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Clinical manifestations of eosinophilic meningitis caused by Angiostrongylus cantonensis: 18 years' experience in a medical center in southern Taiwan.
J Microbiol Immunol Infect. 2011 Oct; 44(5):382-9.JM

Abstract

BACKGROUND

With the improvement of public health, eosinophilic meningitis associated with Angiostrongylus cantonensis infection is now seldom reported in Taiwan. Eosinophilic meningitis typically occurred sporadically in children. This study aims to analyze the clinical manifestations and change in the contemporary epidemiology of eosinophilic meningitis in Taiwan.

METHODS

This is a retrospective study of patients diagnosed with eosinophilic meningitis at Kaohsiung Veterans General Hospital, from December 1991 to September 2009. The demographic characteristics, clinical presentations, laboratory data, radiographic imaging, and treatment and clinical outcome were analyzed. A PubMed search with the keywords of eosinophilic meningitis, A cantonensis, and Taiwan was performed to retrieve cases of eosinophilic meningitis caused by A cantonensis since 1960.

RESULTS

Thirty-seven patients were diagnosed to have eosinophilic meningitis during a period of 18 years. The median age was 32 years (range, 2-80 years). Ninety five percent (35/37) of the patients were adults. The median incubation period was 10.5 days (range, 3-80 days). Most of the patients presented with headache (29, 78%), fever (25, 68%), and 11(30%) had hyperesthesia. Patients with hyperesthesia had longer incubation period (55 vs. 7 days, p=0.004), lower serum immunoglobulin E levels (127.5 vs. 1295 IU/mL, p<0.001), and longer duration between symptom onset and spinal taps (14 vs. 5 days, p=0.011). Three patients presented initially with lymphocytic meningitis, and eosinophilia only appeared on a second lumbar puncture. Magnetic resonance imaging of the brain disclosed leptomeningeal enhancement (17/26, 65%) and increased signal intensity (10/26, 38%) on T2-weighted and fluid-attenuated inversion recovery images. There were eight relapses and two patients died. No sequela was noted except in one 2-year-old toddler, who had weakness of both lower limbs.

CONCLUSIONS

The epidemiology of eosinophilic meningitis has changed during the past two decades in Taiwan and occurs mainly in adults in the setting of outbreaks. Hyperesthesia; repeated lumbar puncture in cases with lymphocytic meningitis of uncertain cause; and a detailed history, including food consumption, are important to establish an accurate diagnosis.

Authors+Show Affiliations

Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, 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 available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21524976

Citation

Tseng, Yu-Ting, et al. "Clinical Manifestations of Eosinophilic Meningitis Caused By Angiostrongylus Cantonensis: 18 Years' Experience in a Medical Center in Southern Taiwan." Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, vol. 44, no. 5, 2011, pp. 382-9.
Tseng YT, Tsai HC, Sy CL, et al. Clinical manifestations of eosinophilic meningitis caused by Angiostrongylus cantonensis: 18 years' experience in a medical center in southern Taiwan. J Microbiol Immunol Infect. 2011;44(5):382-9.
Tseng, Y. T., Tsai, H. C., Sy, C. L., Lee, S. S., Wann, S. R., Wang, Y. H., Chen, J. K., Wu, K. S., & Chen, Y. S. (2011). Clinical manifestations of eosinophilic meningitis caused by Angiostrongylus cantonensis: 18 years' experience in a medical center in southern Taiwan. Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, 44(5), 382-9. https://doi.org/10.1016/j.jmii.2011.01.034
Tseng YT, et al. Clinical Manifestations of Eosinophilic Meningitis Caused By Angiostrongylus Cantonensis: 18 Years' Experience in a Medical Center in Southern Taiwan. J Microbiol Immunol Infect. 2011;44(5):382-9. PubMed PMID: 21524976.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical manifestations of eosinophilic meningitis caused by Angiostrongylus cantonensis: 18 years' experience in a medical center in southern Taiwan. AU - Tseng,Yu-Ting, AU - Tsai,Hung-Chin, AU - Sy,Cheng Len, AU - Lee,Susan Shin-Jung, AU - Wann,Shue-Ren, AU - Wang,Yung-Hsing, AU - Chen,Jei-Kuang, AU - Wu,Kuan-Sheng, AU - Chen,Yao-Shen, Y1 - 2011/01/20/ PY - 2010/04/29/received PY - 2010/07/14/revised PY - 2010/08/26/accepted PY - 2011/4/29/entrez PY - 2011/4/29/pubmed PY - 2012/1/24/medline SP - 382 EP - 9 JF - Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi JO - J Microbiol Immunol Infect VL - 44 IS - 5 N2 - BACKGROUND: With the improvement of public health, eosinophilic meningitis associated with Angiostrongylus cantonensis infection is now seldom reported in Taiwan. Eosinophilic meningitis typically occurred sporadically in children. This study aims to analyze the clinical manifestations and change in the contemporary epidemiology of eosinophilic meningitis in Taiwan. METHODS: This is a retrospective study of patients diagnosed with eosinophilic meningitis at Kaohsiung Veterans General Hospital, from December 1991 to September 2009. The demographic characteristics, clinical presentations, laboratory data, radiographic imaging, and treatment and clinical outcome were analyzed. A PubMed search with the keywords of eosinophilic meningitis, A cantonensis, and Taiwan was performed to retrieve cases of eosinophilic meningitis caused by A cantonensis since 1960. RESULTS: Thirty-seven patients were diagnosed to have eosinophilic meningitis during a period of 18 years. The median age was 32 years (range, 2-80 years). Ninety five percent (35/37) of the patients were adults. The median incubation period was 10.5 days (range, 3-80 days). Most of the patients presented with headache (29, 78%), fever (25, 68%), and 11(30%) had hyperesthesia. Patients with hyperesthesia had longer incubation period (55 vs. 7 days, p=0.004), lower serum immunoglobulin E levels (127.5 vs. 1295 IU/mL, p<0.001), and longer duration between symptom onset and spinal taps (14 vs. 5 days, p=0.011). Three patients presented initially with lymphocytic meningitis, and eosinophilia only appeared on a second lumbar puncture. Magnetic resonance imaging of the brain disclosed leptomeningeal enhancement (17/26, 65%) and increased signal intensity (10/26, 38%) on T2-weighted and fluid-attenuated inversion recovery images. There were eight relapses and two patients died. No sequela was noted except in one 2-year-old toddler, who had weakness of both lower limbs. CONCLUSIONS: The epidemiology of eosinophilic meningitis has changed during the past two decades in Taiwan and occurs mainly in adults in the setting of outbreaks. Hyperesthesia; repeated lumbar puncture in cases with lymphocytic meningitis of uncertain cause; and a detailed history, including food consumption, are important to establish an accurate diagnosis. SN - 1995-9133 UR - https://www.unboundmedicine.com/medline/citation/21524976/Clinical_manifestations_of_eosinophilic_meningitis_caused_by_Angiostrongylus_cantonensis:_18_years'_experience_in_a_medical_center_in_southern_Taiwan_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1684-1182(11)00065-X DB - PRIME DP - Unbound Medicine ER -