Cantonese angiostrongyliasis B83.2

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Nematode infection that causes eosinophilic meningitis or mengioencephalitis. Most frequent cause of eosinophilic meningitis.

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  • Angiostrongylus cantonensis (nematode, threadworm). Occurs in rodents and humans.
  • Infection through consumption of raw snails or transport hosts (e.g. crabs, frogs), raw salads, vegetables, fruit and contaminated water. Cutaneous infections are also possible.
  • The adults parasitize in the pulmonary arteries of rats, the larvae hatch from the adults, penetrate the bronchial tree, cough up and swallow again and are then excreted with the stool. They are then ingested by snails, where the 3rd larvae develop, which are then ingested by rats through the consumption of snails. In the rat, they penetrate the intestinal mucosa, liver, but circulation and also the CNS. There they mature into young adults which reach the right heart and finally pulmonary arteries of the rat via the subarachnoid space, brain and jugular veins.
  • In humans, the parasite does not develop further.

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Occurrence in Southeast Asia and Oceania, Australia, Madagascar, La Reunion, Mauritius, Egypt, Ivory Coast, Puerto Rico, Cuba, New Orleans.

Clinical features
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  • Incubation period 1-6 weeks.
  • Skin lesions are rare. Leading is the pronounced headache symptomatology (100% of cases) as a result of eosinophilic meningitis. Also meningism, nausea, vomiting. Asymmetrical paresthesias of the extremities and trunk with burning pain and pronounced sensitivity to touch over several dermatomes, facial nerve paresis and other cerebral nerve paralyses can occur. Photophobia is not uncommon.
  • Children: severe course with loss of consciousness and cramps.
  • Pneumonitis and infestation of the eye.

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  • Eosinophilic pleocytosis in cerebrospinal fluid with only moderately increased protein content and normal glucose.
  • Bluteosinophilia.
  • Detection of circulating antigens in cerebrospinal fluid.
  • Detection of antibodies in blood (ELISA, immunoblot).

Differential diagnosis
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Gnathostomiasis; paragonimiasis; cysticercosis; schistosomiasis; toxocariasis; aseptic meningitis of other genesis.

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Symptomatic. Some authors recommend albendazole 15 mg/kg bw/day for 2 weeks. In case of ocular infestation, surgical extraction of the parasite from the eye by ophthalmologists is recommended.

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  • Mostly spontaneous subsidence of the symptoms.
  • Deaths have been described, mainly in young children.

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Avoidance of contaminated food and contaminated water.

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  1. Lai CH, Yen CM et al (2007) Eosinophilic meningitis caused by Angiostrongylus cantonensis after ingestion of raw frogs. Am J Trop Med Hyg 76: 399-402
  2. Jitpimolmard S, Sawanyawisuth K et al (2007) Albendazole therapy for eosinophilic meningitis caused by Angiostrongylus cantonensis. Parasitol Res 100: 1293-1296


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Last updated on: 29.10.2020