title: Angiostrongylus cantonensis eosinophilic meningitis: a clinical study of 42 consecutive cases in French Polynesia.
abstract: BACKGROUND
  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.affiliation: Department of Internal Medicine, French Polynesia Hospital Center, 98716 Pirae, Tahiti, French Polynesia.
authors.forename: Erwan
authors.initials: E
authors.lastname: Oehler
authors.affiliation: Department of Neurology, French Polynesia Hospital Center, 98716 Pirae, Tahiti, French Polynesia.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Ghawche
authors.affiliation: Department of Pneumology, French Polynesia Hospital Center, 98716 Pirae, Tahiti, French Polynesia.
authors.forename: Alex
authors.initials: A
authors.lastname: Delattre
authors.affiliation: Laboratory of Pathology, French Polynesia Hospital Center, 98716 Pirae, Tahiti, French Polynesia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Berberian
authors.affiliation: Laboratory of Microbiology, French Polynesia Hospital Center, 98716 Pirae, Tahiti, French Polynesia.
authors.forename: Marc
authors.initials: M
authors.lastname: Levy
authors.affiliation: Department of Internal Medicine, French Polynesia Hospital Center, 98716 Pirae, Tahiti, French Polynesia. Electronic address: florent.valour@chu-lyon.fr.
authors.forename: Florent
authors.initials: F
authors.lastname: Valour
mesh_terms: D000293:Adolescent; D000328:Adult; D017185:Angiostrongylus cantonensis / Q000302:isolation & purification*; D000818:Animals; D000969:Antinematodal Agents / Q000627:therapeutic use; D015331:Cohort Studies; D004804:Eosinophils / Q000469:parasitology*; D005260:Female; D006801:Humans; D008297:Male; D008581:Meningitis / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology* / Q000473:pathology; D011114:Polynesia / Q000453:epidemiology; D012189:Retrospective Studies; D012621:Seasons; D017206:Strongylida Infections / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology* / Q000473:pathology; D055815:Young Adult
chemical_list: D000969:Antinematodal Agents
keywords: Angiostrongylus cantonensis; Eosinophils; Meningitis