An Interesting Case of Eosinophilic Meningitis

Abstract

Angiostrongylus cantonensis is one of the causative agents of eosinophilic meningitis. Humans get infected when they ingest raw or partially cooked snails or monitor lizards (Varanus bengalensis). There is a popular belief that the tongue and the liver of the monitor lizard has aphrodisiac properties. A 20-year-old man was admitted to our hospital with a history of fever, headache and vomiting.His cerebrospinal fluid revealed eosinophilia. He gave a history of the ingestion of a monitor lizard, ten days prior to the onset of the symptoms. So, a diagnosis of eosinophilic meningitis due to Angiostrongylus cantonensis was made. He was treated with oral albendazole and prednisolone. His symptoms improved gradually within two weeks from his admission.

Angiostrongylus cantonensis: a review of its distribution, molecular biology and clinical significance as a human pathogen

“…Human A. cantonensis infections have also been linked to several paratenic host species. Reports describing the ingestion of monitor lizards in Sri Lanka, Thailand & India, raw frogs in China and, freshwater shrimp, fish & crabs in the Pacific Islands, implicate ingestion of these disparate hosts as a route for acquiring Angiostrongylus infections (Hidelaratchi et al 2005; Malvy et al 2008; Tsai et al 2011; Cowie, 2013 b ; Pai et al 2013; Eamsobhana, 2014).…”

Eosinophilic meningitis: A case series and review of literature of Angiostrongylus cantonensis and Gnathostoma spinigerum

“…Interestingly, from India, only one case report [8] could prove the microbiologic diagnosis of Angiostrongylus, as the worm was retrieved from the eye in this case. In the case series [6,7] and another case report [9] from India, all the affl icted males had history of ingestion of monitor lizards as an aphrodisiac. Even though the serologic diagnosis could not be made in all these cases, the specifi c history of exposure to fl esh of monitor lizard pointed to the diagnosis of angiostrongyliasis.…”

“…[4] Commonest causes of eosinophilic meningitis are angiostrongyliasis (rat lung worm) and gnathostomiasis worldwide. [5] In India, eosinophilic meningitis has been reported in 2 case series [6,7] and 2 case reports [8,9] and has not been reported in children below 15 years of age. We present two children with eosinophilic meningitis with peripheral eosinophilia, both residents of western suburbs of Mumbai and the proposed etiologic agents based on the clinical setting and their response to antihelminthic agents.…”

Parasitic Infections in Pediatric Population of India: Epidemiology, Diagnosis, and Strategies for Prevention

“…The pointers to the diagnosis are presence of peripheral and CSF eosinophilia and a history of contact with host animals while the definitive diagnosis requires identification of the organism in host tissues. [148][149][150][151][152] Gnathostoma spinigerum is another cause of eosinophilic meningitis. 148 The definitive hosts are dogs and cats which pass the parasite eggs in feces that develop into larval stage in Cyclops.…”