Eosinophilic meningitis caused by Angiostrongylus cantonensis: Report of 17 cases

Hung Chin Tsai, Yung Ching Liu, Calvin M. Kunin, Susan Shin Jung Lee, Yao Shen Chen, Hsi Hsun Lin, Tsung Hung Tsai, Wei Ru Lin, Chun Kai Huang, Muh Yong Yen, Chuan Min Yen

Research output: Contribution to journalArticle

125 Citations (Scopus)

Abstract

PURPOSE: To describe two outbreaks of Angiostrongylus can-tonensis infection that occurred in Kaohsiung, Taiwan, during 1998 and 1999, and to characterize the source of the outbreaks and the clinical manifestations of the disease. SUBJECTS AND METHODS: We performed a retrospective cohort study among Thai laborers with eosinophilic meningitis who ate raw snails (Ampullarium canaliculatus), as well as an environmental surveillance of larvae in snails. RESULTS: We enrolled 17 Thai laborers in whom severe headache and eosinophilia developed within 4 to 23 days after eating raw snails. Twelve (71%) developed eosinophilic meningitis. Third-stage larvae were found in the cerebrospinal fluids of 2 patients and in all 12 tested snails. Specific antibodies to A. cantonensis were detected in serum from 16 of the patients and in cerebrospinal fluid from 5 of the patients. Central nervous system manifestations included headache (n = 17 [100%]), fever (n = 11 [65%]), Brudzinski's sign/stiff neck (n = 11 [65%]), hyperesthesia (n = 3 [18%]), cranial nerve palsy (n = 2 [12%]), diplopia (n = 2 [12%]), and ataxia (n = 1 [6%]). Laboratory findings included peripheral eosinophilia (n = 15 [88%]) and cerebrospinal fluid eosinophilia (n = 12 [71%]); elevated immunoglobulin (Ig) E levels (n = 13 [100%]); and transient increases in white blood cell count (n = 7 [41%]) and in serum levels of creatine kinase (n = 7 [41%]), transaminase (n = 3 [18%]), and lactate dehydrogenase (n = 2 [12%]). The severity of illness and eosinophilia were correlated with the number of ingested snails. Meningeal and basal ganglion enhancement was noted on magnetic resonance imaging in several patients. Treatment with mebendazole combined with glucocorticosteroids appeared to shorten the course of the infection, but not the number of relapses. The eosinophil count fell to normal within 3 months, but IgE levels remained elevated for as long as 6 months. All patients recovered with minimal neurologic sequelae. CONCLUSION: Eosinophilic meningitis caused by A. cantonensis should be considered in patients who have headache or central nervous system manifestations after eating raw snails.

Original languageEnglish
Pages (from-to)109-114
Number of pages6
JournalAmerican Journal of Medicine
Volume111
Issue number2
DOIs
Publication statusPublished - Aug 1 2001
Externally publishedYes

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Angiostrongylus cantonensis
Snails
Meningitis
Eosinophilia
Headache
Cerebrospinal Fluid
Immunoglobulin E
Disease Outbreaks
Larva
Angiostrongylus
Central Nervous System
Eating
Hyperesthesia
Mebendazole
Cranial Nerve Diseases
Diplopia
Environmental Monitoring
Ataxia
Creatine Kinase
Transaminases

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Tsai, H. C., Liu, Y. C., Kunin, C. M., Lee, S. S. J., Chen, Y. S., Lin, H. H., ... Yen, C. M. (2001). Eosinophilic meningitis caused by Angiostrongylus cantonensis: Report of 17 cases. American Journal of Medicine, 111(2), 109-114. https://doi.org/10.1016/S0002-9343(01)00766-5

Eosinophilic meningitis caused by Angiostrongylus cantonensis : Report of 17 cases. / Tsai, Hung Chin; Liu, Yung Ching; Kunin, Calvin M.; Lee, Susan Shin Jung; Chen, Yao Shen; Lin, Hsi Hsun; Tsai, Tsung Hung; Lin, Wei Ru; Huang, Chun Kai; Yen, Muh Yong; Yen, Chuan Min.

In: American Journal of Medicine, Vol. 111, No. 2, 01.08.2001, p. 109-114.

Research output: Contribution to journalArticle

Tsai, HC, Liu, YC, Kunin, CM, Lee, SSJ, Chen, YS, Lin, HH, Tsai, TH, Lin, WR, Huang, CK, Yen, MY & Yen, CM 2001, 'Eosinophilic meningitis caused by Angiostrongylus cantonensis: Report of 17 cases', American Journal of Medicine, vol. 111, no. 2, pp. 109-114. https://doi.org/10.1016/S0002-9343(01)00766-5
Tsai, Hung Chin ; Liu, Yung Ching ; Kunin, Calvin M. ; Lee, Susan Shin Jung ; Chen, Yao Shen ; Lin, Hsi Hsun ; Tsai, Tsung Hung ; Lin, Wei Ru ; Huang, Chun Kai ; Yen, Muh Yong ; Yen, Chuan Min. / Eosinophilic meningitis caused by Angiostrongylus cantonensis : Report of 17 cases. In: American Journal of Medicine. 2001 ; Vol. 111, No. 2. pp. 109-114.
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abstract = "PURPOSE: To describe two outbreaks of Angiostrongylus can-tonensis infection that occurred in Kaohsiung, Taiwan, during 1998 and 1999, and to characterize the source of the outbreaks and the clinical manifestations of the disease. SUBJECTS AND METHODS: We performed a retrospective cohort study among Thai laborers with eosinophilic meningitis who ate raw snails (Ampullarium canaliculatus), as well as an environmental surveillance of larvae in snails. RESULTS: We enrolled 17 Thai laborers in whom severe headache and eosinophilia developed within 4 to 23 days after eating raw snails. Twelve (71{\%}) developed eosinophilic meningitis. Third-stage larvae were found in the cerebrospinal fluids of 2 patients and in all 12 tested snails. Specific antibodies to A. cantonensis were detected in serum from 16 of the patients and in cerebrospinal fluid from 5 of the patients. Central nervous system manifestations included headache (n = 17 [100{\%}]), fever (n = 11 [65{\%}]), Brudzinski's sign/stiff neck (n = 11 [65{\%}]), hyperesthesia (n = 3 [18{\%}]), cranial nerve palsy (n = 2 [12{\%}]), diplopia (n = 2 [12{\%}]), and ataxia (n = 1 [6{\%}]). Laboratory findings included peripheral eosinophilia (n = 15 [88{\%}]) and cerebrospinal fluid eosinophilia (n = 12 [71{\%}]); elevated immunoglobulin (Ig) E levels (n = 13 [100{\%}]); and transient increases in white blood cell count (n = 7 [41{\%}]) and in serum levels of creatine kinase (n = 7 [41{\%}]), transaminase (n = 3 [18{\%}]), and lactate dehydrogenase (n = 2 [12{\%}]). The severity of illness and eosinophilia were correlated with the number of ingested snails. Meningeal and basal ganglion enhancement was noted on magnetic resonance imaging in several patients. Treatment with mebendazole combined with glucocorticosteroids appeared to shorten the course of the infection, but not the number of relapses. The eosinophil count fell to normal within 3 months, but IgE levels remained elevated for as long as 6 months. All patients recovered with minimal neurologic sequelae. CONCLUSION: Eosinophilic meningitis caused by A. cantonensis should be considered in patients who have headache or central nervous system manifestations after eating raw snails.",
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AU - Lee, Susan Shin Jung

AU - Chen, Yao Shen

AU - Lin, Hsi Hsun

AU - Tsai, Tsung Hung

AU - Lin, Wei Ru

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AU - Yen, Muh Yong

AU - Yen, Chuan Min

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N2 - PURPOSE: To describe two outbreaks of Angiostrongylus can-tonensis infection that occurred in Kaohsiung, Taiwan, during 1998 and 1999, and to characterize the source of the outbreaks and the clinical manifestations of the disease. SUBJECTS AND METHODS: We performed a retrospective cohort study among Thai laborers with eosinophilic meningitis who ate raw snails (Ampullarium canaliculatus), as well as an environmental surveillance of larvae in snails. RESULTS: We enrolled 17 Thai laborers in whom severe headache and eosinophilia developed within 4 to 23 days after eating raw snails. Twelve (71%) developed eosinophilic meningitis. Third-stage larvae were found in the cerebrospinal fluids of 2 patients and in all 12 tested snails. Specific antibodies to A. cantonensis were detected in serum from 16 of the patients and in cerebrospinal fluid from 5 of the patients. Central nervous system manifestations included headache (n = 17 [100%]), fever (n = 11 [65%]), Brudzinski's sign/stiff neck (n = 11 [65%]), hyperesthesia (n = 3 [18%]), cranial nerve palsy (n = 2 [12%]), diplopia (n = 2 [12%]), and ataxia (n = 1 [6%]). Laboratory findings included peripheral eosinophilia (n = 15 [88%]) and cerebrospinal fluid eosinophilia (n = 12 [71%]); elevated immunoglobulin (Ig) E levels (n = 13 [100%]); and transient increases in white blood cell count (n = 7 [41%]) and in serum levels of creatine kinase (n = 7 [41%]), transaminase (n = 3 [18%]), and lactate dehydrogenase (n = 2 [12%]). The severity of illness and eosinophilia were correlated with the number of ingested snails. Meningeal and basal ganglion enhancement was noted on magnetic resonance imaging in several patients. Treatment with mebendazole combined with glucocorticosteroids appeared to shorten the course of the infection, but not the number of relapses. The eosinophil count fell to normal within 3 months, but IgE levels remained elevated for as long as 6 months. All patients recovered with minimal neurologic sequelae. CONCLUSION: Eosinophilic meningitis caused by A. cantonensis should be considered in patients who have headache or central nervous system manifestations after eating raw snails.

AB - PURPOSE: To describe two outbreaks of Angiostrongylus can-tonensis infection that occurred in Kaohsiung, Taiwan, during 1998 and 1999, and to characterize the source of the outbreaks and the clinical manifestations of the disease. SUBJECTS AND METHODS: We performed a retrospective cohort study among Thai laborers with eosinophilic meningitis who ate raw snails (Ampullarium canaliculatus), as well as an environmental surveillance of larvae in snails. RESULTS: We enrolled 17 Thai laborers in whom severe headache and eosinophilia developed within 4 to 23 days after eating raw snails. Twelve (71%) developed eosinophilic meningitis. Third-stage larvae were found in the cerebrospinal fluids of 2 patients and in all 12 tested snails. Specific antibodies to A. cantonensis were detected in serum from 16 of the patients and in cerebrospinal fluid from 5 of the patients. Central nervous system manifestations included headache (n = 17 [100%]), fever (n = 11 [65%]), Brudzinski's sign/stiff neck (n = 11 [65%]), hyperesthesia (n = 3 [18%]), cranial nerve palsy (n = 2 [12%]), diplopia (n = 2 [12%]), and ataxia (n = 1 [6%]). Laboratory findings included peripheral eosinophilia (n = 15 [88%]) and cerebrospinal fluid eosinophilia (n = 12 [71%]); elevated immunoglobulin (Ig) E levels (n = 13 [100%]); and transient increases in white blood cell count (n = 7 [41%]) and in serum levels of creatine kinase (n = 7 [41%]), transaminase (n = 3 [18%]), and lactate dehydrogenase (n = 2 [12%]). The severity of illness and eosinophilia were correlated with the number of ingested snails. Meningeal and basal ganglion enhancement was noted on magnetic resonance imaging in several patients. Treatment with mebendazole combined with glucocorticosteroids appeared to shorten the course of the infection, but not the number of relapses. The eosinophil count fell to normal within 3 months, but IgE levels remained elevated for as long as 6 months. All patients recovered with minimal neurologic sequelae. CONCLUSION: Eosinophilic meningitis caused by A. cantonensis should be considered in patients who have headache or central nervous system manifestations after eating raw snails.

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