Central nervous system manifestations of Angiostrongylus cantonensis infection

Martins, Yuri Chaves; Tanowitz, Herbert B.; Kazacos, Kevin R.

doi:10.1016/j.actatropica.2014.10.002

Cited by 63 publications

(56 citation statements)

References 81 publications

(170 reference statements)

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“…In vitro culture studies (Gosnell & Kramer, ) have shown that, after parasitic infection, dramatic changes occur in the expression of cytokines and chemokines, thus promoting the production and activation of eosinophils, and infiltration of the meninges by lymphocytes, plasma cells, and eosinophils is common. The increase in CSF protein levels may be related to damage to the blood–brain barrier, but its underlying mechanisms remain unclear (Martins, Tanowitz, & Kazacos, ; Xie et al, ). In our patient group, 17/27 patients showed elevated peripheral and CSF eosinophil counts, whereas 21/27 patients showed elevated CSF protein levels, which have major implications for the diagnosis of this disease.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging findings and clinical manifestations in cerebral angiostrongyliasis from Dali, China

Yang

Yang²,

Chen³

et al. 2019

Brain and Behavior

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Purpose To analyze magnetic resonance imaging (MRI) findings and clinical diagnosis and treatment data relating to Angiostrongylus cantonensis infection to gain insight into the disease. Materials and Methods We retrospectively analyzed the epidemiology, clinical manifestations, diagnosis and treatment data, imaging manifestations, and outcomes of 27 patients who were clinically diagnosed with angiostrongyliasis and who underwent contrast‐enhanced brain MRI. Results Patients with A. cantonensis infection had a history of eating raw mollusks in the endemic area, and they mainly presented with dizziness and headache of varying degrees and vomiting ( n = 7). Laboratory examinations revealed increased peripheral blood and cerebrospinal fluid (CSF) eosinophils, as well as increased CSF protein levels. Brain MRI findings mainly included eosinophilic meningitis, whereas linear or nodular enhancement of the pia mater was observed in enhanced T1‐weighted and fluid‐attenuated inversion recovery images, accompanied by encephalitis or vasculitis. Meningitis manifested as multiple, thickened flow voids around the meninges, and contrast‐enhanced scans showed substantial enhancement in intracranial dilated and hyperplastic blood vessels. Conclusion The possibility of A. cantonensis infection should be considered in the effective use of albendazole or mebendazole as a treatment. Combining clinical history with laboratory examination is helpful in diagnosing A. cantonensis infection. A final definite diagnosis can be confirmed by detecting larvae in the CSF. The administration of corticosteroids during pathogen therapy can substantially reduce the therapeutic response.

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Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging findings and clinical manifestations in cerebral angiostrongyliasis from Dali, China

Yang

Yang²,

Chen³

et al. 2019

Brain and Behavior

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“…Angiostrongylus cantonensis, the rat lungworm is the most common cause of eosinophilic ME in southern Asia and the Pacific and Caribbean islands [77]. This nematode is also endemic in portions of Australia, southeastern USA, Egypt, Nigeria, Ivory coast, and South America [78]. Several cases have been reported among travellers returning from endemic regions [79e81] who get infected through ingestion of a raw or poorly cooked intermediate host (snail, slug) or a paratenic host (freshwater prawns, frogs, planaria, monitor lizards).…”

Section: Parasitesmentioning

confidence: 99%

Diagnostic approach to encephalitis and meningoencephalitis in adult returning travellers

Kenfak

Epéron

Schibler

et al. 2019

Clinical Microbiology and Infection

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a b s t r a c tBackground: Encephalitis and meningoencephalitis are severe, sometime life-threatening infections of the central nervous system. Travellers may be exposed to a variety of neurotropic pathogens. Aims: We propose to review known infectious causes of encephalitis in adults acquired outside Europe, and how to identify them. Sources: We used Pubmed and Embase, to search the most relevant publications over the last years. Content: Microbiologic tests and radiological tools to best identify the causative pathogen in travellers presenting with encephalitis and ME are presented in this narrative review, as well as a diagnostic approach tailored to the visited area and types of exposures. Implications: This review highlights the diagnostic difficulties inherent to exotic causes of central nervous system infections, and attempts to guide clinicians with respect to which microbiological tests to consider, in addition to brain MRI, when approaching a returning traveller presenting with encephalitis.

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“…Murine infection with the nematode Angiostrongylus cantonesis represents an entirely different model of ON. This helminth is neuro-invasive and is capable of causing meningitis, encephalitis, and/or myelitis in humans with an eosinophilic inflammatory response [73] and is also recognized as a cause of optic neuritis in humans [74]. A. cantonesis has recently been used as an infectious trigger for ON in BALB/c mice.…”

Section: Animal Models Of Onmentioning

confidence: 99%

Optic Neuritis: A Model for the Immuno-pathogenesis of Central Nervous System Inflammatory Demyelinating Diseases

Wu¹,

Harp²,

Shindler³

2015

CIR

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Evidence for the tenuous regulation between the immune system and central nervous system (CNS) can be found with examples of interaction between these organ systems gone awry. Multiple sclerosis (MS) is the prototypical inflammatory disease of the CNS and is characterized by widely distributed inflammatory demyelinating plaques that can involve the brain, spinal cord and/or optic nerves. Optic neuritis (ON), inflammatory injury of the optic nerve that frequently occurs in patients with MS, has been the focus of intense study in part given the readily accessible nature of clinical outcome measures. Exploring the clinical and pathological features of ON in relation to other inflammatory demyelinating conditions of the CNS, namely MS and neuromyelitis optica, provides an opportunity to glean common and distinct mechanisms of disease. Emerging data from clinical studies along with various animal models involving ON implicate innate and adaptive immune responses directed at glial targets, including myelin oligodendrocyte glycoprotein and aquaporin 4. Resolution of inflammation in ON is commonly observed both clinically and experimentally, but persistent nerve injury is also one emerging hallmark of ON. One hypothesis seeking evaluation is that, in comparison to other sites targeted in MS, the optic nerve is a highly specialized target within the CNS predisposing to unique immunologic processes that generate ON. Overall, ON serves as a highly relevant entity for understanding the pathogenesis of other CNS demyelinating conditions, most notably MS.

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Central nervous system manifestations of Angiostrongylus cantonensis infection

Cited by 63 publications

References 81 publications

Magnetic resonance imaging findings and clinical manifestations in cerebral angiostrongyliasis from Dali, China

Magnetic resonance imaging findings and clinical manifestations in cerebral angiostrongyliasis from Dali, China

Diagnostic approach to encephalitis and meningoencephalitis in adult returning travellers

Optic Neuritis: A Model for the Immuno-pathogenesis of Central Nervous System Inflammatory Demyelinating Diseases

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