Clinical features and course of Angiostrongylus cantonensis eosinophilic meningitis in patients receiving supportive therapy

Abstract

Acute severe headache is the main presentation of eosinophilic meningitis (EOM) caused by Angiostrongylus cantonensis . Oral corticosteroid treatment is effective in reduction of duration of headache but may be contraindicated in particular patients. This study investigated clinical features and clinical course of eosinophilic meningitis caused by A . cantonensis if left untreated. Additionally, factors associated with duration of headache were evaluated. We conducted a retrospective study between 1997 and 2019 at a university hospital in Thailand. The inclusion criteria were adult patients who were diagnosed with EOM, had a positive serological test for A . cantonensis , received only supportive treatment, and had the complete clinical course documented. Factors associated with duration of headache were executed by multivariate linear regression analysis. A total of 54 patients were used in the final analysis. Of those, 39 patients (79.2%) were male and the mean ± SD age of all patients was 33.7 ± 12.2. The mean ± SD duration of headache was 16.0 ± 12.4 days with the longest duration of 49 days. The only factor associated with duration of headache was gender ( p = 0.036). The male gender had a coefficient of −8.4 (95% CI: −16.2, −0.6). The median duration of headache in male and female patients was 11 and 20 days, respectively. In conclusion, A . cantonensis eosinophilic meningitis can cause long lasting headache, and gender may be associated with duration of headache.

A national surveillance of eosinophilic meningitis in Thailand

“…One limitation of this predictive model is that it will be valid only if no preventive intervention is implemented, in which case it may be useful for disease monitoring purposes. We also did not examine any causal relationship between EOM and other factors ( Sawanyawisuth et al, 2020 , Sawanyawisuth et al, 2011 , Sawanyawisuth et al, 2012 , Sawanyawisuth et al, 2010 ; Tongdee et al, 2021 ). Finally, unreported or undiagnosed EOM cases will be missed using retrieved data from the database.…”

Eosinophilic meningitis epidemiological data from a national database in Thailand’s Department of Disease Control: a pragmatic, retrospective analytical study

“…Eosinophilic meningitis (EOM) is a neglected and rare neurological disease found worldwide [1]. The most common cause of EOM is the parasitic infection Angiostrongylus cantonensis [2][3][4]. A. cantonensis is a roundworm neurotropic that was discovered by Chen in Guangzhou, China, in 1935 [5].…”

“…Humans are infected with A. cantonensis via consumption of raw freshwater snails, shrimp, lizard, or contaminated water [3]. There are at least 51 molluscan families that serve as intermediate hosts for A. cantonensis, which is the main cause of EOM [6].…”

Corticosteroid treatment reduces headache in eosinophilic meningitis: a systematic review

“…If treated with analgesic alone, the severe headaches caused by EOM can last up to 49 days( 10 ). However, this duration can be reduced with corticosteroid administration( 11 ), as it decreases inflammation in the meninges and brain.…”

“…From 1997 to 2008, there were 13 outbreaks in mainland China alone (6). If EOM is left untreated or undiagnosed, individuals are at increased risk of several severe neurological complications such as encephalitis or radiculomyelitis (7)(8)(9). The risk of encephalitis in untreated or undetected cases of EOM is 26% per day (7).…”