title: Corticosteroids for parasitic eosinophilic meningitis.
abstract: BACKGROUND
  Angiostrongylus cantonensis (A. cantonensis) is the major cause of infectious eosinophilic meningitis. Dead larvae of this parasite cause inflammation and exacerbate symptoms of meningitis. Corticosteroids are drugs used to reduce the inflammation caused by this parasite.
  
  
  OBJECTIVE
  To assess the efficacy and safety of corticosteroids for the treatment of eosinophilic meningitis.
  
  
  METHODS
  We searched CENTRAL (2014, Issue 11), MEDLINE (1950 to November Week 3, 2014), EMBASE (1974 to December 2014), Scopus (1960 to December 2014), Web of Science (1955 to December 2014), LILACS (1982 to December 2014) and CINAHL (1981 to December 2014).
  
  
  METHODS
  Randomised controlled trials (RCTs) of corticosteroids versus placebo for eosinophilic meningitis.
  
  
  METHODS
  Two review authors (SiT, SaT) independently collected and extracted study data. We graded the methodological quality of the RCTs. We identified and analysed outcomes and adverse effects.
  
  
  RESULTS
  We did not identifiy any new trials for inclusion or exclusion in this 2014 update. One study involving 110 participants (55 participants in each group) met our inclusion criteria. The corticosteroid (prednisolone) showed a benefit in shortening the median time to resolution of headaches (five days in the treatment group versus 13 days in the control group, P value < 0.0001). Corticosteroids were also associated with smaller numbers of participants who still had headaches after a two-week course of treatment (9.1% versus 45.5%, P value < 0.0001). The number of patients who needed repeat lumbar puncture was also smaller in the treatment group (12.7% versus 40%, P value = 0.002). There was a reduction in the median time of analgesic use in participants receiving corticosteroids (10.5 versus 25.0, P value = 0.038). There were no reported adverse effects from prednisolone in the treatment group.
  
  
  CONCLUSIONS
  Corticosteroids significantly help relieve headache in patients with eosinophilic meningitis, who have a pain score of four or more on a visual analogue scale. However, there is only one RCT supporting this benefit and this trial did not clearly mention allocation concealment and stratification. Therefore, we agreed to grade our included study as a moderate quality trial. Future well-designed RCTs are necessary.
authors: Neurological Institute, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
authors: Sikawat
authors: S
authors: Thanaviratananich
authors: Sanguansak
authors: S
authors: Thanaviratananich
authors: Chetta
authors: C
authors: Ngamjarus
mesh_terms: D000818:Animals; D020807:Central Nervous System Parasitic Infections / Q000188:drug therapy*; D004802:Eosinophilia / Q000188:drug therapy*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008581:Meningitis / Q000188:drug therapy*; D011239:Prednisolone / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone