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

Espírito-Santo, Maria Cristina Carvalho do; Pintó, Pedro; Mota, Dan Jessé Gonçalves da; Gryschek, Ronaldo César Borges

doi:10.1590/s0036-46652013000200012

Cited by 40 publications

(28 citation statements)

References 17 publications

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“…All human cases of H. gingivalis infections reported to date were diagnosed at autopsy, despite antemortem suspicions of parasitic infection in some cases. Neurological nematodiasis is rare but can involve parasites such as Angiostrongylus cantonensis, Strongyloides stercoralis, Toxocara canis, Trichinella spiralis, and Gnathostoma spinigerum, typically associated with CSF and peripheral eosinophilia (39)(40)(41)(42)(43)(44)(45)(46). During H. gingivalis infection, CSF may initially show only moderate pleocytosis and eosinophilia may be absent (10,11) and larvae are usually not found in CSF obtained by lumbar puncture.…”

Section: Case Reportmentioning

confidence: 99%

First Human Case of Fatal Halicephalobus gingivalis Meningoencephalitis in Australia

et al. 2015

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h Halicephalobus gingivalis (previously Micronema deletrix) is a free-living nematode known to cause opportunistic infections, mainly in horses. Human infections are very rare, but all cases described to date involved fatal meningoencephalitis. Here we report the first case of H. gingivalis infection in an Australian human patient, confirmed by nematode morphology and sequencing of ribosomal DNA. The implications of this case are discussed, particularly, the need to evaluate real-time PCR as a diagnostic tool. CASE REPORTA 74-year-old lady from a regional town in the Eyre Peninsula of South Australia with a 4-day history of mental state deterioration, fever, and a loss of coordination was transferred to the Royal Adelaide Hospital. She was moderately immune suppressed by methotrexate and etanercept treatment for rheumatoid arthritis and had a history of diabetes. During the admission, her conscious state deteriorated rapidly, requiring mechanical ventilation and admission to the intensive care unit (ICU). Subsequently, she developed signs of brainstem involvement and exhibited a loss of corneal and gag reflexes. She was administered benzylpenicillin, ceftriaxone, and aciclovir for presumptive meningoencephalitis of bacterial or viral etiology. Cerebrospinal fluid (CSF) obtained by lumbar puncture demonstrated 280 ϫ10 6 polymorphonuclear leukocytes (PMN)/liter, 18 ϫ10 6 mononuclear lymphocytes/liter, elevated CSF protein of 1.59 g/liter, and CSF glucose of 3.3 mmol/ liter; aerobic and anaerobic bacterial culture results were negative, as were PCR results for Streptococcus pneumoniae, Neisseria meningitidis, herpes simplex virus, and varicella-zoster virus. CSF India ink stain and cryptococcal antigen lateral flow assay (Immy, Inc., Norman, OK, USA) results were negative. Magnetic resonance imaging (MRI) of the brain exhibited a left-predominant, asymmetrical meningeal enhancement in the frontoparietal cortex, without any detectable brainstem changes. Two days later, repeated lumbar punctures showed a marked elevation of PMN to 2,500 ϫ10 6 cells/liter and 34 ϫ10 6 mononuclear cells/liter, with no bacteria detected upon Gram staining. CSF stained with DiffQuick (Alere, Brisbane, Australia) showed 99% PMN with very few eosinophils. CSF protein was markedly elevated (5.46 g/liter), and CSF glucose was 1.3 mmol/liter. Microscopic examination of 100 l of unstained CSF was performed after centrifugation at 700 ϫ g for 10 min, but no amoebic trophozoites were detected. With a suspicion of parasitic infection, given the unexplained high PMN counts, the antimicrobial treatment strategy was changed to liposomal amphotericin B, sulfadiazine, pentamidine, and azithromycin to target protists such as amoebae and Toxoplasma gondii. CSF was subjected to PCR for Naegleria fowleri, Acanthamoeba sp., and Balamuthia mandrillaris, but all test results were negative. No anti-Strongyloides serum antibody (IgG) was detected in an enzyme-linked immunosorbent assay using somatic larval antigens from Strongyloides ratti (Bordier Affinity Pr...

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Section: Case Reportmentioning

confidence: 99%

First Human Case of Fatal Halicephalobus gingivalis Meningoencephalitis in Australia

et al. 2015

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“…These data are especially useful and can be used by public health authorities to establish policies related to surveillance and planning of preventive actions. Isolated cases of eosinophilic meningoencephalitis have recently been reported in Brazil 9,11,14,15,46,47 . Thus, it is plausible that A. cantonensis continues to spread to new regions, increasing the risk of eosinophilic meningoencephalitis in humans.…”

Section: Several Snails Play Roles As Intermediate Hosts Formentioning

confidence: 99%

“…A. cantonensis has been observed in several regions of the world [3][4][5][6][7] , and they were distributed from Eastern Asia to other continents by two main hosts: rats (definitive hosts) and Achatina fulica Bowdich, 1822 (one of the intermediate hosts), especially during the Second World War 8 . Several species of land and freshwater snails have also been found to be naturally infected with A. cantonensis [9][10][11][12][13][14] . In Brazil, the occurrence of A. cantonensis has been reported in all states except for Acre [9][10][11][12][13][14][15][16][17] .…”

Section: Introductionmentioning

confidence: 99%

“…Several species of land and freshwater snails have also been found to be naturally infected with A. cantonensis [9][10][11][12][13][14] . In Brazil, the occurrence of A. cantonensis has been reported in all states except for Acre [9][10][11][12][13][14][15][16][17] . Man, being an accidental host, acquires parasitosis when eating foods contaminated with stagethree larvae (L3), raw or undercooked mollusks, and paratenic hosts such as shrimp, frogs, fish, and flatworms 4,[18][19][20] , as well as crabs and lizards 21,22 .…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and distribution of Angiostrongylus cantonensis (Nematoda, Angiostrongylidae) in Achatina fulica (Mollusca, Gastropoda) in Baixada Santista, São Paulo, Brazil

Guerino

Pecora

Miranda

et al. 2017

Rev. Soc. Bras. Med. Trop.

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Introduction: Angiostrongylus cantonensis causes eosinophilic meningoencephalitis in humans. Worldwide expansion of this nematode is linked to the dispersion of their hosts. This study aimed to determine the prevalence of A. cantonensis infection in Achatina fulica in the nine municipalities that make up Baixada Santista, São Paulo, Brazil. Methods: Angiostrongylus cantonensis larvae were analyzed using optical microscopy. We performed polymerase chain reaction and restriction fragment length polymorphism using restriction endonuclease ClaI, directed to the internal transcribed spacer region 2 of A. cantonensis larval DNA. Results: Of the 540 snails analyzed, 117 (21.7%) were infected by A. cantonensis. For morphological and morphometric analyses, 60 larvae were used. Second-stage larvae were, on average, 358.2µm long and 26.4µm wide, while third-stage larvae were, on average, 450µm long and 21.12µm wide. The tails of the larvae ended in a fine tip. Conclusions: All municipalities comprising Baixada Santista had A. fulica that were naturally infected with A. cantonensis. All of the observed characteristics were typical of the species.

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“…However, this scenario began to change with the first reported occurrence in the Americas in 1981 when infected rats and snails were found in Cuba (Aguiar et al 1981). Since that time, the occurrence of A. cantonensis has been reported in the United States of America, Jamaica and Ecuador (Kim et al 2002, Slom et al 2002, Wang et al 2008, Pincay et al 2009); it has recently been found in Brazil (Caldeira et al 2007, Lima et al 2009, Espírito-Santo et al 2013). …”

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confidence: 97%

Eosinophilic meningitis caused by Angiostrongylus cantonensis: an emergent disease in Brazil

Morassutti

Thiengo

Fernandez

et al. 2014

Mem. Inst. Oswaldo Cruz

116

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Eosinophilic meningitis (EoM) is an acute disease that affects the central nervous system. It is primarily caused by infection with the nematode Angiostrongylus cantonensis. This infection was previously restricted to certain Asian countries and the Pacific Islands, but it was first reported in Brazil in 2007. Since then, intermediate and definitive hosts infected with A. cantonensis have been identified within the urban areas of many states in Brazil, including those in the northern, northeastern, southeastern and southern regions. The goals of this review are to draw the attention of the medical community and health centres to the emergence of EoM in Brazil, to compile information about several aspects of the human infection and mode of transmission and to provide a short protocol of procedures for the diagnosis of this disease.

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

Cited by 40 publications

References 17 publications

First Human Case of Fatal Halicephalobus gingivalis Meningoencephalitis in Australia

First Human Case of Fatal Halicephalobus gingivalis Meningoencephalitis in Australia

Prevalence and distribution of Angiostrongylus cantonensis (Nematoda, Angiostrongylidae) in Achatina fulica (Mollusca, Gastropoda) in Baixada Santista, São Paulo, Brazil

Eosinophilic meningitis caused by Angiostrongylus cantonensis: an emergent disease in Brazil

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