Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam

Hiraoka, Tomoko; Cuong, Ngo Chi; Hamaguchi, Sugihiro; Kikuchi, Mihoko; Katoh, Shungo; Anh, Le Kim; Anh, Nguyen Thi Hien; Anh, Đặng Đức; Smith, Chris; Maruyama, Haruhiko; Yoshida, Lay-Myint; Cuong, Do Duy; Thuy, Pham Thanh; Ariyoshi, Koya

doi:10.1371/journal.pntd.0008937

Cited by 3 publications

(1 citation statement)

References 30 publications

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“…Conversely, eosinophil count was unremarkable. The absence of eosinophilia in peripheral blood has also been observed in other animals (28) and humans (29) positive for this infection.…”

Section: Discussionsupporting

confidence: 73%

Angiostrongylus cantonensis Nematode Invasion Pathway, Mallorca, Spain

Delgado-Serra¹,

Solà²,

Negre³

et al. 2022

Emerg. Infect. Dis.

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T he rat lungworm, Angiostrongylus cantonensis, infects animals and humans. Although this nematode species is recognized as the main etiologic agent of eosinophilic meningitis (1), infection might result in other central nervous system disorders (2). Clinical manifestations are aggravated by movement and subsequent death of the worms in the central nervous system, causing physical lesions and inflammation in accidental hosts (3). In humans, severe headache, neck stiffness, paresthesia, convulsions, urinary failure, visual impairment, and other symptoms, occasionally leading to coma and death, have been reported (1,4).The life cycle of A. cantonensis worms includes rats as definitive and gastropods as intermediate hosts; crustaceans, planarians, amphibians, reptiles, and fish might act as paratenic hosts (2). More than 20 vertebrate species, including humans, have been reported as A. cantonensis lungworm accidental hosts (5). This long list of vertebrate hosts includes nonhuman primates (6), marsupials (7), bats (8), horses (9), dogs (10), birds (11), and more recently, hedgehogs (12). The role of hedgehogs in the transmission of this parasite remains to be clarified.A. cantonensis worms were detected in Canton, China, infecting the lungs of rats ( 13) and a decade later, in the cerebrospinal fluid of a person from Taiwan (14). For decades, disease-endemic areas were limited to the Pacific basin and Southeast Asia, but this parasite has spread to new territories at an alarming rate (1). The invasion of A. cantonensis lungworms has been associated with unintended importation of infected rats and gastropods on ships (2,15). Almost 3,000 cases of human neuroangiostrongyliasis have been reported (16) from 30 territories (3), although the prevalence might be higher (17).Europe was considered to be nonendemic for A. cantonensis worms until 2018 when the parasite was reported infecting the brains of 2 hedgehogs on the Mediterranean island of Mallorca (12). Although the rat lungworm had been previously reported on Tenerife, a subtropical, non-European overseas oceanic island (18), its detection in Mallorca is an indisputable indication of its presence in Europe (5). Mallorca is a major Mediterranean tourism hotspot, highly interconnected with continental Europe. After the detection, the question remained whether A. cantonensis nematodes could survive the temperate winters of Europe. The purpose of this study was to use sentinel surveillance for symptomatic fauna to confirm whether the rat lungworm has been successfully established on Mallorca.

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“…Conversely, eosinophil count was unremarkable. The absence of eosinophilia in peripheral blood has also been observed in other animals (28) and humans (29) positive for this infection.…”

Section: Discussionsupporting

confidence: 73%

Angiostrongylus cantonensis Nematode Invasion Pathway, Mallorca, Spain

Delgado-Serra¹,

Solà²,

Negre³

et al. 2022

Emerg. Infect. Dis.

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Clinical Efficacy and Safety of Albendazole and Other Benzimidazole Anthelmintics for Rat Lungworm Disease (Neuroangiostrongyliasis): A Systematic Analysis of Clinical Reports and Animal Studies

Jacob

Steel

Lin

et al. 2021

Clinical Infectious Diseases

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The safety and efficacy of benzimidazole anthelmintics for the management of rat lungworm disease (neuroangiostrongyliasis) have been questioned regardless of the numerous global experimental animal studies and clinical reports. In this review, 40 of these experimental animal studies and 104 clinical reports are compiled with a focus on albendazole. Among the 144 articles involving an estimated 1034 patients and 2,561 animals, 4.1% were inconclusive or vague regarding the use of benzimidazoles. Of the remaining 138 articles, 90.5% found benzimidazoles to be safe and effective (885 patients; 2,530 animals), 4.3% as safe but ineffective (73 patients; 3 animals), and 5.0% caused adverse reactions (7 patients; 28 animals). Among the clinical reports with a confirmed diagnosis of neuroangiostrongyliasis in which albendazole monotherapy was used, 100% reported high efficacy (743 patients; 479 animals), and in those where albendazole-corticosteroid co-therapy was used, 97.87% were reported to be effective (323 patients; 130 animals).

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Diagnosis of human angiostrongyliasis in a case of hydrocephalus using next-generation sequencing: a case report and literature review

Liu,

Li,

Zhu

et al. 2024

BMC Neurol

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Background Angiostrongyliasis cantonensis is a severe yet rare parasitic infection caused by the larvae of Angiostrongylus cantonensis. The primary characteristic feature of this foodborne illness in humans is eosinophilic meningitis. Recently, there has been a gradual increase in reported cases globally. Due to the lack of typical clinical symptoms, signs, and specific laboratory tests, early diagnosis of this disease poses significant challenges. Failure to diagnose and treat this condition promptly can result in fatalities. Methods We present the case of a 13-year-old male patient who initially presented with fever and headache. The patient was preliminarily diagnosed with bacterial meningitis and received treatment with antibacterial drugs. However, the patient’s condition worsened, and he developed progressive consciousness disturbances. Eventually, metagenomic next-generation sequencing (mNGS) testing of cerebrospinal fluid samples indicated Angiostrongylus cantonensis infection. Following treatment with albendazole and prednisone, the patient made a full recovery. We include this case report as part of a literature review to emphasize the potential applications of mNGS in the early diagnosis of Angiostrongyliasis cantonensis. Conclusion mNGS technology plays a crucial role in the diagnosis of angiostrongyliasis cantonensis. As this technology continues to evolve and be applied, we believe it will play an increasingly important role in diagnosing, treating, and monitoring angiostrongyliasis cantonensis.

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Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam

Cited by 3 publications

References 30 publications

Angiostrongylus cantonensis Nematode Invasion Pathway, Mallorca, Spain

Angiostrongylus cantonensis Nematode Invasion Pathway, Mallorca, Spain

Clinical Efficacy and Safety of Albendazole and Other Benzimidazole Anthelmintics for Rat Lungworm Disease (Neuroangiostrongyliasis): A Systematic Analysis of Clinical Reports and Animal Studies

Diagnosis of human angiostrongyliasis in a case of hydrocephalus using next-generation sequencing: a case report and literature review

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