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Eosinophilic meningitis caused by Angiostrongylus cantonensis: report of 17 cases.
Am J Med. 2001 Aug; 111(2):109-14.AJ

Abstract

PURPOSE

To describe two outbreaks of Angiostrongylus cantonensis infection that occurred in Kaohsiung, Taiwan, during 1998 and 1999, and to characterize the source of the outbreaks and the clinical manifestations of the disease.

SUBJECTS AND METHODS

We performed a retrospective cohort study among Thai laborers with eosinophilic meningitis who ate raw snails (Ampullarium canaliculatus), as well as an environmental surveillance of larvae in snails.

RESULTS

We enrolled 17 Thai laborers in whom severe headache and eosinophilia developed within 4 to 23 days after eating raw snails. Twelve (71%) developed eosinophilic meningitis. Third-stage larvae were found in the cerebrospinal fluids of 2 patients and in all 12 tested snails. Specific antibodies to A. cantonensis were detected in serum from 16 of the patients and in cerebrospinal fluid from 5 of the patients. Central nervous system manifestations included headache (n = 17 [100%]), fever (n = 11 [65%]), Brudzinski's sign/stiff neck (n = 11 [65%]), hyperesthesia (n = 3 [18%]), cranial nerve palsy (n = 2 [12%]), diplopia (n = 2 [12%]), and ataxia (n = 1 [6%]). Laboratory findings included peripheral eosinophilia (n = 15 [88%]) and cerebrospinal fluid eosinophilia (n = 12 [71%]); elevated immunoglobulin (Ig) E levels (n = 13 [100%]); and transient increases in white blood cell count (n = 7 [41%]) and in serum levels of creatine kinase (n = 7 [41%]), transaminase (n = 3 [18%]), and lactate dehydrogenase (n = 2 [12%]). The severity of illness and eosinophilia were correlated with the number of ingested snails. Meningeal and basal ganglion enhancement was noted on magnetic resonance imaging in several patients. Treatment with mebendazole combined with glucocorticosteroids appeared to shorten the course of the infection, but not the number of relapses. The eosinophil count fell to normal within 3 months, but IgE levels remained elevated for as long as 6 months. All patients recovered with minimal neurologic sequelae.

CONCLUSION

Eosinophilic meningitis caused by A. cantonensis should be considered in patients who have headache or central nervous system manifestations after eating raw snails.

Authors+Show Affiliations

Department of Medicine, Section of Infectious Diseases, Veterans General Hospital-Kaohsiung, Kaohsiung, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

11498063

Citation

Tsai, H C., et al. "Eosinophilic Meningitis Caused By Angiostrongylus Cantonensis: Report of 17 Cases." The American Journal of Medicine, vol. 111, no. 2, 2001, pp. 109-14.
Tsai HC, Liu YC, Kunin CM, et al. Eosinophilic meningitis caused by Angiostrongylus cantonensis: report of 17 cases. Am J Med. 2001;111(2):109-14.
Tsai, H. C., Liu, Y. C., Kunin, C. M., Lee, S. S., Chen, Y. S., Lin, H. H., Tsai, T. H., Lin, W. R., Huang, C. K., Yen, M. Y., & Yen, C. M. (2001). Eosinophilic meningitis caused by Angiostrongylus cantonensis: report of 17 cases. The American Journal of Medicine, 111(2), 109-14.
Tsai HC, et al. Eosinophilic Meningitis Caused By Angiostrongylus Cantonensis: Report of 17 Cases. Am J Med. 2001;111(2):109-14. PubMed PMID: 11498063.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Eosinophilic meningitis caused by Angiostrongylus cantonensis: report of 17 cases. AU - Tsai,H C, AU - Liu,Y C, AU - Kunin,C M, AU - Lee,S S, AU - Chen,Y S, AU - Lin,H H, AU - Tsai,T H, AU - Lin,W R, AU - Huang,C K, AU - Yen,M Y, AU - Yen,C M, PY - 2001/8/11/pubmed PY - 2001/8/31/medline PY - 2001/8/11/entrez SP - 109 EP - 14 JF - The American journal of medicine JO - Am J Med VL - 111 IS - 2 N2 - PURPOSE: To describe two outbreaks of Angiostrongylus cantonensis infection that occurred in Kaohsiung, Taiwan, during 1998 and 1999, and to characterize the source of the outbreaks and the clinical manifestations of the disease. SUBJECTS AND METHODS: We performed a retrospective cohort study among Thai laborers with eosinophilic meningitis who ate raw snails (Ampullarium canaliculatus), as well as an environmental surveillance of larvae in snails. RESULTS: We enrolled 17 Thai laborers in whom severe headache and eosinophilia developed within 4 to 23 days after eating raw snails. Twelve (71%) developed eosinophilic meningitis. Third-stage larvae were found in the cerebrospinal fluids of 2 patients and in all 12 tested snails. Specific antibodies to A. cantonensis were detected in serum from 16 of the patients and in cerebrospinal fluid from 5 of the patients. Central nervous system manifestations included headache (n = 17 [100%]), fever (n = 11 [65%]), Brudzinski's sign/stiff neck (n = 11 [65%]), hyperesthesia (n = 3 [18%]), cranial nerve palsy (n = 2 [12%]), diplopia (n = 2 [12%]), and ataxia (n = 1 [6%]). Laboratory findings included peripheral eosinophilia (n = 15 [88%]) and cerebrospinal fluid eosinophilia (n = 12 [71%]); elevated immunoglobulin (Ig) E levels (n = 13 [100%]); and transient increases in white blood cell count (n = 7 [41%]) and in serum levels of creatine kinase (n = 7 [41%]), transaminase (n = 3 [18%]), and lactate dehydrogenase (n = 2 [12%]). The severity of illness and eosinophilia were correlated with the number of ingested snails. Meningeal and basal ganglion enhancement was noted on magnetic resonance imaging in several patients. Treatment with mebendazole combined with glucocorticosteroids appeared to shorten the course of the infection, but not the number of relapses. The eosinophil count fell to normal within 3 months, but IgE levels remained elevated for as long as 6 months. All patients recovered with minimal neurologic sequelae. CONCLUSION: Eosinophilic meningitis caused by A. cantonensis should be considered in patients who have headache or central nervous system manifestations after eating raw snails. SN - 0002-9343 UR - https://www.unboundmedicine.com/medline/citation/11498063/Eosinophilic_meningitis_caused_by_Angiostrongylus_cantonensis:_report_of_17_cases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(01)00766-5 DB - PRIME DP - Unbound Medicine ER -