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Eosinophilic meningitis

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Abstract

Eosinophilic meningitis (EM) is a distinct clinical entity that may have infectious and noninfectious causes. Worldwide, infection with the helminthic parasite, Angiostrongylus cantonensis, is the most common infectious etiology. Historically, this infection has been acquired through ingestion of competent intermediate and paratenic (carrier) hosts or contaminated food in Southeast Asia and the Pacific Islands. A recent outbreak of A. cantonensis-associated EM among US travelers to Jamaica and subsequent parasitologic surveys of local snails and rats confirm earlier case reports and engender a wider appreciation of the Caribbean islands as a new region for endemic A. cantonensis infections. Clinically, eosinophilia is not always present in the cerebrospinal fluid or in the peripheral blood during the initial manifestions of A. cantonensisassociated EM, which include headache and cutaneous sensory alterations. Effective management of patients involves careful attention to the control of intracranial pressure. Steroid therapy without specific anthelmintic treatment is safe and effective in control of headache of adult patients with A. cantonensis-associated EM.

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References and Recommended Reading

  1. Kuberski T: Eosinophils in cerebrospinal fluid: criteria for eosinophilic meningitis. Hawaii Med J 1981, 40:97–98.

    PubMed  CAS  Google Scholar 

  2. Gavin PJ, Kazacos KR, Tan TQ, et al.: Neural larva migrans caused by the raccoon roundworm Baylisascaris procyonis. Pediatr Infect Dis J 2002, 21:971–975. Recent report of nonfatal, but devastating EM infections in two children. Although rarely reported, B. procyonis infections in raccoons are highly prevalent in many regions within the United States and human cases may be under-reported.

    Article  PubMed  Google Scholar 

  3. Olveda RM, Domingo EO: Schistosomiasis japonica. In Clinical Tropical Medicine and Communicable Diseases. Edited by Mahmoud AAF. London: Bailliere-Tindall; 1987:397–418.

    Google Scholar 

  4. Ismail Y, Arsura EL: Eosinophilic meningitis associated with coccidiodomycois. West J Med 1993, 158:300–301.

    PubMed  CAS  Google Scholar 

  5. Muller W, Schorre W: A case of fatal cryptococcal meningitis with intraventricular granuloma. Acta Nerochir (Wien) 1978, 44:223–235.

    Article  CAS  Google Scholar 

  6. Kuberski T: Eosinophils in the cerebrospinal fluid. Ann Intern Med 1979, 91:70–75.

    PubMed  CAS  Google Scholar 

  7. Francois P, Martin G, Goullier A, et al.: Hypodermose neuromeningee compliquee d’hydrocephalie. Interet de l’imagerie par resonance magnetique nucleaire. Presse Med 1987, 16:1231–1233.

    PubMed  CAS  Google Scholar 

  8. Asperilla MO, Smego RA Jr: Eosinophilic Meningitis associated with ciprofloxacin. Am J Med 1989, 87:589–590.

    Article  PubMed  CAS  Google Scholar 

  9. Weller PF, Liu LX: Eosinophilic meningitis. Semin Neurol 1993, 13:161–168.

    PubMed  CAS  Google Scholar 

  10. Rosetti AO, Meagher-Villemure K, Vingerhoets F, et al.: Eosinophilic aseptic arachnoiditis: a neurological complication in HIV-negative drug addicts. J Neurol 2002, 884–887.

  11. Kliks MM, Palumbo NE: Eosinophilic meningitis beyond the Pacific Basin: the global dispersal of a peridomestic zoonosis caused by Angiostrongylus cantonensis, the nematode lungworm of rats. Soc Sci Med 1992, 34:199–212.

    Article  PubMed  CAS  Google Scholar 

  12. Punyagupta S, Juttijudata P, Bunnag T: Eosinophilic meningitis in Thailand: clinical studies of 484 typical cases probably caused by Angiostrongylus cantonensis. Am J Trop Med Hyg 1975, 24:921–931.

    PubMed  CAS  Google Scholar 

  13. Rosen L, Lolson G, Laigret J, et al.: Studies on eosinophilic meningitis 3. Epidemiologic and clinical observations of Pacific Islands and the possible etiologic role of Angiostrongylus cantonensis. Am J Epidemiol 1967:85:17–44.

    PubMed  CAS  Google Scholar 

  14. Slom TJ, Cortese MM, Gerber SI, et al.: An outbreak of eosinophilic meningitis caused by Angiostrongylus cantonensis in travelers returning from the Caribbean. N Engl J Med 2002, 346:668–675. The largest reported outbreak of A. cantonensis-associated eosinophilic meningitis in the Western Hemisphere outside of the Pacific Basin. The clinical course, timing of the host eosinophilic response, and response of the patients to therapy were carefully documented in relation to the time of the known exposure.

    Article  PubMed  Google Scholar 

  15. Lindo JF, Waugh C, Hall J, et al.: Enzooitic Angiostrongylus cantonensis in rats and snails after an outbreak of human eosinophilic meningitis, Jamaica. Emerg Infect Dis 2002, 8:324–326. First documentation of enzootic A. cantonensis infection in Jamaica. Rats and land snails were found to harbor adult and larval stages of the parasite. Several suspected clinical cases had been described in this area, but endemic A. cantonensis disease had not previously been reported here.

    Article  PubMed  Google Scholar 

  16. Pascual JE, Planas Bouli R, Aguiar H: Eosinophilic meningitis in Cuba caused by Angiostrongylus cantonensis. Am J Trop Med Hyg 1981, 30:960–962.

    PubMed  CAS  Google Scholar 

  17. Pascual Gispert JE, Aguilar Prieto PH, Galvez Oviedo MD: Finding of Angiostrongylus cantonensis in the cerebrospinal fluid of a boy with eosinophilic meningoencephalitis. Rev Cubana Med Trop 1981, 33:92–95.

    Google Scholar 

  18. Martinez-Delgado JF, Gonzalez-Cortinas M, Tapanes-Cruz TR, Ruiz-Mendez A: Eosinophilic meningoencephalitis in Villa Clara (Cuba): a study of 17 patients. Rev Neurol 2000, 31:417–421.

    PubMed  CAS  Google Scholar 

  19. Barrow KO, St. Rose A, Lindo JF: Eosinophilic Meningitis. Is Angiostrongylus cantonensis endemic in Jamaica? West Indian Med J 1996, 45:70–71.

    PubMed  CAS  Google Scholar 

  20. New D, Little M, Cross J: Angiostrongylus cantonensis infection from eating raw snails. N Engl J Med, 332:1105–1106.

  21. Kliks MM, Kroenke K, Hardman JM. Eosinophilic radiculomyeloencephalitis: An angiostrongyliasis outbreak in American Samoa related to ingestion of Achatina fulica snails. Am J Trop Med Hyg 1982, 31:1114–1122.

    PubMed  CAS  Google Scholar 

  22. Tsai HC, Liu YC, Kunin CM, et al.: Eosinophilic meningitis caused by Angiostrongylus cantonensis: report of 17 cases. Am J Med 2001, 111:109–114. Humans are incidental hosts for A. cantonensis, and A. cantonensis does not replicate with humans. Therefore, the severity of symptoms is presumed to correspond, in part, to the number of larvae ingested. The authors were able to correlate disease severity (headache, muscle weakness, orbital pain, CSF, white blood cell count, and eosinophil count) with the number of snails ingested, and therefore, the likely number of larvae.

    Article  PubMed  CAS  Google Scholar 

  23. Kuberski T, Wallace GD: Clinical manifestations of eosinophilic meningitis due to Angiostrongylus cantonensis. Neurology 1979, 29:1566–1570.

    PubMed  CAS  Google Scholar 

  24. Fischer PR: Eosinophilic meningitis. West J Med 1983, 139:372–373.

    PubMed  CAS  Google Scholar 

  25. Hwang KP, Chen ER: Clinical studies on Angiostrongyliasis cantonensis among children in Taiwan. Southeast Asian J Trop Med Public Health 1991, 22(Suppl):194–199.

    PubMed  Google Scholar 

  26. Clouston PD, Corbett AJ, Pryor DS, Garrick R: Eosinophilic meningitis: cause of chronic pain syndrome. J Neurol Neurosurg Psychiatry 1990, 53:778–781.

    Article  PubMed  CAS  Google Scholar 

  27. Prociv P, Tiernan JR: Eosinophilic meningoencephalitis with permanent sequelae. Med J Aust 1987, 147:294–295.

    PubMed  CAS  Google Scholar 

  28. Chotmongkol V, Sawanyawisuth K: Clinical manifestations and outcome of patients with severe eosinophilic meningoencephalitis presumably caused by Angiostrongylus cantonensis. Southeast Asian J Trop Med Public Health 2002, 33:231–234.

    PubMed  Google Scholar 

  29. Punyagupta S, Bunnag T, Juttijudata P: Eosinophilic meningitis in Thailand: clinical and epidemiological characteristics of 162 patients with myeloencephalitis probably caused by Gnathostoma spinigerum. J Neuro Sci 1990, 96:241–256.

    Article  CAS  Google Scholar 

  30. Ko RC, Chiu MC, Kum W, Chan SH: First report of human angiostrongyliasis in Hong Kong diagnosed by computerized axial tomography and ELISA. Trans R Soc Trop Med Hyg 1984, 78:354–355.

    Article  PubMed  CAS  Google Scholar 

  31. Toma H, Matsumura S, Oshiro C, et al.: Ocular angiostrongyliasis without meningitis symptoms in Okinawa, Japan. J Parasitol 2002, 88:211–213.

    PubMed  CAS  Google Scholar 

  32. Cross JH, Chi JCH: ELISA for the detection of Angiostrongylus cantonensis antibodies in patients with eosinophilic meningitis. Southeast Asian J Trop Med Public Health 1982, 13:73–76.

    PubMed  CAS  Google Scholar 

  33. Eamsobhana P, Mak JW, Yong HS: Development of specific immunodiagnosis for human parastrongyliasis. Paper presented at Proceedings of the 8th SEAMIC/IMFJ Technical Meeting on Molecular Biology and Immunology in the Diagnosis of Parasitic Diseases. Bangkok, Thailand: July 3-7, 1995.

  34. Maleewong W, Sombatsawat P, Intapan PM, et al.: Immunoblot evaluation of the specificity of the 29-kDa antigen from young adult female worms Angiostrongylus cantonensis for immunodiagnosis of human angiostrongyliasis. Asian Pac J Allergy Immunol 2001, 19:267–273.

    PubMed  CAS  Google Scholar 

  35. Koo J, Pien F, Kliks MM: Angiostrongylus (parastongylus) eosinophilic meningitis. Rev Infect Dis 1988, 10:1155–1162.

    PubMed  CAS  Google Scholar 

  36. Graybill JR, Sobel J, Saag M, et al., and the NIAID Mycoses Study Group and AIDS Cooperative Treatment Groups: Diagnosis and management of increased intracranial pressure in patients with AIDS and cyrptococcal meningitis. Clin Infect Dis 2000, 30:47–54.

    Article  PubMed  CAS  Google Scholar 

  37. Yii CY, Chen CY, Chen ER, et al.: Epidemiologic studies of eosinophilic meningitis in southern Taiwan. Am J Trop Med Hyg 1976, 24:447–454.

    Google Scholar 

  38. Reid IR, Wallis WE: The chronic and severe forms of eosinophilic meningitis. Aust N Z J Med 1984, 14:163–165.

    PubMed  CAS  Google Scholar 

  39. Chotmongkol V, Sawanyawisuth K, Thavornpitak Y: Corticosteroid treatment of eosinophilic meningitis. Clin Infect Dis 2000, 31:660–662. First randomized, placebo-controlled clinical study for treatment of A. cantonensis-associated eosinophilic meningitis. Prenisolone (60 mg/d) administered for 2 weeks (without specific anthelmintic therapy) was safe and effective in the relief of headache in adult patients with eosinophilic meningitis.

    Article  PubMed  CAS  Google Scholar 

  40. Bowden DK: Eosinophilic meningitis in the New Hebrides: two outbreaks and two deaths. Am J Trop Med Hyg 1981, 30:1141–1143.

    PubMed  CAS  Google Scholar 

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  1. Hines VA Hospital/151, Fifth Avenue & Roosevelt Road, 60141, Hines, IL, USA

    Stuart Johnson MD

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  1. Trevor Slom MD
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  2. Stuart Johnson MD
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Slom, T., Johnson, S. Eosinophilic meningitis. Curr Infect Dis Rep 5, 322–328 (2003). https://doi.org/10.1007/s11908-003-0010-1

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  • DOI: https://doi.org/10.1007/s11908-003-0010-1

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