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Angiostrongylus cantonensis eosinophilic meningitis: a clinical study of 42 consecutive cases in French Polynesia.
Parasitol Int. 2014 Jun; 63(3):544-9.PI

Abstract

INTRODUCTION

In endemic areas, eosinophilic meningitis is mainly caused by Angiostrongylus cantonensis. We describe a series of this poorly-known condition.

METHODS

Retrospective cohort study (2000-2012) including all patients diagnosed with eosinophilic meningitis in French Polynesia.

RESULTS

Forty-two patients (males: 61.9%, age: 22 (IQR 17-32)) were diagnosed with a serologically proven (n=13) or probable A. cantonensis meningitis, mostly during the dry season (66.6%) and following the consumption of or prolonged contact with an intermediate/paratenic host (64.3%). No differential diagnosis was found in probable cases, in whom serological tests were performed earlier (7.5 days (6.5-10)) compared to positive patients (7.5 (6.5-10) versus 11 (7-30) days, p=0.02). The most commonly reported symptom was headache (92.8%). Fever (7.1%) and biological inflammatory syndrome (14.3%) were rare. Blood eosinophil count was 1200/mm(3) (900-2548). Cerebrospinal fluid (CSF) analysis disclosed a protein level of 0.9 g/L (0.7-1.1), a CSF/plasma glucose ratio of 0.50 (0.40-0.55), and 500 leucocytes/mm(3) (292-725; eosinophils: 42.0% (29.5-60); lymphocytes: 46.5% (32.5-59.0)). Thirteen cases (31.0%) were severe, with 11 focal neurological deficits. A delayed hospital referral (OR 1.13, p=0.05) was associated with severity.

CONCLUSIONS

A. cantonensis meningitis must be evocated in young patients with meningitic syndrome, severe headache, and CSF inflammation with predominance of eosinophils.

Authors+Show Affiliations

Department of Internal Medicine, French Polynesia Hospital Center, 98716 Pirae, Tahiti, French Polynesia.Department of Neurology, French Polynesia Hospital Center, 98716 Pirae, Tahiti, French Polynesia.Department of Pneumology, French Polynesia Hospital Center, 98716 Pirae, Tahiti, French Polynesia.Laboratory of Pathology, French Polynesia Hospital Center, 98716 Pirae, Tahiti, French Polynesia.Laboratory of Microbiology, French Polynesia Hospital Center, 98716 Pirae, Tahiti, French Polynesia.Department of Internal Medicine, French Polynesia Hospital Center, 98716 Pirae, Tahiti, French Polynesia. Electronic address: florent.valour@chu-lyon.fr.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24583335

Citation

Oehler, Erwan, et al. "Angiostrongylus Cantonensis Eosinophilic Meningitis: a Clinical Study of 42 Consecutive Cases in French Polynesia." Parasitology International, vol. 63, no. 3, 2014, pp. 544-9.
Oehler E, Ghawche F, Delattre A, et al. Angiostrongylus cantonensis eosinophilic meningitis: a clinical study of 42 consecutive cases in French Polynesia. Parasitol Int. 2014;63(3):544-9.
Oehler, E., Ghawche, F., Delattre, A., Berberian, A., Levy, M., & Valour, F. (2014). Angiostrongylus cantonensis eosinophilic meningitis: a clinical study of 42 consecutive cases in French Polynesia. Parasitology International, 63(3), 544-9. https://doi.org/10.1016/j.parint.2014.02.001
Oehler E, et al. Angiostrongylus Cantonensis Eosinophilic Meningitis: a Clinical Study of 42 Consecutive Cases in French Polynesia. Parasitol Int. 2014;63(3):544-9. PubMed PMID: 24583335.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Angiostrongylus cantonensis eosinophilic meningitis: a clinical study of 42 consecutive cases in French Polynesia. AU - Oehler,Erwan, AU - Ghawche,Frédéric, AU - Delattre,Alex, AU - Berberian,Anthony, AU - Levy,Marc, AU - Valour,Florent, Y1 - 2014/02/26/ PY - 2013/09/30/received PY - 2014/02/08/revised PY - 2014/02/16/accepted PY - 2014/3/4/entrez PY - 2014/3/4/pubmed PY - 2014/12/15/medline KW - Angiostrongylus cantonensis KW - Eosinophils KW - Meningitis SP - 544 EP - 9 JF - Parasitology international JO - Parasitol Int VL - 63 IS - 3 N2 - INTRODUCTION: In endemic areas, eosinophilic meningitis is mainly caused by Angiostrongylus cantonensis. We describe a series of this poorly-known condition. METHODS: Retrospective cohort study (2000-2012) including all patients diagnosed with eosinophilic meningitis in French Polynesia. RESULTS: Forty-two patients (males: 61.9%, age: 22 (IQR 17-32)) were diagnosed with a serologically proven (n=13) or probable A. cantonensis meningitis, mostly during the dry season (66.6%) and following the consumption of or prolonged contact with an intermediate/paratenic host (64.3%). No differential diagnosis was found in probable cases, in whom serological tests were performed earlier (7.5 days (6.5-10)) compared to positive patients (7.5 (6.5-10) versus 11 (7-30) days, p=0.02). The most commonly reported symptom was headache (92.8%). Fever (7.1%) and biological inflammatory syndrome (14.3%) were rare. Blood eosinophil count was 1200/mm(3) (900-2548). Cerebrospinal fluid (CSF) analysis disclosed a protein level of 0.9 g/L (0.7-1.1), a CSF/plasma glucose ratio of 0.50 (0.40-0.55), and 500 leucocytes/mm(3) (292-725; eosinophils: 42.0% (29.5-60); lymphocytes: 46.5% (32.5-59.0)). Thirteen cases (31.0%) were severe, with 11 focal neurological deficits. A delayed hospital referral (OR 1.13, p=0.05) was associated with severity. CONCLUSIONS: A. cantonensis meningitis must be evocated in young patients with meningitic syndrome, severe headache, and CSF inflammation with predominance of eosinophils. SN - 1873-0329 UR - https://www.unboundmedicine.com/medline/citation/24583335/Angiostrongylus_cantonensis_eosinophilic_meningitis:_a_clinical_study_of_42_consecutive_cases_in_French_Polynesia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1383-5769(14)00028-2 DB - PRIME DP - Unbound Medicine ER -