Rat Lungworm Infection Associated with Central Nervous System Disease — Eight U.S. States, January 2011–January 2017

Liu, Eugene; Schwartz, Brian S.; Hysmith, Nicholas D.; DeVincenzo, John P.; Larson, Derek; Maves, Ryan C; Palazzi, Debra L.; Meyer, Chelsea; Custodio, Haidee; Braza, Mariejane M.; Hammoud, Roukaya Al; Rao, Suchitra; Qvarnström, Yvonne; Yabsley, Michael J.; Bradbury, Richard S.; Montgomery, Susan P.

doi:10.15585/mmwr.mm6730a4

Cited by 24 publications

(15 citation statements)

References 8 publications

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“…Human angiostrongyliasis occurs when stage three larvae (L3) of the nematode are ingested either unintentionally (food contaminated by molluscs' slime) or by consumption of raw snails or slugs. The US Centers for Disease Control and Prevention (CDCP) published a report which identified fifty-five percent of twelve angiostrongyliasis cases were likely due to consumption of raw vegetables [9]. Our patient did not have a history of raw seafood, mollusc, or snail ingestion, and the mechanism of infection is unclear.…”

Section: Discussionmentioning

confidence: 92%

Severe Eosinophilic Meningoencephalitis Secondary to Suspected Neuroangiostrongyliasis with a Good Clinical Outcome

Chiong

Lloyd

Post

2019

Case Reports in Infectious Diseases

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Angiostrongylus cantonensishas caused sporadic cases of eosinophilic meningoencephalitis in Sydney, Australia. We describe a 36-year-old man who presented subacutely with fevers, reduced level of consciousness, confusion, ophthalmoplegia, and urinary incontinence. He was diagnosed with severe eosinophilic meningoencephalitis secondary to suspectedAngiostrongylus cantonensisbased on clinical, serological, and radiological findings. The patient was treated with albendazole and prednisolone with full neurological recovery. Management of neuroangiostrongyliasis with anthelminthic is controversial as it is thought to cause worsened outcomes through inciting an inflammatory response as a result of parasite killing. We managed to successfully treat our patient using albendazole and prednisolone and achieved a good outcome.

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Section: Discussionmentioning

confidence: 92%

Severe Eosinophilic Meningoencephalitis Secondary to Suspected Neuroangiostrongyliasis with a Good Clinical Outcome

Chiong

Lloyd

Post

2019

Case Reports in Infectious Diseases

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“…No human cases have been reported in Grenada, the Bahamas, Haiti, and Puerto Rico, although A. cantonensis has been found in the environment on these islands [44]. It is noteworthy that the disease is also expanding in North and South America, in particular in the United States [27], Brazil [32], and some other South American countries [13,44]. In this study, most cases occurred during the rainy season, during which snails abound, particularly the giant African snail, Lissachatina fulica, which was introduced to Martinique in 1989 [31] and is known elsewhere to act as an intermediate host of A. cantonensis.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Neuroangiostrongyliasis is a parasitic disease caused by the accidental ingestion of the nematode Angiostrongylus cantonensis in its larval form. Human infection can lead to eosinophilic meningitis, sometimes complicated by life-threatening radiculomyelitis or encephalitis. Although some cases have been reported from other Caribbean Islands, no cases have been diagnosed in Martinique so far. Here, we report the first eight laboratory-confirmed cases of neuroangiostrongyliasis on the island of Martinique, French West Indies, between 1 January 2002 and 31 December 2017. One case was fatal and five resulted in neurological sequelae. The medical community should consider the risk of A. cantonensis infection in patients living in or returning from Martinique.

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“…Angiostrongylus cantonensis is a global parasite, and in the USA, a relatively high rate of infection in humans and other animals is documented in Hawai'i (Alicata, 1964;Jarvi et al, 2017;Johnston et al, 2019;Niebuhr et al, 2020). The parasite has also been reported in the US mainland, primarily in the southeastern states, with 12 human cases reported between 2011 and 2017 (Liu et al, 2018). It grows and reproduces in its definitive host, rats (Rattus spp.…”

Section: Introductionmentioning

confidence: 99%

Development of a recombinase polymerase amplification (RPA-EXO) and lateral flow assay (RPA-LFA) based on the ITS1 gene for the detection of Angiostrongylus cantonensis in gastropod intermediate hosts

et al. 2020

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Angiostrongylus cantonensis is a parasitic nematode known to infect humans through the ingestion of third stage larvae which can cause inflammation and damage to the central nervous system. Currently, polymerase chain reaction (PCR) is one of the most reliable diagnostic methods for detecting A. cantonensis in humans as well as in gastropod hosts, but requires expensive and specialized equipment. Here, we compare the sensitivity and accuracy of a recombinase polymerase amplification Exo (RPA-EXO) assay, and a recombinase polymerase amplification lateral flow assay (RPA-LFA) with a traditional quantitative PCR (qPCR) assay currently available. The three assays were used to test 35 slugs from Hawai‘i for the presence of A. cantonensis DNA. Consistent results among the three tests were shown in 23/35 samples (65.7%), while 7/35 (20%) were discordant in low infection level samples (<0.01 larvae per mg tissue), and 5/35 (14.3%) were equivocal. To evaluate sensitivity, a partial ITS1 gene was cloned, and serial plasmid dilutions were created ranging from 100 copies μL−1 to ~1 copy μL−1. All three assays consistently detected 50–100 copies μL−1 in triplicate and qPCR was able to detect ~13 copies μL−1 in triplicate. RPA-EXO was able to detect 25 copies μL−1 in triplicate and RPA-LFA was not able to amplify consistently below 50 copies μL−1. Thus, our RPA-EXO and RPA-LFA assays do not appear as sensitive as the current qPCR assay at low DNA concentrations; however, these tests have numerous advantages that may make them useful alternatives to qPCR.

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Rat Lungworm Infection Associated with Central Nervous System Disease — Eight U.S. States, January 2011–January 2017

Cited by 24 publications

References 8 publications

Severe Eosinophilic Meningoencephalitis Secondary to Suspected Neuroangiostrongyliasis with a Good Clinical Outcome

Severe Eosinophilic Meningoencephalitis Secondary to Suspected Neuroangiostrongyliasis with a Good Clinical Outcome

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

Development of a recombinase polymerase amplification (RPA-EXO) and lateral flow assay (RPA-LFA) based on the ITS1 gene for the detection of Angiostrongylus cantonensis in gastropod intermediate hosts

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