A case of eosinophilic meningitis following monitor lizard meat consumption, exacerbated by anthelminthics

Hidelaratchi, M D P; Riffsy, M. T. M.; Wijesekera, J.

doi:10.4038/cmj.v50i2.1577

Cited by 45 publications

(38 citation statements)

References 6 publications

(7 reference statements)

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“…Presumably, anthelminthic drugs kill causative worm larvae and the corticosteroids suppress hypersensitivity reactions triggered by antigens released from the worms. Thus, anthelminthic treatment alone tends to exacerbate neurologic symptoms [6],[47], and corticosteroid treatment alone improves symptoms but fails to cure patients, resulting in relapses [9], [48]–[50]. In the present study, 26 patients were given a combination treatment resulting in significantly improved conditions.…”

Section: Discussionmentioning

confidence: 70%

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Human Angiostrongyliasis Outbreak in Dali, China

Zhang

Chen

et al. 2009

PLoS Negl Trop Dis

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BackgroundSeveral angiostrongyliasis outbreaks have been reported in recent years but the disease continues to be neglected in public health circles. We describe an outbreak in Dali, southwest China in order to highlight some key problems for the control of this helminth infection.Methodology/Principal FindingsAll available medical records of suspected angiostrongyliasis patients visiting hospitals in Dali in the period 1 October 2007–31 March 2008 were reviewed, and tentative diagnoses of varying strengths were reached according to given sets of criteria. Snails collected from local markets, restaurants and natural habitats were also screened for the presence of Angiostrongylus cantonensis. A total of 33 patients met criteria for infection, and 11 among them were classified as clinically confirmed. An additional eight patients were identified through a surveillance system put in operation in response to the outbreak. The epidemic lasted for 8 months with its peak in February 2008. Of the 33 patients, 97.0% complained of severe headache. 84.8% patients had high eosinophil cell counts either in the peripheral blood or in cerebrospinal fluid (CSF). Three-quarters of the patients were treated with a combination of albendazole and corticosteroids, resulting in significantly improved overall conditions. Twenty-two patients reported the consumption of raw or undercooked snails prior to the onset of the symptoms, and approximately 1.0% of the Pomacea canaliculata snails on sale were found to be infected with A. cantonensis. The snails were also found in certain habitats around Dali but no parasites were detected in these populations.Conclusions/SignificanceThe import and sale of infected P. canaliculata is the likely trigger for this angiostrongyliasis outbreak. Awareness of angiostrongyliasis must be raised, and standardized diagnosis and treatment are needed in order to provide clinicians with a guide to address this disease. Health education campaigns could limit the risk, and a hospital-based surveillance system should be established in order to detect future outbreaks.

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Section: Discussionmentioning

confidence: 70%

“…in an outbreak in Jamaica [5]. Monitor lizard is considered as the main source of infection in India and Sri Lanka [6],[7] while freshwater shrimps, fish and crabs are a suspected way of infection in the Pacific Islands [8],[9]. Angiostrongyliasis has been widely spread in the wake of biological invasion.…”

Section: Introductionmentioning

confidence: 99%

Human Angiostrongyliasis Outbreak in Dali, China

Zhang

Chen

et al. 2009

PLoS Negl Trop Dis

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“…2 The use of antiparasitic drugs such as albendazole or mebendazole are controversial because of the possibility of exacerbating neurologic symptoms due to release of parasitic toxins. 2,36 However, these drugs are widely used in some countries as they have been shown to relieve symptoms and reduce the extent of the disease in some patients. 31 Our collection and identification of A. cantonensisinfected snails reflected a high prevalence of the parasite in the region.…”

Section: Discussionmentioning

confidence: 99%

First Evidence of Angiostrongyliasis Caused by Angiostrongylus cantonensis in Guadeloupe, Lesser Antilles

Dard¹,

Piloquet

Qvarnström

et al. 2017

The American Society of Tropical Medicine and Hygiene

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“…10 Still, other studies report exacerbations of neurologic symptoms when anti-helminthic drugs are used alone for treatment, likely due to an inflammatory response to the dying parasite. 11 Further studies to define the optimal treatment strategy are needed.…”

Section: Denouementmentioning

confidence: 99%

Eosinophilic Meningitis in a Previously Healthy 13-year-old Child

Thyssen

Mitchell²,

Qvarnström

et al. 2013

Pediatric Infectious Disease Journal

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Keywords eosinophilic meningitis; Angiostrongylus cantonensis; rat lung wormA previously healthy 13-year-old male developed acute onset of a bi-temporal headache. The headache persisted, and two weeks later, he was diagnosed with sinusitis and was given amoxicillin. On illness day 17, he experienced worsening headache, slurred speech, transient left facial droop, right hand numbness, and dizziness. At a local emergency department (ED), magnetic resonance imaging (MRI) of the brain showed no significant abnormalities, though images were obscured by artifact from his orthodontic hardware. He was discharged without a specific diagnosis after his neurologic symptoms had resolved. On illness day 19, the patient had return of hand tingling and slurred speech and presented to the Children's Hospital Colorado ED. He was diagnosed with an atypical migraine and was treated with ketorolac, diphenhydramine, and prochlorperazine. His symptoms improved, and he was discharged.On illness day 20, the patient experienced severe right eye pain and recurrence of his headache. He returned to his local ED and was hospitalized after minimal clinical improvement with treatment for migraine. At that time, his Romberg sign was abnormal, he was ataxic, and he had diplopia. On illness day 22, he underwent a lumbar puncture (LP) because of concern of pseudotumor cerebri. The cerebral spinal fluid (CSF) showed white blood cell count (WBC) of 763/mm 3 (with a differential of 80% lymphocytes, 15% monocytes, and 5% eosinophils), red blood cell count (RBC) of 2/mm 3 , protein of 49 mg/dL, and glucose of 54 mg/dL. Intravenous acyclovir was started but was discontinued when polymerase chain reaction assay (PCR) of the CSF for herpes simplex virus returned negative. Bacterial and fungal cultures of the CSF were negative. He was discharged home after a three-day hospitalization.

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A case of eosinophilic meningitis following monitor lizard meat consumption, exacerbated by anthelminthics

Cited by 45 publications

References 6 publications

Human Angiostrongyliasis Outbreak in Dali, China

Human Angiostrongyliasis Outbreak in Dali, China

First Evidence of Angiostrongyliasis Caused by Angiostrongylus cantonensis in Guadeloupe, Lesser Antilles

Eosinophilic Meningitis in a Previously Healthy 13-year-old Child

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