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Outbreak of eosinophilic meningitis associated with drinking raw vegetable juice in southern Taiwan.
Am J Trop Med Hyg. 2004 Aug; 71(2):222-6.AJ

Abstract

The most common cause of eosinophilic meningitis is the rat lungworm Angiostrongylus cantonensis a parasite that is endemic in the southeast Asian and Pacific regions. Outbreaks of eosinophilic meningitis associated with drinking raw vegetable juice are rarely reported, even in regions of endemic infection. We performed a cohort study among Taiwanese with eosinophilic meningitis who drank raw vegetable juice within three months of the onset of the outbreak. Clinical manifestations, laboratory examinations, and outcomes were prospectively followed. Five native Taiwanese met the case definition of eosinophilic meningitis. Specific antibodies to A. cantonensis were detected in the serum of five of the patients and in the cerebrospinal fluid (CSF) of four of the patients. Central nervous system manifestations included headache (n = 5 [100%]), Brudzinski's sign/stiff neck (n = 5 [100%]), hyperesthesia/paresthesias (n = 5 [100%]), and cranial nerve palsy (n = 1 [20%]). Laboratory findings included peripheral (n = 5 [100%]) and CSF eosinophilia (n = 4 [80%]), transient increases in the white blood cell count (n = 1 [20%]), and in serum levels of creatine kinase (n = 1 [20%]). Meningeal enhancement, as well as high signal intensity, at the subcortical white matter on T2 weighted and fluid attenuated inversion recovery images were observed on magnetic resonance imaging in four patients. There were three episodes of relapse during treatment and all resolved with after a lumbar puncture and/or administration of steroids. At the 12-month follow up, all five patients had recovered without neurologic sequelae. Risk factors identification showed that consumption of raw vegetable juice was associated with illness (Pearson correlation test r = 0.867, P = 0.01). There was association between the presence of raw vegetable juice and CSF eosinophilia (Spearman's correlation test r = 0.816, P = 0.004).

Authors+Show Affiliations

Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China. hctsai1011@yahoo.com.twNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15306715

Citation

Tsai, Hung-Chin, et al. "Outbreak of Eosinophilic Meningitis Associated With Drinking Raw Vegetable Juice in Southern Taiwan." The American Journal of Tropical Medicine and Hygiene, vol. 71, no. 2, 2004, pp. 222-6.
Tsai HC, Lee SS, Huang CK, et al. Outbreak of eosinophilic meningitis associated with drinking raw vegetable juice in southern Taiwan. Am J Trop Med Hyg. 2004;71(2):222-6.
Tsai, H. C., Lee, S. S., Huang, C. K., Yen, C. M., Chen, E. R., & Liu, Y. C. (2004). Outbreak of eosinophilic meningitis associated with drinking raw vegetable juice in southern Taiwan. The American Journal of Tropical Medicine and Hygiene, 71(2), 222-6.
Tsai HC, et al. Outbreak of Eosinophilic Meningitis Associated With Drinking Raw Vegetable Juice in Southern Taiwan. Am J Trop Med Hyg. 2004;71(2):222-6. PubMed PMID: 15306715.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outbreak of eosinophilic meningitis associated with drinking raw vegetable juice in southern Taiwan. AU - Tsai,Hung-Chin, AU - Lee,Susan Shin-Jung, AU - Huang,Chun-Kai, AU - Yen,Chuan-Min, AU - Chen,Eng-Rin, AU - Liu,Yung-Ching, PY - 2004/8/13/pubmed PY - 2004/9/21/medline PY - 2004/8/13/entrez SP - 222 EP - 6 JF - The American journal of tropical medicine and hygiene JO - Am J Trop Med Hyg VL - 71 IS - 2 N2 - The most common cause of eosinophilic meningitis is the rat lungworm Angiostrongylus cantonensis a parasite that is endemic in the southeast Asian and Pacific regions. Outbreaks of eosinophilic meningitis associated with drinking raw vegetable juice are rarely reported, even in regions of endemic infection. We performed a cohort study among Taiwanese with eosinophilic meningitis who drank raw vegetable juice within three months of the onset of the outbreak. Clinical manifestations, laboratory examinations, and outcomes were prospectively followed. Five native Taiwanese met the case definition of eosinophilic meningitis. Specific antibodies to A. cantonensis were detected in the serum of five of the patients and in the cerebrospinal fluid (CSF) of four of the patients. Central nervous system manifestations included headache (n = 5 [100%]), Brudzinski's sign/stiff neck (n = 5 [100%]), hyperesthesia/paresthesias (n = 5 [100%]), and cranial nerve palsy (n = 1 [20%]). Laboratory findings included peripheral (n = 5 [100%]) and CSF eosinophilia (n = 4 [80%]), transient increases in the white blood cell count (n = 1 [20%]), and in serum levels of creatine kinase (n = 1 [20%]). Meningeal enhancement, as well as high signal intensity, at the subcortical white matter on T2 weighted and fluid attenuated inversion recovery images were observed on magnetic resonance imaging in four patients. There were three episodes of relapse during treatment and all resolved with after a lumbar puncture and/or administration of steroids. At the 12-month follow up, all five patients had recovered without neurologic sequelae. Risk factors identification showed that consumption of raw vegetable juice was associated with illness (Pearson correlation test r = 0.867, P = 0.01). There was association between the presence of raw vegetable juice and CSF eosinophilia (Spearman's correlation test r = 0.816, P = 0.004). SN - 0002-9637 UR - https://www.unboundmedicine.com/medline/citation/15306715/Outbreak_of_eosinophilic_meningitis_associated_with_drinking_raw_vegetable_juice_in_southern_Taiwan_ L2 - https://medlineplus.gov/meningitis.html DB - PRIME DP - Unbound Medicine ER -