and eosinophilic meningitis. In Mayotte, an island in the Indian Ocean, cases are rare but regular. The main objective of our study was to describe the epidemiological and diagnosis clues of HA in Mayotte. The secondary objectives were to evaluate the contribution of Real-Time Polymerase Chain Reaction (RT- PCR) for the diagnosis of HA, delineate the characteristics of the local transmission and ascertain the presence of A. cantonensis in Achatina fulica, the potential vector of the disease.Materials and MethodsBetween 2007 and 2012, all cases of eosinophilic meningitis were retrospectively included and investigated by RT- PCR in the CSF. Descriptive analysis was conducted for clinical, biological and radiological features, and were analyzed for all patients together with the search for prognostic factors for mortality. Concurrently, geolocalization and temporal parameters were studied to correlate the occurrence of the cases with rainfall seasons and snails were collected to enhance a parasitic carriage with real time PCR.ResultsDuring the 6-year period of the study, 14 cases were identified (2.3 cases/year) and 9 among 10 remaining CSF were positive in PCR. Among 14 cases of EM, 13 were less than 2 year-old children. The 1 year mortality rate was 5/14 (35.7%). Among survivors, 3/7 (42.8%) presented neurological sequelae. Factors associated with mortality were dysfunction of cranial nerves, abnormal brain imaging, and CSF glucose level inferior to 2 mmol/l. Occurrence of cases was temporarily and spatially correlated to the rainy season. Among the 64 collected giant snails, 6 (9.4%) were positive with A. cantonensis PCR. The likely main route of transmission was the children licking snails, carriers of the parasite.ConclusionIn Mayotte, HA was mainly found in paediatric cases under 2 years old, and evidenced a life-threatening disease. PCR seems to be a promising tool in the definitive diagnosis of HA. Population should be aware of the role of A. fulica, and not let the children have direct contact with the snails.

First cases of Angiostrongylus cantonensis infection reported in Martinique, 2002–2017

“…Blood eosinophilia at admission was inconsistent, with a median of 1.72 G/L (13% of the WBC count in blood) and a range of 0.49-6.43 G/L (5-31%). Median eosinophilia in the CSF at first lumbar puncture was 74.5 (25% of the WBC count in CSF), with a range of 0-1550/mm 3 (4-68%) [35] and/or corticosteroids [18]. Clinical outcomes ranged from rapid recovery without sequelae for two patients to neurological sequelae manifested as strabismus and intellectual disability for five patients.…”

“…In this study, neuroangiostrongyliasis cases occurred in two distinct epidemiological situations: three in infants less than 2 years old and five in patients over 11 years with mental diagnoses. The mode of transmission in infants was linked to poor living conditions with probable accidental consumption of contaminated snails or slugs when playing outside, as described on Mayotte, a French island in the Western Indian Ocean, in children under two years of age [18]. For adults, contamination was instead linked to intellectual disability associated with risky eating behaviour.…”

“…From 2002 to 2010, samples provided for A. cantonensis serological testing were sent to the only laboratory performing neuroangiostrongyliasis infection diagnosis in France, including its overseas regions (Laboratory of the Centre Hospitalier de Gonesse, Gonesse, France). An indirect immunofluorescence (IIF) assay was used for the detection of antibodies against A. cantonensis antigens, as described in [18]. Due to logistical constraints and availability of certain reagents, patient serodiagnosis in this laboratory ceased in 2010 and no other laboratory then performed the test in France.…”

Achatina fulica na zona urbana de Maringá-PR: na perspectiva da análise ambiental (Achatina fulica in the urban area of Maringá-PR: from the perspective of environmental analysis)

“…Em campo, a maior parte dos entrevistados afirmou que os caracóis não possuem ciclo reprodutivo em seu terreno, mas sim, nos terrenos vazios, com ausência de impermeabilização do solo, em que, nos dias após a chuva, os caracóis se deslocam para as residências da quadra. Epelboin et al, (2016) afirmaram que o aparecimento de Achatina fulica está diretamente relacionada as estações chuvosas.…”

Angiostrongylus cantonensis Infection of Central Nervous System, Guiana Shield

“…The frequency of A. cantonensis infections in humans in the Guiana Shield is probably underestimated as a result of the spontaneous course of recovery for most cases ( 8 ), lack of knowledge of the parasite by health professionals, limited availability of laboratory diagnostic tools, and the absence of national surveillance. Although the disease usually resolves spontaneously, case-fatality rates can reach 5% ( 9 ). The lack of clinical suspicion for angiostrongyliasis on the basis of signs and symptoms and delay in initiation of treatment may lead to adverse neurologic outcomes, especially in young children ( 10 ).…”