Clinical manifestations of eosinophilic meningitis due to Angiostrongylus cantonensis

Abstract

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.

Eosinophilic Meningitis Due to Angiostrongylus cantonensis in Switzerland

“…After an incubation period that varies from 2-35 days [2], during which the larvae of A. cantonensis migrate to the CNS, patients develop a variety of symptoms [3][4][5]. Hyperesthesia occurring in up to 54% of patients is particularly characteristic and was present in our patient upon specific questions.…”

“…The CSF shows a pleocytosis, usually ranging from 150-1,500 cells/µl [2,3], with an eosinophilia ranging between 10-92%, generally > 20%.The CSF protein is slightly increased, whereas the glucose level is normal [2-4, 8, 9]. A Giemsa stain of the CSF is therefore crucial and should always be done in travelers returning from endemic areas with symptoms of chronic meningitis.The white blood cell count is normal or slightly increased and the eosinophilia is less pronounced than in the CSF and may even be absent [2].…”

First Evidence of Angiostrongyliasis Caused by Angiostrongylus cantonensis in Guadeloupe, Lesser Antilles

“…Definitive diagnosis by the direct detection of larvae in CSF is rarely achieved due to adhesion of larvae to nerves. 28 Detection of antibodies produced in response to the infection can be performed on serum or CSF using enzyme-linked immunosorbent assay or western blot techniques. The diagnostic performance of these assays varies depending on the purity of the native antigenic preparation used for detection.…”

Eosinophilic meningitis

“…In the Jamaica outbreak [14•], similar to other large series of adult cases [12,23], headache was the most common symptom, and management of this symptom was the most difficult clinical issue. Visual disturbances or photophobia were seen in 92%, and nuchal rigidity or neck pain and fatigue were seen in 80% of the cases [14•].…”