[Two outbreaks of eosinophilic meningitis in Yunann (China) clinical, epidemiological and therapeutical issues].
Eosinophilic meningitis is an uncommon clinical entity, which is mostly caused by Angiostrongylus cantonensis, a nematode which parasitizes rat's lungs. Humans represent a dead-end in the parasite's lifecycle and become infected by ingesting snails, slugs or transport hosts. Due to uncontrolled proliferation and circulation of snails and rats, human angiostrongyliasis has emerged in new foci in continental China. The treatment, which relies upon a combination of albendazole and corticosteroids, is still a matter of debate. In order to assess the epidemiological features of two outbreaks which occurred in Kunming, capital of the Yunnan province, 2003 and 2005, along with the clinical and treatment issues, a retro-prospective study was carried out among thirty-four clinical cases of eosinophilic meningitis. Furthermore, a parasitological survey was carried out on randomized samples of snails sold in the markets of the city On admission, all cases were found to have acute headaches and an eosinophilic pleocytosis rate > 5% in the cerebro spinal fluid (CSF). All patients reported the consumption of raw snails Pomacea canaliculata, 14 days on average before the onset of headaches (range 1-30 days). Hyperesthesia due to radiculitis was observed in 68% of the cases and the meningitis syndrome was present in 41%. The average value of blood eosinophil count in CSF and in peripheral blood was 38% and 900/ml, respectively. Two treatment schedules were used (without randomization): one with progressive doses over 4 weeks; the other with immediate high doses for 10 days with 3 sessions separated by 14-day intervals. The results were compared by the Kaplan Meier log rank test. All the cases had a favorable evolution. The analysis suggested better effectiveness and tolerance of the albendazole - dexamethasone combination used at the highest dosage, namely 20mglkg daily and 10mg daily respectively. Eosinophilic meningitis appeared to be recently emerging or re-emerging in Kunming. Deep-rooted culinary habits of eating raw food, and large amount of snails sold on local markets (about one ton per day) provide ideal conditions for the outbreak, or occurrence of this disease. According to the resdjlts of this study Chinese local authorities should be urged to improve information to the population about the risks of eating raw snails, in order to strengthen the control of both rat and snail populations and reinforce the supervision of local food markets.
Zhou
Z
Z
The Second Affiliated Hospital of Kunming Medical University, Chine.
Barennes
H
H
Zhou
N
N
Ding
L
L
Zhu
Y H
YH
Strobel
M
M
D015766:Albendazole / Q000627:therapeutic use*; D017185:Angiostrongylus cantonensis / Q000302:isolation & purification*; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D004032:Diet / Q000009:adverse effects; D004196:Disease Outbreaks; D004802:Eosinophilia / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D004804:Eosinophils; D006801:Humans; D007958:Leukocyte Count; D008581:Meningitis / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D051381:Rats / Q000469:parasitology; D012189:Retrospective Studies; D012908:Snails / Q000469:parasitology; D017206:Strongylida Infections / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*
D000871:Anthelmintics; D015766:Albendazole