Clinical manifestations of eosinophilic meningitis caused by Angiostrongylus cantonensis: 18 years’ experience in a medical center in southern Taiwan

Tseng, Yu Ting; Tsai, Hung Chin; Sy, Cheng Len; Lee, Susan Shin Jung; Wann, Shue Ren; Wang, Yung Hsing; Chen, Jei Kuang; Wu, Kang; Chen, Yao Shen

doi:10.1016/j.jmii.2011.01.034

Cited by 55 publications

(45 citation statements)

References 26 publications

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“…Furthermore, they also report the presence of fever (68%), hypertesia (30%), nuchal rigidity (17%), nausea and vomiting (16%), disorders of consciousness (9%), abdominal pain (9%), extraocular muscle palsy (4%) and facial palsy (1%) 23 .…”

Section: Discussionmentioning

confidence: 99%

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THE FIRST CASE OF Angiostrongylus cantonensis EOSINOPHILIC MENINGITIS DIAGNOSED IN THE CITY OF SÃO PAULO, BRAZIL

Espírito-Santo

Pintó

Mota

et al. 2013

Rev. Inst. Med. trop. S. Paulo

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SUMMARYIntroduction: Angiostrongylus cantonensis is a natural parasite found in lung arteries of rats, which in humans may cause eosinophilic meningitis. Objective: To report the first case of eosinophilic meningitis caused by Angiostrongylus cantonensis in the city of São Paulo, Brazil. Case report: A male patient, 11 years old, living in the southern area of São Paulo, was admitted to the Pediatric Emergency Department with ongoing headaches for three days, but no fever or any other complaint. The presence of snails and rodents was reported in the peridomicile. The child was awake, lucid, oriented; muscular strength preserved, isochoric, photo reagent pupils and terminal nuchal rigidity -Glasgow Coma Scale (GCS) = 15. The laboratory tests showed a mild leukocytosis with 1736 eosinophils/mm³ and the CSF analysis disclosed 160 leukocytes/mm³ with 36% of eosinophils. The bacterial culture was negative. Computed Cerebral Tomography showed no alterations. The RT-PCR assay for detecting Angiostrongylus cantonensis larvae and DNA was negative. ELISA antibodies for IgG anti-A. cantonensis was negative in serum and undetermined in CSF and samples collected five days after the onset of symptoms. Seroconversion was observed in the sample collected 135 days later. Conclusion: the epidemiological and clinical data, the CSF alterations with eosinophilia and the seroconversion strongly suggest Angiostrongylus cantonensis eosinophilic meningitis.

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Section: Discussionmentioning

confidence: 99%

“…Based , reported that no decrease in the duration of the disease was observed with the use of corticosteroids, either alone or alongside antihelminthic drugs 23 .…”

mentioning

confidence: 99%

THE FIRST CASE OF Angiostrongylus cantonensis EOSINOPHILIC MENINGITIS DIAGNOSED IN THE CITY OF SÃO PAULO, BRAZIL

Espírito-Santo

Pintó

Mota

et al. 2013

Rev. Inst. Med. trop. S. Paulo

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“…Fever and malaise, though nonspecific, may also occur prior to the development of CNS disease (5). Peripheral eosinophilia was observed in 66 to 68% of cases, and CSF eosinophilia of Ն10% was noted in approximately 70 to 95% of cases (5,6). Thus, the laboratory finding of serum and especially CSF eosinophilia is an invaluable laboratory marker for A. cantonensis infection in the absence of other adjunct laboratory diagnostics.…”

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confidence: 99%

The Brief Case: Angiostrongylus cantonensis Eosinophilic Meningitis in a Returned Traveler

2017

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A 22-year-old male without significant prior medical history presented to the hospital with headache and double vision of 1 month's duration. He reported a trip to the island of Hawaii 1.5 months prior, where he spent time on the beach, including in the ocean, and ate various types of seafood, including sushi, crab, mahimahi, and shrimp. No other close contacts from his travel became ill. His symptoms began 2 weeks after his return, with headaches, malaise, red eyes, and ear pain. All of these symptoms resolved with a short course of oral antibiotics except the headache and malaise. Approximately a week from his initial symptoms, he developed fevers, and a lumbar puncture was performed, showing 270 white blood cells (WBC)/l, 2 red blood cells (RBC)/l, 85% mononuclear cells, 12% eosinophils, and 3% polymorphonuclear cells (PMN). Cerebral spinal fluid (CSF), bacterial culture, and Epstein-Barr virus (EBV) and herpes simplex virus (HSV) real-time PCRs were all negative, and he was assigned a presumptive diagnosis of viral meningitis. Two weeks later, he developed double vision. He was referred to ophthalmology, where an ophthalmologic exam revealed papilledema and bilateral cranial nerve 6 palsy. A noncontrasted brain computed tomography was performed, which was normal. Magnetic resonance imaging of the brain showed a markedly abnormal appearance of the brain and optic nerves, with a T2 hyperintense signal and enhancement in the bilateral optic nerves suggestive of acute inflammation. Additionally, scattered cerebral cortex-based nodular foci of enhancement with a T2 signal abnormality were seen. Lumbar puncture was repeated, with an opening pressure of 28 cm H 2 O, 588 WBC/l, no RBC, 61% eosinophils, 29% lymphocytes, 9% monocytes, 1% PMN, protein of 343 mg/dl, and glucose at 36 mg/dl. CSF was tested by PCR for HSV and varicella-zoster virus (VZV), and direct staining and culture were performed for aerobic organisms, fungi, and acid-fast bacillus; all were negative. Serum HIV testing was also negative. CSF flow cytometry showed marked acute inflammation with abundant eosinophils. No malignant cells were identified. A CSF cysticercosis IgG enzyme-linked immunosorbent assay (ELISA) was positive. A CSF sample was sent to the CDC for an Angiostrongylus cantonensis real-time PCR, which was positive. The patient was diagnosed with Angiostrongylus cantonensis eosinophilic meningitis with likely exposure from consumption of undercooked crab or shrimp in a known region of endemic Angiostrongylus cantonensis on the big island of Hawaii. He was started on prednisone and had several additional therapeutic lumbar punctures for treatment of increased intracranial pressure, with significant improvement in his clinical symptoms at the 2-month follow-up. DISCUSSIONEosinophilic meningitis is a rare, underrecognized clinical entity with a distinct differential diagnosis. It is defined by the presence of Ն10% eosinophils/l of the total

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“…in rats in urban Brisbane and some surrounding areas., surpassing the two previous surveys of 123 . In fact, sero-conversion might never occur in small children 5,120 .…”

Section: Discussionmentioning

confidence: 62%

“…mackerrasae and Brazilian female A. cantonensis all showed similar degrees of recognition to the serum from human infected with A. cantonensis from Brazil (positive control), serum from experimentally infected rat and guinea pigs ( Figure 8&9). Typical signs, such as blood and CSF eosinophilia, and sero-conversion are not always present in early stages of infection 123 . In fact, sero-conversion might never occur in small children 5,120 .…”

Section: Sds-page and Western Blots Comparing The Two Angiostrongylusmentioning

confidence: 99%

Molecular and pathological studies on Angiostrongylus species in southeast Queensland

Aghazadeh¹

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Despite an apparent increase in cases of angiostrongyliasis in humans and animals in Australia, the epidemiology of infection with the two species of Angiostrongylus that co-exist in this country, namely A. cantonensis and A. mackerrasae, is poorly understood. This knowledge gap is particularly important with respect to Angiostrongylus mackerrasae, a species evidently native to Australia, as its ability to cause disease in humans is unknown.Likewise, there is little information on the roles of native and introduced species of rodents and molluscs as hosts of Angiostrongylus species in Australia. This thesis focuses on the gaps in the knowledge about the epidemiology of two species in southeast Queensland, highlighting the hotspots for transmission of the parasite in urban Brisbane. A comprehensive survey of rats belonging to the species Rattus rattus, Rattus norvegicus and Rattus fuscipes was conducted. The prevalence of infection with Angiostrongylus spp. was 16.5% in Rattus spp. trapped in urban Brisbane and surrounds which is much higher than estimates of earlier studies. This highlights the possible risk of zoonotic infection in children, dogs and wildlife in this region and indicates the necessity for public awareness as well as more detailed epidemiological studies on this parasite in eastern Australia.Of the two Australian species, Angiostrongylus mackerrasae appears to be adapted to life in the native bush rat, Rattus fuscipes. This species evidently has an identical life cycle to that of Angiostrongylus cantonensis. A. mackerrasae may have greater potential to infect non-rodent hosts as it has been found as adult form in the lungs, as has been recorded for an individual flying fox.This raises concerns as to the potential of this native angiostrongylid to infect domestic animals and humans. To date, data on the taxonomy, epidemiology and population genetics of A. mackerrasae are poor or unknown. Here, we describe the mitochondrial (mt) genome of A. mackerrasae with the aim of addressing some of these knowledge gaps.The complete mitochondrial (mt) genome of A. mackerrasae was amplified from a single morphologically identified adult worm, by long-PCR in two overlapping amplicons (8 kb and 10 kb). The amplicons were sequenced using the MiSeq Illumina platform and annotated using an in-house pipeline. Amino acid sequences inferred from individual protein coding genes of the mt genomes were concatenated and then subjected to phylogenetic analysis using Bayesian inference.The mt genome of A. mackerrasae is 13,640 bp in size and contains 12 protein coding genes (cox1-3, nad1-6, nad4L, atp6 and cob), and two ribosomal RNA (rRNA) and 22 transfer RNA (tRNA) genes. The mt genome of A. mackerrasae has similar characteristics to those of other Angiostrongylus species which is explained in detail in chapter 3. Phylogenic comparisons reveal III that A. mackerrasae is closely related to A. cantonensis and the two sibling species may have recently diverged compared with all other species in the genus with a highl...

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Clinical manifestations of eosinophilic meningitis caused by Angiostrongylus cantonensis: 18 years’ experience in a medical center in southern Taiwan

Cited by 55 publications

References 26 publications

THE FIRST CASE OF Angiostrongylus cantonensis EOSINOPHILIC MENINGITIS DIAGNOSED IN THE CITY OF SÃO PAULO, BRAZIL

THE FIRST CASE OF Angiostrongylus cantonensis EOSINOPHILIC MENINGITIS DIAGNOSED IN THE CITY OF SÃO PAULO, BRAZIL

The Brief Case: Angiostrongylus cantonensis Eosinophilic Meningitis in a Returned Traveler

Molecular and pathological studies on Angiostrongylus species in southeast Queensland

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