title: Clinical aspects of eosinophilic meningitis and meningoencephalitis caused by Angiostrongylus cantonensis, the rat lungworm.
abstract: Angiostrongylus Eosinophilic Meningitis is caused by human infection with larvae of the rat lungworm, Angiostrongylus cantonensis. The clinical presentation includes a spectrum of disease, from meningitis through radiculitis, cranial nerve abnormalities, ataxia, encephalitis, coma, and rarely death. The condition is diagnosed by recognizing the triad of: the clinical syndrome, eosinophils in the cerebrospinal fluid or blood, and exposure history. A history of eating raw or poorly cooked snails is classic, but ingestion of other intermediate hosts or unwashed produce (such as lettuce) harboring hosts is not uncommon. Several serologic tests exist but none has yet been fully validated. There is good evidence that a 2 week course of high dose corticosteroids shortens the duration and severity of symptoms. There is somewhat weaker evidence that albendazole reduces symptoms. The combination of prednisolone and albendazole is being used more commonly for treatment. Some suggestions for future research are given.
authors.affiliation: Infectious Disease and Tropical Medicine, Mount Prospect, IL, USA. gsmurphy@ix.netcom.com
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Murphy
authors.forename: Stuart
authors.initials: S
authors.lastname: Johnson
mesh_terms: D017185:Angiostrongylus cantonensis; D000818:Animals; D004802:Eosinophilia / Q000175:diagnosis* / Q000469:parasitology / Q000628:therapy*; D006801:Humans; D008581:Meningitis / Q000175:diagnosis* / Q000469:parasitology / Q000628:therapy*; D017206:Strongylida Infections / Q000150:complications* / Q000469:parasitology
keywords: Albendazole; Angiostrongylus cantonensis; Anthelmintic; Corticosteroid; Diagnosis; Eosinophilic meningitis; Eosinophilic meningoencephalitis; Eosinophilic radiculomeningoencephalomyelitis; Human; Nematode; Prednisolone; Rat lungworm; Slug; Snail; Treatment
references.citation: Am J Trop Med Hyg. 1969 Mar;18(2):206-16
references.pmid: 5777734
references.citation: Lancet Infect Dis. 2008 Oct;8(10):621-30
references.pmid: 18922484
references.citation: Med J Aust. 1999 Jun 7;170(11):541-3
references.pmid: 10397046
references.citation: Am J Trop Med Hyg. 1975 Nov;24(6 Pt 1):921-31
references.pmid: 1200257
references.citation: Am J Trop Med Hyg. 1988 Aug;39(2):191-5
references.pmid: 3407839
references.citation: J Travel Med. 2007 Nov-Dec;14(6):407-10
references.pmid: 17995537
references.citation: Clin Microbiol Rev. 2009 Apr;22(2):322-48, Table of Contents
references.pmid: 19366917
references.citation: Exp Parasitol. 2009 Sep;123(1):1-5
references.pmid: 19559022
references.citation: Am J Trop Med Hyg. 1975 May;24(3):447-54
references.pmid: 1155688
references.citation: Appl Environ Microbiol. 2010 Aug;76(15):5287-9
references.pmid: 20543049
references.citation: Am J Trop Med Hyg. 2004 Aug;71(2):222-6
references.pmid: 15306715
references.citation: Trans R Soc Trop Med Hyg. 2008 Oct;102(10):990-6
references.pmid: 18501934
references.citation: Trans R Soc Trop Med Hyg. 1987;81(5):807-10
references.pmid: 3450002
references.citation: Am J Trop Med Hyg. 2006 Jun;74(6):1122-4
references.pmid: 16760531
references.citation: N Engl J Med. 1996 May 2;334(18):1178-84
references.pmid: 8602186
references.citation: Am J Trop Med Hyg. 2011 Oct;85(4):685-90
references.pmid: 21976573
references.citation: J Neurol Sci. 1990 May;96(2-3):241-56
references.pmid: 2376755
references.citation: Am J Trop Med Hyg. 2004 Apr;70(4):425-8
references.pmid: 15100458
references.citation: Am J Med. 2004 Nov 15;117(10):802-3
references.pmid: 15541333
references.citation: Arq Neuropsiquiatr. 2009 Dec;67(4):1093-6
references.pmid: 20069226
references.citation: Curr Infect Dis Rep. 2003 Aug;5(4):322-328
references.pmid: 12866984
references.citation: Folia Parasitol (Praha). 1987;34(1):87-92
references.pmid: 3583131
references.citation: J Neurol. 1990 Aug;237(5):279-80
references.pmid: 2230841
references.citation: J Parasitol Res. 2009;2009:
references.pmid: 20798874
references.citation: J Antimicrob Chemother. 1998 Feb;41(2):145-7
references.pmid: 9533454
references.citation: Am J Trop Med Hyg. 1982 Nov;31(6):1114-22
references.pmid: 7149098
references.citation: Southeast Asian J Trop Med Public Health. 2002 Jun;33(2):231-4
references.pmid: 12236418
references.citation: Am J Trop Med Hyg. 1981 Sep;30(5):1141-3
references.pmid: 6974509
references.citation: Clin Infect Dis. 2009 Feb 1;48(3):322-7
references.pmid: 19123863
references.citation: J Microbiol Immunol Infect. 2011 Oct;44(5):382-9
references.pmid: 21524976
references.citation: Parasitol Res. 1997;83(1):10-5
references.pmid: 9000226
references.citation: Clin Infect Dis. 2000 Sep;31(3):660-2
references.pmid: 11017811
references.citation: Am J Trop Med Hyg. 2009 Sep;81(3):443-5
references.pmid: 19706911
references.citation: Rev Infect Dis. 1988 Nov-Dec;10(6):1155-62
references.pmid: 3060943
references.citation: J Microbiol Immunol Infect. 2001 Mar;34(1):50-6
references.pmid: 11321128
references.citation: J Parasitol. 1986 Aug;72(4):512-6
references.pmid: 3783345
references.citation: Am J Med. 2001 Aug;111(2):109-14
references.pmid: 11498063
references.citation: Hawaii J Med Public Health. 2013 Jun;72(6 Suppl 2):41-5
references.pmid: 23901383
references.citation: Southeast Asian J Trop Med Public Health. 1991 Dec;22 Suppl:194-9
references.pmid: 1822885
references.citation: J Parasitol. 2002 Feb;88(1):211-3
references.pmid: 12053973
references.citation: Int J Infect Dis. 2009 Jul;13(4):425-31
references.pmid: 19117782
references.citation: Am J Trop Med Hyg. 1997 Apr;56(4):408-12
references.pmid: 9158049
references.citation: Chin Med J (Engl). 2008 Jan 5;121(1):67-72
references.pmid: 18208669
references.citation: Parasitology. 1983 Dec;87 (Pt 3):525-31
references.pmid: 6657308
references.citation: Exp Parasitol. 2006 May;113(1):8-15
references.pmid: 16410005
references.citation: Am J Trop Med Hyg. 1967 Jul;16(4):454-61
references.pmid: 4952148
references.citation: J Antimicrob Chemother. 2006 Feb;57(2):294-300
references.pmid: 16319180
references.citation: Clin Radiol. 2005 Feb;60(2):242-50
references.pmid: 15664579
references.citation: Southeast Asian J Trop Med Public Health. 1996 Jun;27(2):291-6
references.pmid: 9279992
references.citation: N Engl J Med. 2002 Feb 28;346(9):668-75
references.pmid: 11870244
references.citation: Am J Trop Med Hyg. 1976 Mar;25(2):233-49
references.pmid: 1259085
references.citation: Am J Trop Med Hyg. 1981 Sep;30(5):960-2
references.pmid: 7283014
references.citation: Am J Trop Med Hyg. 2008 Oct;79(4):568-70
references.pmid: 18840746
references.citation: J Parasitol. 2010 Apr;96(2):377-81
references.pmid: 19874073
references.citation: Parasitol Res. 2007 May;100(6):1293-6
references.pmid: 17177056
references.citation: N Engl J Med. 1995 Apr 20;332(16):1105-6
references.pmid: 7898546
references.citation: AJNR Am J Neuroradiol. 2000 Jun-Jul;21(6):1090-4
references.pmid: 10871020
references.citation: Med J Aust. 1999 Jun 7;170(11):517-8
references.pmid: 10397038
references.citation: Parasitol Res. 2004 Jul;93(4):311-7
references.pmid: 15179507
references.citation: Drug Metab Dispos. 2010 Apr;38(4):573-80
references.pmid: 20089736