Severe CNS angiostrongyliasis in a young marine: a case report and literature review

McAuliffe, Liane; Ensign, Shannon P. Fortin; Larson, Derek; Bavaro, Mary; Yetto, Joseph M.; Cathey, Michael; Mukaigawara, Mitsuru; Narita, Masashi; Ohkusu, Kiyofumi; Quast, Timothy; Volk, Charles

doi:10.1016/s1473-3099(18)30434-1

Cited by 41 publications

(48 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For this reason, treatment usually involves co-administration of corticosteroids to limit the inflammatory reaction [ 6 , 7 , 8 ]. Inclusion of corticosteroids, such as dexamethasone, has been used for a long time in the clinic and has played a useful role in suppressing inflammation in the brain.However, long-term usage or high dosage may be problematic by causing several adverse effects, such as immunodepression, adrenal suppression, and gastroesophageal reflux [ 3 , 9 ]. In order to increase the survival rate and quality of treatment, it may be helpful to replace the use of steroids with other anti-neuroinflammatory agents.…”

Section: Introductionmentioning

confidence: 99%

Albendazole-Schisandrin B Co-Therapy on Angiostrongylus cantonensis-Induced Meningoencephalitis in Mice

et al. 2020

View full text Add to dashboard Cite

Currently, Angiostrongylus cantonensis infections are predominantly treated with albendazole. However, the use of albendazole can provoke certain neurological symptoms as a result of the immune response triggered by the dead worms. Therefore, treatment usually involves co-administration of corticosteroids to limit the inflammatory reaction. Corticosteroids play a useful role in suppressing inflammation in the brain; however, long-term usage or high dosage may make it problematic.Schisandrin B, an active ingredient from Schisandra chinensis, has been shown to have anti-inflammatory effects on the brain. This study aimed to investigate the effects and potential of schisandrin B in combination with albendazole to treat Angiostrongylus-induced meningoencephalitis. Here, we show that albendazole-schisandrin B co-treatment suppressed neuroinflammation in Angiostrongylus-infected mice and increased the survival of the mice. Accordingly, albendazole-schisandrin B co-treatment significantly inhibited inflammasome activation, pyroptosis, and apoptosis. The sensorimotor functions of the mice were also repaired after albendazole-schisandrin B treatment. Immune response was shown to shift from Th2 to Th1, which reduces inflammation and enhances immunity against A. cantonensis. Collectively, our study showed that albendazole-schisandrin B co-therapy may be used as an encouraging treatment for Angiostrongylus-induced meningoencephalitis.

show abstract

Section: Introductionmentioning

confidence: 99%

Albendazole-Schisandrin B Co-Therapy on Angiostrongylus cantonensis-Induced Meningoencephalitis in Mice

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Serology on both blood and CSF is available from only a few specialist laboratories around the world and detects antibodies to A. cantonensis only after several weeks of infection. Even specific DNA might not be detected by polymerase chain reaction until 20 days after infection . Serological responses also depend on the number of larvae ingested; small numbers might not provoke detectable antibody levels.…”

Section: Discussionmentioning

confidence: 99%

“…By about 3 weeks post‐infection, most of the still‐surviving worms (now L5s) will probably be capable of migrating out into the lungs, so killing them may be counterproductive, exacerbating the extent, intensity and duration of CNS inflammation . This hypothesis may explain reported cases in which administration of albendazole more than 3 weeks after onset of symptoms exacerbated the disease …”

Section: Discussionmentioning

confidence: 99%

“…Even specific DNA might not be detected by polymerase chain reaction until 20 days after infection. 18 Serological responses also depend on the number of larvae ingested; small numbers might not provoke detectable antibody levels. In most cases, therefore, laboratory confirmation is generally unavailable in the first 3 weeks after exposure to infection, although symptoms might appear between 1 and 2 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…7 This hypothesis may explain reported cases in which administration of albendazole more than 3 weeks after onset of symptoms exacerbated the disease. 18,21 Because the critical window for using anthelminthics is so restricted (within the first 3 weeks post-infection), a period when diagnostic tests are often inconclusive, it is incumbent upon clinicians to be attuned to this disease and its varied presentations. While asymptomatic and subclinical cases of neuroangiostrongyliasis undoubtedly occur, they are associated with minimal morbidity and should not be treated.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Two cases of neuroangiostrongyliasis: A rare disease because rarely considered or rarely diagnosed?

Berkhout

Prociv²,

Herbert

et al. 2019

J Paediatrics Child Health

View full text Add to dashboard Cite

Aim The rat lungworm, Angiostrongylus cantonensis, is well established in eastern Australia, where it is the almost exclusive cause of human eosinophilic meningoencephalitis (EME). While neuroangiostrongyliasis can result in severe morbidity or death, its diagnosis requires a high index of clinical suspicion among medical practitioners. Prevention requires a high level of public awareness. Methods We report two cases of EME in children from Queensland and summarise all reported Australian cases from the literature. We discuss the pathogenesis of neuroangiostrongyliasis, with particular reference to the timing of prophylaxis and treatment. Results A 5‐year‐old girl developed severe headache, eosinophilic meningitis and abnormal neuroimaging following a holiday to Bali. A 10‐year‐old boy with Rubinstein‐Taybi syndrome, marked developmental delay and pica developed EME following ingestion of a snail, resulting in long‐term morbidity. From 1971 to 2018, 28 Australian cases have been reported, with acquisition restricted to Southeast Queensland and New South Wales. Ages ranged from 10 months to 45 years; most were male and most likely acquired infection from consuming unwashed lettuce or vegetables. The mortality rate was 18%; most fatalities occurred in children <1 year old. Long‐term neurological deficit was reported in 14% of cases and a full recovery in 57% of cases. Conclusions Heightened medical and public awareness of the parasite is required to prevent infection and subsequent disease. A better understanding of the efficacy of prophylactic anthelmintic following ingestion or handling of molluscs and further studies of epidemiology of this parasite will inform and facilitate public health recommendations.

show abstract

Neurocysticercosis and Other CNS Helminthic Infections

Tanabe

Schilling

White

2020

Current Clinical Neurology

View full text Add to dashboard Cite

Severe CNS angiostrongyliasis in a young marine: a case report and literature review

Cited by 41 publications

References 59 publications

Albendazole-Schisandrin B Co-Therapy on Angiostrongylus cantonensis-Induced Meningoencephalitis in Mice

Albendazole-Schisandrin B Co-Therapy on Angiostrongylus cantonensis-Induced Meningoencephalitis in Mice

Two cases of neuroangiostrongyliasis: A rare disease because rarely considered or rarely diagnosed?

Neurocysticercosis and Other CNS Helminthic Infections

Contact Info

Product

Resources

About