Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 35-27: Angiostrongyliasis + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ Eosinophilic meningoencephalitis Transient cranial neuropathies +++ General Considerations ++ Nematodes of rats of the genus Angiostrongylus cause two distinct syndromes in humans Angiostrongylus cantonensis, the rat lungworm, causes eosinophilic meningoencephalitis Angiostrongylus costaricensis causes gastrointestinal inflammation In both diseases, human infection follows ingestion of larvae within slugs or snails (and also crabs, prawns, or centipedes for A cantonensis) or on material contaminated by these organisms Since the parasites are not in their natural hosts, they cannot complete their life cycles, but they can cause disease after migrating to the brain or gastrointestinal tract In A cantonensis infection, disease is caused primarily by worm larvae migrating through the CNS and an inflammatory response to dying worms A cantonensis can migrate from the brain to the pulmonary arteries +++ Demographics ++ A cantonensis is seen primarily in southeast Asia and some Pacific islands; 82 cases have been reported in Hawaii between 2007 and 2017 + Clinical Findings Download Section PDF Listen +++ +++ Symptoms and Signs ++ After an incubation period of 1 day to 2 weeks, presenting symptoms and signs include Headache Stiff neck Nausea, vomiting Cranial nerve abnormalities Paresthesias +++ Differential Diagnosis ++ Tuberculous, coccidioidal, or aseptic meningitis Neurocysticercosis Neurosyphilis Lymphoma Paragonimiasis Echinococcosis Gnathostomiasis + Diagnosis Download Section PDF Listen +++ ++ Diagnosis strongly suggested by finding eosinophilic CSF pleocytosis (over 10% eosinophils) in patients with a history of travel to endemic area Peripheral eosinophilia may not be present Definitive diagnosis is made by recovery of A cantonensis larvae from the CSF and the eyes, although this is uncommon + Treatment Download Section PDF Listen +++ ++ No specific treatment is available Antihelminthic therapy may be harmful for A cantonensis infection, since responses to dying worms may worsen with therapy If antihelminthic treatment is to be used, albendazole is probably the best choice, and therapy should be early in the disease course (within 3 weeks of exposure) Corticosteroids have commonly been used, and these are probably appropriate if antihelminthics are provided + Outcome Download Section PDF Listen +++ +++ Complications ++ Parasite deaths may exacerbate CNS inflammatory lesions +++ Prognosis ++ Most cases resolve spontaneously after 2–8 weeks However, serious sequelae and death have been reported +++ Prevention ++ Controlling rat population Cooking snails, prawns, fish, and crabs for 3–5 min or by freezing them (–15°C for 24 h) Examining vegetables for mollusks before eating Washing contaminated vegetables to eliminate larvae contained in mollusk mucus is not always successful +++ When to Admit ++ All patients + References Download Section PDF Listen +++ + +Barratt J et al. Angiostrongylus cantonensis: a review of its distribution, molecular biology and clinical significance as a human pathogen. Parasitology. 2016 Aug;143(9):1087–118. [PubMed: 27225800] + +Johnston DI et al. Review of cases of angiostrongyliasis in Hawaii, 2007–2017. Am J Trop Med Hyg. 2019 Sep;101(3):608–16. [PubMed: 31287041] + +Martins YC et al. Central nervous system manifestations of Angiostrongylus cantonensis infection. Acta Trop. 2015 Jan; 141(Pt A):46–53. [PubMed: 25312338] + +McAuliffe L et al. Severe CNS angiostrongyliasis in a young marine: a case report and literature review. Lancet Infect Dis. 2019 Apr;19(4):e132–e142. [PubMed: 30454904] + +Ramirez-Avila L et al. Eosinophilic meningitis due to Angiostrongylus and Gnathostoma species. Clin Infect Dis. 2009 Feb 1; 48(3):322–7. [PubMed: 19123863]