Eosinophilic meningitis

Abstract

Eosinophilic meningitis (EM) is a distinct clinical entity that may have infectious and noninfectious causes. Worldwide, infection with the helminthic parasite, Angiostrongylus cantonensis, is the most common infectious etiology. Historically, this infection has been acquired through ingestion of competent intermediate and paratenic (carrier) hosts or contaminated food in Southeast Asia and the Pacific Islands. A recent outbreak of A. cantonensis-associated EM among US travelers to Jamaica and subsequent parasitologic surveys of local snails and rats confirm earlier case reports and engender a wider appreciation of the Caribbean islands as a new region for endemic A. cantonensis infections. Clinically, eosinophilia is not always present in the cerebrospinal fluid or in the peripheral blood during the initial manifestions of A. cantonensis-associated EM, which include headache and cutaneous sensory alterations. Effective management of patients involves careful attention to the control of intracranial pressure. Steroid therapy without specific anthelmintic treatment is safe and effective in control of headache of adult patients with A. cantonensis-associated EM.

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

“…[14][15][16][17] Most studies have reported acute symptoms; to our knowledge, few descriptions of long-term outcomes have been published. [18][19][20] Treatment is primarily supportive; systemic corticosteroids may decrease symptom duration, but the use of antihelminthic therapy is controversial. 21,22 We previously reported a laboratory-and hospital-based investigation in Hawaii that included case data from January 2001 to February 2005.…”

Albendazole therapy for eosinophilic meningitis caused by Angiostrongylus cantonensis

“…However, this regimen did not show a clinical benefit over corticosteroid alone because of the small number of cases (N = 26). In addition, corticosteroid treatment is highly effective in blocking the inflammatory process (Chotmongkol et al 2000;Slom and Johnson 2003) and may mask the effectiveness of combining albendazole. Because albendazole has a parasiticidal effect, it theoretically may have a synergistic effect with corticosteroid to further reduce the duration of headache.…”

Angiostrongyliasis in the Americas

“…The main procedure to treat eosinophilic meningoencephalitis is based on reduction of the symptoms by the use of analgesics and/or corticoids and careful removal of the cerebrospinal fluid (CSF) at frequent intervals (Slom et al, 2003). The combined use of albendazole and prednisolone for two weeks has been shown to be safe and effective (Chotmongkol et al, 2004).…”