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Key Features

  • Angiostrongylus costaricensis causes gastrointestinal inflammation

  • Human infection follows ingestion of larvae within slugs or snails or on material contaminated by these organisms

  • Since the parasites are not in their natural hosts, they cannot complete their life cycles

  • However, they can cause disease after migrating to the brain or gastrointestinal tract

Clinical Findings

  • Parasites penetrate ileocecal vasculature and develop into adults, which lay eggs, but do not complete their life cycle

  • Disease is due to an inflammatory response to dying worms in the intestinal tract, with an eosinophilic granulomatous response, at times including vasculitis and ischemic necrosis

  • Common findings mimic appendicitis and include

    • Abdominal pain (commonly localized to right lower quadrant)

    • Vomiting

    • Fever

    • A mass may be appreciated

  • Symptoms may recur over months

  • Uncommon findings

    • Intestinal perforation or obstruction

    • Disease due to migration of worms to other sites

Diagnosis

  • Biopsy of inflamed intestinal tissue may show worms localized to mesenteric arteries and eosinophilic granulomas

Treatment

  • Many cases managed surgically, usually for suspected appendicitis

  • It is not known if antihelminthic therapy is helpful

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