title: Angiostrongylus cantonensis Infection on Mayotte Island, Indian Ocean, 2007-2012.
abstract: Human angiostrongyliasis (HA) is a neurological helminthic disease caused by the lung worm Angiostrongylus cantonensis. It is suspected in the combination of travel or a residence in an endemic area and eosinophilic meningitis. In Mayotte, an island in the Indian Ocean, cases are rare but regular. The main objective of our study was to describe the epidemiological and diagnosis clues of HA in Mayotte. The secondary objectives were to evaluate the contribution of Real-Time Polymerase Chain Reaction (RT- PCR) for the diagnosis of HA, delineate the characteristics of the local transmission and ascertain the presence of A. cantonensis in Achatina fulica, the potential vector of the disease.
  
  
  
  Between 2007 and 2012, all cases of eosinophilic meningitis were retrospectively included and investigated by RT- PCR in the CSF. Descriptive analysis was conducted for clinical, biological and radiological features, and were analyzed for all patients together with the search for prognostic factors for mortality. Concurrently, geolocalization and temporal parameters were studied to correlate the occurrence of the cases with rainfall seasons and snails were collected to enhance a parasitic carriage with real time PCR.
  
  
  
  During the 6-year period of the study, 14 cases were identified (2.3 cases/year) and 9 among 10 remaining CSF were positive in PCR. Among 14 cases of EM, 13 were less than 2 year-old children. The 1 year mortality rate was 5/14 (35.7%). Among survivors, 3/7 (42.8%) presented neurological sequelae. Factors associated with mortality were dysfunction of cranial nerves, abnormal brain imaging, and CSF glucose level inferior to 2 mmol/l. Occurrence of cases was temporarily and spatially correlated to the rainy season. Among the 64 collected giant snails, 6 (9.4%) were positive with A. cantonensis PCR. The likely main route of transmission was the children licking snails, carriers of the parasite.
  
  
  
  In Mayotte, HA was mainly found in paediatric cases under 2 years old, and evidenced a life-threatening disease. PCR seems to be a promising tool in the definitive diagnosis of HA. Population should be aware of the role of A. fulica, and not let the children have direct contact with the snails.
authors.affiliation: Department of Prevention, Actions and Public Health, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte.|Infectious and Tropical Diseases Department, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.
authors.forename: Loïc
authors.initials: L
authors.lastname: Epelboin
authors.affiliation: Intensive Care Unit, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte.
authors.forename: Renaud
authors.initials: R
authors.lastname: Blondé
authors.affiliation: Department of Pediatrics, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte.
authors.forename: Abdourahim
authors.initials: A
authors.lastname: Chamouine
authors.affiliation: Department of Pediatrics, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Chrisment
authors.affiliation: Institut Pasteur, Environment and Infectious Risks Research and Expertise Unit, Paris, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Diancourt
authors.affiliation: Geography Institute (UFR08)-Paris 1 Panthéon-Sorbonne University, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Villemant
authors.affiliation: Department of Pediatrics, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte.
authors.forename: Agnès
authors.initials: A
authors.lastname: Atale
authors.affiliation: Medical Biology Laboratory, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte.
authors.forename: Claire
authors.initials: C
authors.lastname: Cadix
authors.affiliation: Institut Pasteur, Environment and Infectious Risks Research and Expertise Unit, Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Caro
authors.affiliation: Victor Segalen University, Bordeaux 2, Bordeaux, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Malvy
authors.affiliation: Medical Biology Laboratory, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte.
authors.forename: Louis
authors.initials: L
authors.lastname: Collet
mesh_terms: D000293:Adolescent; D017185:Angiostrongylus cantonensis / Q000235:genetics / Q000302:isolation & purification*; D000818:Animals; D002648:Child; D002675:Child, Preschool; D017507:Comoros / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D012621:Seasons; D012908:Snails / Q000469:parasitology; D017206:Strongylida Infections / Q000453:epidemiology* / Q000469:parasitology* / Q000473:pathology