Elsberg Syndrome with Eosinophilic Meningoencephalitis Caused by Angiostrongylus cantonensis

Furugen, Makoto; Yamashiro, Satoshi; Tamayose, Maki; Naha, Yui; Miyagi, Kazuya; Nakasone, Chikara; Uchihara, Teruhito; Haranaga, Shusaku; Azuma, Masato; Yara, Satomi; Shinzato, Takashi; Higa, Futoshi; Toma, Hiromu; Tateyama, Masao; Fujita, Jiro

doi:10.2169/internalmedicine.45.1871

Cited by 16 publications

(7 citation statements)

References 8 publications

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“…However, patients more often present with headache, neck stiffness, paraesthesia, muscle weakness, Brudzinski's sign, fever, vomiting and nausea. Symptoms such as face/limb paralysis, memory loss, confusion, dizziness, conscious disturbance, tinnitus, hyperesthesia, dystonia, urinary retention, photophobia, pneumonitis, peritonitis, abdominal pain, bowel dysfunction, orbital/retro-orbital pain and paralysis of the extra-ocular muscles, are also less common (Chau et al 2003; Podwall et al 2004; Furugen et al 2006; Jin et al 2008; Li et al 2008; Wang et al 2008, 2010; Tseng et al 2011; Kwon et al 2013). Symptoms can be protracted, taking months to disappear (Hochberg et al 2011).…”

Section: Pathophysiology and Clinical Manifestationsmentioning

confidence: 99%

Angiostrongylus cantonensis: a review of its distribution, molecular biology and clinical significance as a human pathogen

et al. 2016

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Angiostrongylus cantonensis is a metastrongyloid nematode found widely in the Asia-Pacific region, and the aetiological agent of angiostrongyliasis; a disease characterized by eosinophilic meningitis. Rattus rats are definitive hosts of A. cantonensis, while intermediate hosts include terrestrial and aquatic molluscs. Humans are dead-end hosts that usually become infected upon ingestion of infected molluscs. A presumptive diagnosis is often made based on clinical features, a history of mollusc consumption, eosinophilic pleocytosis in cerebral spinal fluid, and advanced imaging such as computed tomography. Serological tests are available for angiostrongyliasis, though many tests are still under development. While there is no treatment consensus, therapy often includes a combination of anthelmintics and corticosteroids. Angiostrongyliasis is relatively rare, but is often associated with morbidity and sometimes mortality. Recent reports suggest the parasites' range is increasing, leading to fatalities in regions previously considered Angiostrongylus-free, and sometimes, delayed diagnosis in newly invaded regions. Increased awareness of angiostrongyliasis would facilitate rapid diagnosis and improved clinical outcomes. This paper summarizes knowledge on the parasites' life cycle, clinical aspects and epidemiology. The molecular biology of Angiostrongylus spp. is also discussed. Attention is paid to the significance of angiostrongyliasis in Australia, given the recent severe cases reported from the Sydney region.

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Section: Pathophysiology and Clinical Manifestationsmentioning

confidence: 99%

Angiostrongylus cantonensis: a review of its distribution, molecular biology and clinical significance as a human pathogen

et al. 2016

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“…Other symptoms include eosinophilic meningoencephalitis [37], eosinophilic radiculomyelitis [38], ocular angiostrongyliasis [39], as well as nasal [40] or pulmonary infections [41],[42]. Further, most angiostrongyliasis infections are self-limiting and recovery without sequelae is the norm [11],[19],[35].…”

Section: Discussionmentioning

confidence: 99%

Human Angiostrongyliasis Outbreak in Dali, China

Zhang

Chen

et al. 2009

PLoS Negl Trop Dis

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BackgroundSeveral angiostrongyliasis outbreaks have been reported in recent years but the disease continues to be neglected in public health circles. We describe an outbreak in Dali, southwest China in order to highlight some key problems for the control of this helminth infection.Methodology/Principal FindingsAll available medical records of suspected angiostrongyliasis patients visiting hospitals in Dali in the period 1 October 2007–31 March 2008 were reviewed, and tentative diagnoses of varying strengths were reached according to given sets of criteria. Snails collected from local markets, restaurants and natural habitats were also screened for the presence of Angiostrongylus cantonensis. A total of 33 patients met criteria for infection, and 11 among them were classified as clinically confirmed. An additional eight patients were identified through a surveillance system put in operation in response to the outbreak. The epidemic lasted for 8 months with its peak in February 2008. Of the 33 patients, 97.0% complained of severe headache. 84.8% patients had high eosinophil cell counts either in the peripheral blood or in cerebrospinal fluid (CSF). Three-quarters of the patients were treated with a combination of albendazole and corticosteroids, resulting in significantly improved overall conditions. Twenty-two patients reported the consumption of raw or undercooked snails prior to the onset of the symptoms, and approximately 1.0% of the Pomacea canaliculata snails on sale were found to be infected with A. cantonensis. The snails were also found in certain habitats around Dali but no parasites were detected in these populations.Conclusions/SignificanceThe import and sale of infected P. canaliculata is the likely trigger for this angiostrongyliasis outbreak. Awareness of angiostrongyliasis must be raised, and standardized diagnosis and treatment are needed in order to provide clinicians with a guide to address this disease. Health education campaigns could limit the risk, and a hospital-based surveillance system should be established in order to detect future outbreaks.

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“…Other aetiologies such as HSV1, human herpes virus, varicella zoster virus, Epstein–Barr virus,17 and ECHO virus18 have also been reported. Although urinary retention accompanying eosinophilic meningitis caused by A cantonensis has been reported in a few paediatric cases,19 only one adult with urinary retention considered to be caused by A cantonensis has been reported (by Furugen et al in 20069), but bilateral leg weakness had not been described.…”

Section: Discussionmentioning

confidence: 99%

Sacral myeloradiculitis (Elsberg syndrome) secondary to eosinophilic meningitis caused by Angiostrongylus cantonensis

et al. 2009

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Elsberg syndrome secondary to eosinophilic meningitis caused by Angiostrongylus cantonensis is uncommon. Clinicians should consider a wide differential diagnosis including tumour, spinal cord infarction, necrosis, vasculitis, drug induced or other sources of infection. In addition, acute urinary retention is a urological emergency and clinicians should keep in mind the prevention of bladder overdistension. The intervention of rehabilitation programmes and clean intermittent catheterisation education for bladder management, in accordance with the patient's condition, is also important. Earlier rehabilitation is important to ensure a speedy recovery and to prevent further complications.

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Elsberg Syndrome with Eosinophilic Meningoencephalitis Caused by Angiostrongylus cantonensis

Abstract: Abstract

Cited by 16 publications

References 8 publications

Angiostrongylus cantonensis: a review of its distribution, molecular biology and clinical significance as a human pathogen

Angiostrongylus cantonensis: a review of its distribution, molecular biology and clinical significance as a human pathogen

Human Angiostrongyliasis Outbreak in Dali, China

Sacral myeloradiculitis (Elsberg syndrome) secondary to eosinophilic meningitis caused by Angiostrongylus cantonensis

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