[Eosinophilic meningoencephalitis in Villa Clara (Cuba). A study of 17 patients].
BACKGROUND
Infection by Angiostrongylus cantonensis is caused by eating snails and slugs or contaminated vegetables, and is the commonest cause of eosinophilic meningoencephalitis throughout the world.


OBJECTIVE
To make a further study of this condition, analyze the clinical behaviour and evaluate the cerebrospinal fluid findings and response to treatment.


METHODS
We made a retrospective, descriptive study by reviewing the clinical histories of a series of 17 adult patients attended in two university hospitals in the province of Villa Clara (Cuba), between December 1991 and January 2000. We recorded the characteristics of the clinical picture, results of the complementary investigations, treatment given and clinical course and the necropsy findings of the three patients who died. The data was collected from questionnaires.


RESULTS
Headache was a constant symptom. Twelve patients had high temperatures and seven had stiff necks. Motor deficit and coma were seen in the three patients who died. In two patients the cranial nerves were involved. Spinal fluid pleocytosis varied between 48 and 2570 cells/mm3. Initially there was lymphocyte predominance in 10 patients and subsequently eosinophil conversion. The peripheral eosinophilia, seen in all patients, varied between 7% and 61%. Of the 14 patients cured, eight received symptomatic treatment and six antihelminth drugs. Steroids were given to only one patient. Of the three patients who died, two had received antihelminth drugs.


CONCLUSIONS
Motor deficit and coma worsen the prognosis, which is generally good. There is no relation between cerebrospinal fluid pleocytosis and raised protein levels in the cerebrospinal fluid, nor between blood eosinophilia and prognosis. The most difficult differential diagnosis in our patients was with leptospirosis. No differences were seen in clinical evolution in relation to the treatment given.
Martínez-Delgado
J F
JF
Servicio de Medicina Interna, Hospital Provincial Arnaldo Milián Castro, Santa Clara, Cuba.
González-Cortiñas
M
M
Tápanes-Cruz
T R
TR
Ruiz-Méndez
A
A
D000328:Adult; D017185:Angiostrongylus cantonensis / Q000276:immunology / Q000302:isolation & purification; D000818:Animals; D000911:Antibodies, Monoclonal / Q000276:immunology; D002391:Catchment Area, Health; D003462:Cuba / Q000453:epidemiology; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D004802:Eosinophilia / Q000150:complications / Q000453:epidemiology* / Q000469:parasitology; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007964:Leukocytosis / Q000134:cerebrospinal fluid; D008590:Meningoencephalitis / Q000150:complications / Q000453:epidemiology* / Q000469:parasitology; D011596:Psychomotor Disorders / Q000175:diagnosis / Q000209:etiology; D017206:Strongylida Infections / Q000134:cerebrospinal fluid / Q000276:immunology / Q000469:parasitology; D011795:Surveys and Questionnaires
D000911:Antibodies, Monoclonal; D007073:Immunoglobulin E