An Outbreak of Eosinophilic Meningitis Caused byAngiostrongylus cantonensisin Travelers Returning from the Caribbean

Abstract

Among travelers at risk, the presence of headache, elevated intracranial pressure, and pleocytosis, with or without eosinophilia, particularly in association with paresthesias or hyperesthesias, should alert clinicians to the possibility of A. cantonensis infection.

Real-Time Polymerase Chain Reaction Detection of Angiostrongylus cantonensis DNA in Cerebrospinal Fluid from Patients with Eosinophilic Meningitis

“…Clinical and epidemiological details have been presented elsewhere for six of the patients. [25][26][27][28][29] Five patients had knowingly ingested raw snails: four as part of exotic cuisine, one as a dare. Two patients were part of an outbreak in Jamaica where a Caesar salad was implicated as the source of infection.…”

“…Two patients were part of an outbreak in Jamaica where a Caesar salad was implicated as the source of infection. 25 The source of infection for the other patients remains unknown. However, four patients were less than 2 years of age, and one patient was intellectually challenged, making it plausible that these became infected by putting infected mollusks in their mouth.…”

Eosinophilic Meningitis Attributable to Angiostrongylus cantonensis Infection in Hawaii: Clinical Characteristics and Potential Exposures

“…1,2 Individual cases and outbreaks of infection with this nematode have been reported for years in endemic areas of Southeast Asia and the Pacific Rim (e.g., China, Taiwan, Thailand, and the Pacific Islands) and travelers returning from endemic areas. [3][4][5][6] In the United States, angiostrongyliasis is endemic in Hawaii; one human case was reported in New Orleans, LA. 7 A. cantonensis is becoming more widespread in the world, in part because of ship-borne transport of rats and introduction of non-native snails/slugs.…”

First report of Angiostrongylus cantonensis in Porto Alegre, State of Rio Grande do Sul, Southern Brazil

“…According to Wang et al 1 , more than 2,820 cases have been reported in approximately 30 countries, mostly in Asia and the Pacifi c Islands. A. cantonensis infection has been increasingly detected in travelers returning from endemic areas 2 and is now considered to be a growing food safety concern 3 . Laboratory isolation and identifi cation of this parasite were reported for the fi rst time in Brazil in the State of Espírito Santo after eosinophilic meningitis was diagnosed in two patients 4 , followed by its detection in two patients in Pernambuco 5 .…”

“…, Alessandra Loureiro Morassutti [1] , Ana Cristina Aramburu da Silva [1] and Carlos Graeff-Teixeira [2] [1]. …”