Severe form of radiculo - myelo - neuropathy with meningo - encephalitis secondary to Angiostrongylus cantonensis infection: Unusual corpus callosal lesions and serial magnetic resonance imaging findings

Nalini, Atchayaram; Ramakrishna, Anil; Dekumoy, Paron; Kumar, R; Pakdee, Wallop; Saini, Jitender; Hegde, Vinay

doi:10.4103/0028-3886.117613

Cited by 21 publications

(16 citation statements)

References 12 publications

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“…In gnathostomiasis with CNS involvement, abnormal CT or MRI findings are common (Kanpittaya et al 2012). Conversely, AEM patients may have normal CT or MRI findings though non-specific cerebral oedema, focal oedematous changes, nodular enhancing lesions, meningeal/leptomeningeal enhancement and mild ventricular dilatation may be apparent (Tsai et al 2003, 2012; Jin et al 2008; Wang et al 2010; Tseng et al 2011; Kanpittaya et al 2012; Nalini et al 2013). Intracerebral haemorrhage and myelitis are more suggestive of gnathostomiasis (Kanpittaya et al 2012).…”

Section: Diagnosismentioning

confidence: 99%

Angiostrongylus cantonensis: a review of its distribution, molecular biology and clinical significance as a human pathogen

et al. 2016

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Angiostrongylus cantonensis is a metastrongyloid nematode found widely in the Asia-Pacific region, and the aetiological agent of angiostrongyliasis; a disease characterized by eosinophilic meningitis. Rattus rats are definitive hosts of A. cantonensis, while intermediate hosts include terrestrial and aquatic molluscs. Humans are dead-end hosts that usually become infected upon ingestion of infected molluscs. A presumptive diagnosis is often made based on clinical features, a history of mollusc consumption, eosinophilic pleocytosis in cerebral spinal fluid, and advanced imaging such as computed tomography. Serological tests are available for angiostrongyliasis, though many tests are still under development. While there is no treatment consensus, therapy often includes a combination of anthelmintics and corticosteroids. Angiostrongyliasis is relatively rare, but is often associated with morbidity and sometimes mortality. Recent reports suggest the parasites' range is increasing, leading to fatalities in regions previously considered Angiostrongylus-free, and sometimes, delayed diagnosis in newly invaded regions. Increased awareness of angiostrongyliasis would facilitate rapid diagnosis and improved clinical outcomes. This paper summarizes knowledge on the parasites' life cycle, clinical aspects and epidemiology. The molecular biology of Angiostrongylus spp. is also discussed. Attention is paid to the significance of angiostrongyliasis in Australia, given the recent severe cases reported from the Sydney region.

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Section: Diagnosismentioning

confidence: 99%

Angiostrongylus cantonensis: a review of its distribution, molecular biology and clinical significance as a human pathogen

et al. 2016

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“…[ 7 ] MRI findings in angiostrongyliasis have been reported to be diverse and non-specific. [ 8 ] Multiple scattered hyperintensities with and without contrast enhancement are the most commonly described. [ 8 ] Sometimes computed tomogram (CT) and MRI may not reveal any abnormality.…”

Section: Discussionmentioning

confidence: 99%

“…[ 8 ] Multiple scattered hyperintensities with and without contrast enhancement are the most commonly described. [ 8 ] Sometimes computed tomogram (CT) and MRI may not reveal any abnormality. Our case showed scattered T2 hyperintensities and unique finding of DWI hyperintensities which represent the foci of microabscesses or developing infarcts.…”

Section: Discussionmentioning

confidence: 99%

Unusual Larva in the CSF and Unique MRI Findings in a Case of Eosinophilic Meningitis

Rai

Madi

Pai

et al. 2014

Journal of Clinical Imaging Science

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Eosinophilic meningitis may be caused by non-infectious and infectious agents. Angiostrongylus cantonensis is the commonest causative agent of eosinophilic meningitis. Rats are the primary hosts of this parasite. Humans get infected by ingestion of raw or inadequately cooked hosts (snails or monitor lizard) or food contaminated with the infective third-stage larvae. A 16-year-old boy was admitted to our hospital with history of fever, headache, and altered sensorium. Magnetic resonance imaging of the brain showed unique findings. Cerebrospinal fluid (CSF) examination showed eosinophilia and the CSF wet mount identified a larva. Patient history revealed ingestion of monitor lizard 2 weeks prior to onset of symptoms. Hence, a diagnosis of eosinophilic meningitis caused by A. cantonensis was made. He was treated with oral albendazole and steroids, resulting in gradual improvement. A. cantonensis as a cause of eosinophilic meningitis is a possibility in patients who present with headache and vomiting after eating raw meat (monitor lizard). To the best of our knowledge, this is a very rare case being reported from India where the larva was identified during the microscopic examination of the CSF.

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“…Fever and cranial nerve involvement is rare [2,3]. Case of myeloradiculopathy have also been reported [4].…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic Meningits: A Review

Mittal¹

2016

J Neuroinfect Dis

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Severe form of radiculo - myelo - neuropathy with meningo - encephalitis secondary to Angiostrongylus cantonensis infection: Unusual corpus callosal lesions and serial magnetic resonance imaging findings

Cited by 21 publications

References 12 publications

Angiostrongylus cantonensis: a review of its distribution, molecular biology and clinical significance as a human pathogen

Angiostrongylus cantonensis: a review of its distribution, molecular biology and clinical significance as a human pathogen

Unusual Larva in the CSF and Unique MRI Findings in a Case of Eosinophilic Meningitis

Eosinophilic Meningits: A Review

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