title: Clinical manifestations of eosinophilic meningitis caused by Angiostrongylus cantonensis: 18 years' experience in a medical center in southern Taiwan.
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.affiliation: Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Tseng
authors.forename: Hung-Chin
authors.initials: HC
authors.lastname: Tsai
authors.forename: Cheng Len
authors.initials: CL
authors.lastname: Sy
authors.forename: Susan Shin-Jung
authors.initials: SS
authors.lastname: Lee
authors.forename: Shue-Ren
authors.initials: SR
authors.lastname: Wann
authors.forename: Yung-Hsing
authors.initials: YH
authors.lastname: Wang
authors.forename: Jei-Kuang
authors.initials: JK
authors.lastname: Chen
authors.forename: Kuan-Sheng
authors.initials: KS
authors.lastname: Wu
authors.forename: Yao-Shen
authors.initials: YS
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D017185:Angiostrongylus cantonensis / Q000302:isolation & purification*; D000818:Animals; D020809:Central Nervous System Helminthiasis / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000379:methods; D004196:Disease Outbreaks; D004802:Eosinophilia / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008581:Meningitis / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology / Q000473:pathology*; D008875:Middle Aged; D010274:Parasitology / Q000379:methods; D012189:Retrospective Studies; D017206:Strongylida Infections / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology / Q000473:pathology*; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult