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A severe case of Angiostrongylus eosinophilic meningitis with encephalitis and neurologic sequelae in Hawa'i.
Hawaii J Med Public Health. 2013 Jun; 72(6 Suppl 2):41-5.HJ

Abstract

Angiostrongylus eosinophilic meningitis is caused by infection with larvae of the rat lungworm, Angiostrongylus cantonensis. We report the case of an adult who ingested a raw, giant African snail (Achatina fulica) on the island of O'ahu in Hawa'i and developed an eosinophilic meningoencephalitis with severe headache, confusion, sixth cranial nerve palsy, ataxia, limb weakness, and paresthesia. He was treated with lumbar punctures to relieve pressure, high dose corticosteroids, and 14 days of albendazole. He had a prolonged convalescence, requiring 3 months of prednisone, and still had evidence of motor nerve weakness 4 months after exposure. A field investigation at the site of exposure yielded 5 of 9 Achatina fulica snails with evidence of A. cantonensis DNA by PCR. Cerebrospinal fluid samples from the patient were negative acutely but positive on day 15 of symptoms, using an investigational, real-time PCR assay. We discuss clinical management of this case in light of the current medical literature.

Authors+Show Affiliations

Departments of Family Practice, Tripler Army Medical Center, Honolulu, HI, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

23901383

Citation

Kwon, Edward, et al. "A Severe Case of Angiostrongylus Eosinophilic Meningitis With Encephalitis and Neurologic Sequelae in Hawa'i." Hawai'i Journal of Medicine & Public Health : a Journal of Asia Pacific Medicine & Public Health, vol. 72, no. 6 Suppl 2, 2013, pp. 41-5.
Kwon E, Ferguson TM, Park SY, et al. A severe case of Angiostrongylus eosinophilic meningitis with encephalitis and neurologic sequelae in Hawa'i. Hawaii J Med Public Health. 2013;72(6 Suppl 2):41-5.
Kwon, E., Ferguson, T. M., Park, S. Y., Manuzak, A., Qvarnstrom, Y., Morgan, S., Ciminera, P., & Murphy, G. S. (2013). A severe case of Angiostrongylus eosinophilic meningitis with encephalitis and neurologic sequelae in Hawa'i. Hawai'i Journal of Medicine & Public Health : a Journal of Asia Pacific Medicine & Public Health, 72(6 Suppl 2), 41-5.
Kwon E, et al. A Severe Case of Angiostrongylus Eosinophilic Meningitis With Encephalitis and Neurologic Sequelae in Hawa'i. Hawaii J Med Public Health. 2013;72(6 Suppl 2):41-5. PubMed PMID: 23901383.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A severe case of Angiostrongylus eosinophilic meningitis with encephalitis and neurologic sequelae in Hawa'i. AU - Kwon,Edward, AU - Ferguson,Tomas M, AU - Park,Sarah Y, AU - Manuzak,Augustina, AU - Qvarnstrom,Yvonne, AU - Morgan,Stephen, AU - Ciminera,Paul, AU - Murphy,Gerald S, PY - 2013/8/1/entrez PY - 2013/8/2/pubmed PY - 2014/5/23/medline KW - Achatina fulica KW - Albendazole KW - Angiostrongylus cantonensis KW - Angiostrongylus eosinophilic meningitis KW - Case report KW - Cerebral angiostrongyliasis KW - Corticosteroid KW - Eosinophilic meningitis KW - Hawa‘i KW - Human KW - Meningoencephalitis KW - Neuroangiostrongyliasis KW - Radiculomeningoencephalitis KW - Snail SP - 41 EP - 5 JF - Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health JO - Hawaii J Med Public Health VL - 72 IS - 6 Suppl 2 N2 - Angiostrongylus eosinophilic meningitis is caused by infection with larvae of the rat lungworm, Angiostrongylus cantonensis. We report the case of an adult who ingested a raw, giant African snail (Achatina fulica) on the island of O'ahu in Hawa'i and developed an eosinophilic meningoencephalitis with severe headache, confusion, sixth cranial nerve palsy, ataxia, limb weakness, and paresthesia. He was treated with lumbar punctures to relieve pressure, high dose corticosteroids, and 14 days of albendazole. He had a prolonged convalescence, requiring 3 months of prednisone, and still had evidence of motor nerve weakness 4 months after exposure. A field investigation at the site of exposure yielded 5 of 9 Achatina fulica snails with evidence of A. cantonensis DNA by PCR. Cerebrospinal fluid samples from the patient were negative acutely but positive on day 15 of symptoms, using an investigational, real-time PCR assay. We discuss clinical management of this case in light of the current medical literature. SN - 2165-8242 UR - https://www.unboundmedicine.com/medline/citation/23901383/A_severe_case_of_Angiostrongylus_eosinophilic_meningitis_with_encephalitis_and_neurologic_sequelae_in_Hawa'i_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23901383/ DB - PRIME DP - Unbound Medicine ER -