Eosinophilic Meningitis Caused by Angiostrongylus Cantonensis Associated With Eating Raw Snails: Correlation of Brain Magneticresonance Imaging Scans With Clinical Findings

Abstract

Angiostrongylus cantonensis is the most common cause of eosinophilic meningitis worldwide. Human infection occurs after ingestion of the worms in raw snails or fish that serve as intermediate hosts. Two outbreaks of central nervous system infection with A. cantonensis occurred in Kaoshiung, Taiwan, during 1998 and 1999 among Thai laborers who ate raw snails. A detailed clinical studies of 17 of these patients was conducted, including study of 13 patients who underwent magnetic resonance imaging (MRI) scans of the brain. The MRI scans revealed high signal intensities over the globus pallidus and cerebral peduncle on TI-weighted imaging, leptomeningeal enhancement, ventriculomegaly, and punctate areas of abnormal enhancement within the cerebral and cerebellar hemisphere on gadolinium-enhancing T1 imaging, and a hyperintense signal on T2-weighted images. There was a significant correlation between severity of headache, cerebrospinal fluid (CSF) pleocytosis, and CSF and blood eosinophilia with MRI signal intensity in T1-weighted imaging (P < 0.05). Eosinophilic meningitis produced by A. cantonensis needs to added to the list of causes of hyperintense basal ganglia lesions found on T1-weighted MRI scans in tropical countries.

Clinical manifestations of eosinophilic meningitis caused by Angiostrongylus cantonensis: 18 years’ experience in a medical center in southern Taiwan

“…25 In our study, hyperintense basal ganglia abnormalities on T1-weighted MRI were seen in 8 patients. 10 This finding is relatively nonspecific 26 and not been reported in past literature.…”

Encephalitis Caused by Angiostrongylus cantonensis after Eating Raw Frogs Mixed with Wine as a Health Supplement

“…Multiple enhancing nodules in the brain and linear enhancement in the leptomeninges, accompanied by stick-shaped enhancement are the characteristic signs of the disease on Gd-DTPA-enhanced T1-weighted images (17). Also there is a significant correlation between the severity of headache, cerebrospinal fluid (CSF) pleocytosis, and CSF and blood eosinophilia with MRI signal intensity in T1-weighted imaging (18). In addition, lepto-meningeal enhancement, ventriculomegaly and abnormal enhancement within the cerebral and cerebellar hemisphere is found on the T2WI and FLAIR imaging.…”

The effect of temperature on the development of Angiostrongylus cantonensis (Chen 1935) in Pomacea canaliculata (Lamarck 1822)

“…Until 1992, over 2,500 cases of A. cantonensis-related meningitis have been reported in approximately 30 countries (Kliks and Palumbo 1992). The number of eosinophilic meningitis cases rapidly increased in recent years, partly due to some outbreaks involving many persons in Jamaica (Slom et al 2002), Taiwan (Tsai et al 2001;Tsai et al 2003;Tsai et al 2004), and China (Xue et al 2000;. Today, A. cantonensis is regarded as the primary cause of human eosinophilic meningitis in many parts of the Indo-Pacific region (Prociv et al 2000).…”