Neuroimmunological findings of Angiostrongylus cantonensis meningitis in ecuadorian patients

Abstract

Meningitis caused by Angiostrongylus cantonensis has recently been reported in patients resulting from the first outbreaks in subtropical regions of Ecuador. Method: Eight young adult patients from the two outbreaks were studied. IgA, IgM, IgG and albumin in cerebrospinal fluid and serum were quantified and plotted in cerebrospinal fluid/serum quotient diagrams (Reibergrams). The anamnesis on the patients included asking about any consumption of raw snails, symptoms and harm caused. Results: Mean eosinophilia of 7.5% and 26% in serum and cerebrospinal fluid respectively was observed, as well as a moderate increase in total proteins. The most frequent pattern of intrathecal synthesis was observed in three classes of immunoglobulins. Intrathecal synthesis of IgM was observed in all cases two weeks after the first symptoms appeared. Conclusion: The intrathecal synthesis patterns of eosinophilic meningitis due to Angiostrongylus cantonensis, facilitated by cerebrospinal fluid analysis, were similar to those of previous cases from abroad. Key words: Angiostrongylus cantonensis, Ecuador, eosinophilia, intrathecal synthesis, meningitis, Reibergram.Hallazgos neuroinmunologicos en meningitis por Angiostrongylus cantonesis en pacientes ecuatorianos RESUMEN La meningitis provocada por Angiostrongylus cantonensis ha sido reportada recientemente en pacientes procedentes de los primeros brotes reportados en regiones subtropicales de Ecuador. Método: Ocho adultos jóvenes procedentes de dos brotes fueron estudiados. Se cuantificó IgA, IgM, IgG y albúmina en suero y líquido cefalorraquídeo y fueron colocados en los gráficos de las razones líquido cefalorraquídeo/suero (reibergramas). La anamnesia incluía ingestión de caracoles crudos, los síntomas y los daños provocados. Resultados: Una eosinofílica promedio de 7,5 y 26% en suero y líquido cefalorraquídeo fue observada al igual que un moderado incremento en las proteínas totales. El patrón de síntesis intratecal predominante fue de tres clases de inmunoglobulinas. La síntesis intratecal de IgM se observó en todos los casos a las dos semanas después del inicio de los síntomas. Conclusión: El patrón de síntesis intratecal de la meningitis eosinofílica por Angiostrongylus cantonensis facilitado por el análisis del líquido cefalorraquídeo fue similar a los casos previos reportados fuera del país.

A Case Report on Eosinophilic Meningitis Caused by Angiostrongylus cantonensis

“…Gnathostoma infection is another cause of eosinophilic meningitis4. In Cuba, Ecuador and other countries they are using reibergrams to help as an auxiliary tool in the diagnosis5. Therefore, we had limited experience with this disease.…”

Central nervous system manifestations of Angiostrongylus cantonensis infection

“…Taken together, these observations indicate that eosinophils have a complex role in the disease pathogenesis requiring further studies. Furthermore, the toxicity of worm components, neurotoxins produced by eosinophils, NK cell activation, and the intrathecal synthesis and activation of complement may also contribute to the pathogenesis of neuroangiostrongyliasis (Chen et al, 2014; Dorta-Contreras et al, 2011; Padilla-Docal et al, 2011; Padilla-Docal et al, 2013). …”

Angiostrongyliasis in the Americas

“…It has been postulated that this zoonosis spread to the Americas in the twentieth century , where there have been reports of sporadic outbreaks. The first report of eosinophilic meningoencephalitis occurred in Cuba , followed by United States (News et al, 1995), Jamaica (Barrow et al, 1996), Brazil (Lima et al, 2009) and more recently Ecuador (Dorta-Contreras et al, 2011). After the reports of parasitism in humans, the naturally infected definitive host was identified, except in Ecuador.…”