Gnathostoma infection after ingestion of raw fish is a probable cause of eosinophilic meningitis in the Brazilian Amazon

ABSTRACT We report a case of eosinophilic meningitis associated with the ingestion of raw fish (Cichla sp.) from the Brazilian Amazon, likely caused by Gnathostoma. A 36-year-old male visited Juruena river on a fishing trip. After 50 days, the patient presented with an intense frontal headache. A cerebrospinal fluid examination revealed 63% eosinophilia. Another individual who ingested raw fish developed linear dermatitis on the abdominal wall. Anti-Gnathostoma serum antibodies were detected, and the patient made a full recovery after treatment with corticosteroids and albendazole. To date, autochthonous Gnathostoma spp. infections in Latin American countries have only caused linear panniculitis. This report raises awareness of gnathostomiasis-causing meningitis.

Eosinophilic meningitis due to A. Cantonensis revealed at autopsy

Parasitic infection of the central nervous system could be fatal, and its incidence is rising due to increasing worldwide travel. Amongst the various nematodes, Angiostrongylus contonensis is the commonest and causes eosinophilic meningitis. It is a zoonotic disease produced due to the ingestion of raw or undercooked snails or slugs. Most cases of angiostrongyliasis are mild and self-limiting, but death can occur in severe cases lacking timely and proper treatment. Very few autopsy cases of A. cantonensis are reported. We present the case of a 32-year-old mentally challenged orphan male with eosinophilic meningitis at autopsy.

El riesgo de parasitismo por Angiostrongylus cantonensis: una problemática reemergente en Cuba / The risk of parasitism by Angiostrongylus cantonensis: a re-emerging problem in Cuba / O risco de parasitismo devido a Angiostrongylus cantonensis: um problema reemergente em Cuba

RESUMEN Introducción: El riesgo de parasitismo por Angiostrongylus cantonensis transmitido por el caracol gigante africano es una problemática reemergente en Cuba. Objetivo: Sistematizar contenidos esenciales relacionados con el caracol gigante africano y el parásito Angiostrongylus cantonensis, el riesgo de meningitis eosinofílica y su manejo. Método: En el Hospital General Docente "Dr. Agostinho Neto", entre septiembre y diciembre de 2019 se hizo una revisión narrativa sobre el tema a través de una búsqueda en bases de datos electrónicas (Biblioteca Virtual en Salud): LILACS, PubMed, SciELO, RedALyC, Scopus, Cochrane. Resultados: La información se estructuró en caracterización del caracol gigante africano y el riesgo de infección por Angiostrongylus cantonensis en Cuba, patogénesis y epidemiologia de la angiostrongylosis, y diagnóstico y tratamiento de la meningitis eosinofílica por este nemátodo. Se identificaron controversias sobre los criterios diagnósticos, el protocolo de actuación para su prevención y rehabilitación, y la carencia de un instrumento para estratificar el riesgo de esta infección. Conclusiones: Se sistematizaron contenidos esenciales sobre el caracol gigante africano, lo que posibilita la preparación de los profesionales para incrementar la percepción del riesgo de infección por Angiostrongylus cantonensis en la población.

ABSTRACT Introduction: The risk of parasitism by Angiostrongylus cantonensis transmitted by the giant African land snail, Lissachatina fulica is a re-emerging problem in Cuba. Objective: Systematize essential contents related to the giant African land snail and the parasite Angiostrongylus cantonensis, the risk of eosinophilic meningitis and its management. Method: A narrative review was made on the subject in the Teaching General Hospital "Dr. Agostinho Neto", between September and December 2019 through a search in electronic databases (Virtual Health Library): LILACS, PubMed, SciELO, RedALyC, Scopus, Cochrane. Results: The information was structured in the characterization of the African giant land snail and the risk of infection by Angiostrongylus cantonensis in Cuba, pathogenesis and epidemiology of angiostrongylosis, and diagnosis and treatment of eosinophilic meningitis by this nematode. Controversies were identified regarding the diagnostic criteria, the protocol of action for its prevention and rehabilitation, and the lack of an instrument to stratify the risk of this infection. Conclusions: Essential content on the giant African land snail was systematized, enabling the preparation of professionals to increase the perception of the risk of infection by Angiostrongylus cantonensis in the population.

RESUMO Introdução: O risco de parasitismo causado por Angiostrongylus cantonensis transmitido pelo caracol gigante africano é um problema reemergente em Cuba. Objetivo: Sistematizar conteúdos essenciais relacionados ao caracol gigante africano e ao parasita Angiostrongylus cantonensis, ao risco de meningite eosinofílica e seu manejo. Método: No Hospital Geral de Ensino "Dr. Agostinho Neto", entre setembro e dezembro de 2019, foi realizada uma revisão narrativa do assunto através de uma busca em bases de dados eletrônicas (Biblioteca Virtual em Saúde): LILACS, PubMed, SciELO, RedALyC, Scopus, Cochrane. Resultados: As informações foram estruturadas na caracterização do caracol gigante africano e no risco de infecção por Angiostrongylus cantonensis em Cuba, patogênese e epidemiologia da angiostrongilose, diagnóstico e tratamento da meningite eosinofílica por esse nematóide. Foram identificadas controvérsias sobre os critérios diagnósticos, o protocolo de ação para sua prevenção e reabilitação e a falta de um instrumento para estratificar o risco dessa infecção. Conclusões: Foram sistematizados conteúdos essenciais sobre o caracol gigante africano, o que possibilita a preparação de profissionais para aumentar a percepção do risco de infecção por Angiostrongylus cantonensis na população.

Infection by Angiostrongylus cantonensis in both humans and the snail Achatina (Lissachatina) fulica in the city of Macapá, in the Amazon Region of Brazil

In January and February 2019, a malacological survey was conducted in the area surrounding the residence of a 12-year-old child that had contracted cerebral angiostrongyliasis in the municipality of Macapá, capital of the Amapá State, northern Brazil. The serological examination was positive for Angiostrongylus cantonensis infection, the principal etiological agent of this parasitosis. A sample of 54 molluscs was artificially and individually digested for parasitological analysis, containing 38 specimens of Achatina fulica, nine specimens of Bulimulus tenuissimus and seven specimens of Sarasinula linguaeformis. A. fulica was the most abundant mollusc, and the only species infected with A. cantonensis, as well as presenting co-infections with other nematodes. This is the first report of cerebral angiostrongyliasis in the Amazon Region, and the first record of A. fulica infected with A. cantonensis in Amapá. These findings highlight the potential risks of human angiostrongyliasis, and the need to implement public health measures to control the spread of the disease.

El caracol gigante africano (Achatinafulica) y sus efectos en la salud humana / The giant African snail (Achatinafulica) and its effects on human health / O caracol gigante africano (Achatinafulica) e seus efeitos na saúde humana

RESUMEN Introducción: el caracol gigante africano (CGA) o Achatinafulica se considera una de las cien especies exóticas invasoras más dañinas del mundo. Su principal riesgo para la salud humana resulta de la posibilidad de actuar como huésped de nematodos. Desarrollo: el CGA es el hospedero intermediario de varios parásitos incluidos Aelurostrongylusabstrusus, Angiostrongyluscantonensis, Angiostrongyluscostaricensis, Schistosomamansoni, Hymenolepisspp. Y Fasciola hepática. El A. cantonesises el principal microorganismo causal de la meningitis eosinofílica (ME) y es agente trasmisor de la bacteria gramnegativa Aeromonashydrophila. Entre las manifestaciones clínicas más comunes de la ME se incluyen cefalea intensa, rigidez nucal, náuseas vómitos y parestesias. La detección de eosinófilos en el líquido cefalorraquídeo (LCR) y la sangre periférica contribuyen a su diagnóstico. El tratamiento en formas graves de la ME se basa en el uso de corticosteroides y punciones lumbares seriadas para extracción del LCR. El empleo de antihelmínticos es controversial. Conclusiones: la presencia del caracol gigante africano en Cuba eleva el riesgo de enfermedades. La aparición de manifestaciones clínicas del sistema nervioso central impone la necesidad de indagar sobre la exposición a este molusco y demanda de la búsqueda de signos y síntomas de meningitis eosinofílica. Se requiere desarrollar en el futuro estudios controlados y aleatorizados sobre la eficacia de los fármacos para el tratamiento de la enfermedad, entre ellos los antihelmínticos.

ABSTRACT Introduction: the giant African snail (CGA) or Achatinafulica is considered one of the one hundred most harmful invasive alien species in the world. Its main risk to human health results from the possibility of acting as a host of nematodes. Development: the CGA is the intermediate host of several parasites including Aelurostrongylusabstrusus, Angiostrongyluscantonensis, Angiostrongyluscostaricensis, Schistosomamansoni, Hymenolepisspp. And Fasciola hepatica. A. cantonesises is the main causative organism of eosinophilic meningitis (ME) and is a transmitting agent of the gram-negative bacterium Aeromonashydrophila. The most common clinical manifestations of ME include intense headache, nuchal rigidity, nausea, vomiting and paresthesias. The detection of eosinophils in the cerebrospinal fluid (CSF) and peripheral blood contribute to its diagnosis. Treatment in severe forms of EM is based on the use of corticosteroids and serial lumbar punctures for CSF removal. The use of anthelmintics is controversial. Conclusions: the presence of the giant African snail in Cuba increases the risk of diseases. The appearance of clinical manifestations of the central nervous system imposes the need to inquire about the exposure to this mollusk and demand the search for signs and symptoms of eosinophilic meningitis. In the future, controlled and randomized studies on the efficacy of drugs for the treatment of the disease, including anthelmintics, need to be developed.

RESUMO Introdução: o caramujo gigante africano (CGA) ou Achatinafulica é considerado uma das cem espécies exóticas invasoras mais nocivas do mundo. Seu principal risco para a saúde humana resulta da possibilidade de atuar como hospedeiro de nematóides. Desenvolvimento: A CGA é o hospedeiro intermediário de vários parasitas incluindo Aelurostrongylusabstrusus, Angiostrongylus cantonensis, Angiostrongyluscostaricensis, Schistosoma mansoni, Hymenolepisspp. E Fasciola hepatica. A. cantonesises o principal organismo causador de meningite eosinofílica (ME) e é agente de bactérias gram-negativas bactérias Aeromonas hydrophila transmissão. As manifestações clínicas mais comuns da EM incluem cefaléia intensa, rigidez de nuca, náusea, vômito e parestesias. A detecção de eosinófilos no líquido cefalorraquidiano (LCR) e no sangue periférico contribui para o seu diagnóstico. O tratamento em formas graves de EM baseia-se no uso de corticosteróides e punções lombares em série para remoção do LCR. O uso de anti-helmínticos é controverso. Conclusões: a presença do gigante caramujo africano em Cuba aumenta o risco de doenças. O aparecimento de manifestações clínicas do sistema nervoso central impõe a necessidade de investigar a exposição a este molusco e procura de sinais e sintomas de meningite eosinofílica. No futuro, estudos controlados e randomizados sobre a eficácia de medicamentos para o tratamento da doença, incluindo anti-helmínticos, precisam ser desenvolvidos.

Human neuroimmune response against angiostrongylus cantonensis

Introduction: Angiostrongylus cantonensis is a zoonotic pathogen that causes human angiostrongyliasis; its main clinical manifestation is eosinophilic meningitis. It was reported in Cuba for the first time in America. Objective: To review the main immunological findings about the human neuroimmune response against this parasite. Methods: This paper is based on a review of the papers mainly from Cuban authors published in the last 10 years about the human neuroimmune response against this helmint. This information becomes more relevant after the introduction of the African giant snail Lissachatina fulica in Cuba in 2014. Results: The humoral immune response is based on the immunoglobulin intrathecal synthesis. When the third-stage larvae go to the central nervous system at the first lumbar puncture there are no major immunoglobulin synthesis. One week later an immune intrathecal response is done by a two-class major immunoglobulin class mainly IgG+ IgA Intrathecal activation of complement is evident of intrathecal synthesis of major immunoglobulins during this disease. The activation of complement system components in cerebrospinal fluid is relevant to the understanding of this tropical disease, which is emerging in the Western hemisphere. Intrathecal synthesis of at least one of the major immunoglobulins and a wide spectrum of patterns may be observed. Although intrathecal synthesis of C3c and IgE is always present, C4 intrathecal synthesis does not occur in every patient. The diversity of intrathecal synthesis and activation of the different complement pathways enables their division into three variant groups. In each one could be finding the activation of one or several complement pathways including the participation of MBL, MASP-2 and ficolins as part of the lectin pathway complement activation. Conclusion: The neuroimmune response against Angiostrongylus cantonensis eosinophilic meningoencephalitis is an example of the host-parasite interaction(AU)

Prevalence and distribution of angiostrongylus cantonensis (nematoda, angiostrongylidae) in achatina fulica (mollusca, gastropoda) in baixada santista, São Paulo, Brazil

ABSTRACT INTRODUCTION Angiostrongylus cantonensis is causes eosinophilic meningoencephalitis in humans. Worldwide expansion of this nematode is linked to the dispersion of their hosts. This study aimed to determine the prevalence of A. cantonensis infection in Achatina fulica in the nine municipalities that make up Baixada Santista, São Paulo, Brazil. METHODS Angiostrongylus cantonensis larvae were analyzed using optical microscopy. We performed polymerase chain reaction and restriction fragment length polymorphism using restriction endonuclease ClaI, directed to the internal transcribed spacer region 2 of A. cantonensis larval DNA. RESULTS Of the 540 snails analyzed, 117 (21.7%) were infected by A. cantonensis. For morphological and morphometric analyses, 60 larvae were used. Second-stage larvae were, on average, 358.2µm long and 26.4µm wide, while third-stage larvae were, on average, 450µm long and 21.12µm wide. The tails of the larvae ended in a fine tip. CONCLUSIONS All municipalities comprising Baixada Santista had A. fulica that were naturally infected with A. cantonensis. All of the observed characteristics were typical of the species.

Eosinophilic Meningitis after Bovine Graft Duraplasty for Arnold-Chiari Malformation Type 1 in a 33-year-old Man

Cases of pediatric eosinophilic meningitis following duraplasty with a bovine graft have been reported. These patients recovered following the surgical removal of the dural graft or steroid therapy. Decompression for Chiari malformation is a common procedure in both pediatric and adult neurosurgery. We describe the case of a 33-yr-old male patient with eosinophilic meningitis following Chiari decompression via bovine graft duraplasty. Cerebrospinal fluid (CSF) study showed 49 red blood cells/μL and 129 leukocytes/μL with 17% eosinophils. There was no evidence of infectious disease. To our knowledge, this is the first report of adult eosinophilic meningitis after bovine graft duraplasty in Korea.

Neuronal Apoptosis: Pathological Basis of Behavioral Dysfunctions Induced by Angiostrongylus cantonensis in Rodents Model

Angiostrongylus cantonensis invades the central nervous system (CNS) of humans to induce eosinophilic meningitis and meningoencephalitis and leads to persistent headache, cognitive dysfunction, and ataxic gait. Infected mice (nonpermissive host), admittedly, suffer more serious pathological injuries than rats (permissive host). However, the pathological basis of these manifestations is incompletely elucidated. In this study, the behavioral test, histological and immunohistochemical techniques, and analysis of apoptotic gene expression, especially caspase-3, were conducted. The movement and motor coordination were investigated at week 2 post infection (PI) and week 3 PI in mice and rats, respectively. The cognitive impairs could be found in mice at week 2 PI but not in rats. The plaque-like lesion, perivascular cuffing of inflammatory cells, and dilated vessels within the cerebral cortex and hippocampus were more serious in mice than in rats at week 3 PI. Transcriptomic analysis showed activated extrinsic apoptotic pathway through increased expression of TNFR1 and caspase-8 in mice CNS. Immunohistochemical and double-labeling for NeuN and caspase-3 indicated the dramatically increased expression of caspase-3 in neuron of the cerebral cortex and hippocampus in mice but not in rats. Furthermore, western-blotting results showed high expression of cleaved caspase-3 proteins in mice but relatively low expression in rats. Thus, extrinsic apoptotic pathway participated in neuronal apoptosis might be the pathological basis of distinct behavioral dysfunctions in rodents with A. cantonensis infection. It provides the evidences of a primary molecular mechanism for the behavioral dysfunction and paves the ways to clinical diagnosis and therapy for A. cantonensis infection.

Eosinophilic meningitis: A case series and review of literature of Angiostrongylus cantonensis and Gnathostoma spinigerum.

Eosinophilic meningitis is defi ned as the presence of >10 eosinophils/μL in cerebrospinal fl uid (CSF) or at least 10% eosinophils in the total CSF leukocyte count. Eosinophilic meningitis has been reported in two case series and two case reports in India till date and has not been reported in children below 15 years of age. We present two children with eosinophilic meningitis with peripheral eosinophilia and the proposed etiologic agents based on the clinical setting and their response to antihelminthic agents.

Eosinophilic meningitis caused by Angiostrongylus cantonensis: an emergent disease in Brazil

Eosinophilic meningitis (EoM) is an acute disease that affects the central nervous system. It is primarily caused by infection with the nematode Angiostrongylus cantonensis. This infection was previously restricted to certain Asian countries and the Pacific Islands, but it was first reported in Brazil in 2007. Since then, intermediate and definitive hosts infected with A. cantonensis have been identified within the urban areas of many states in Brazil, including those in the northern, northeastern, southeastern and southern regions. The goals of this review are to draw the attention of the medical community and health centres to the emergence of EoM in Brazil, to compile information about several aspects of the human infection and mode of transmission and to provide a short protocol of procedures for the diagnosis of this disease.

Angiostrongylus cantonensis: un parásito emergente en Ecuador / Angiostrongylus cantonensis: an emerging parasite in Ecuador

Introducción: en 2008 se notificó por primera vez la presencia de Angiostrongylus cantonensis en Ecuador, así como los primeros casos de una enfermedad emergente causada por sus larvas, la meningitis eosinofilica. Métodos: se realizó una revisión de la literatura básica y actualizada sobre aspectos generales de Angiostrongylus cantonensis en el mundo y particulares en Ecuador, que incluyó los hallazgos parasitológicos, clínicos y malacológicos relacionados con la enfermedad. Resultados: se informan los hallazgos iniciales acerca de la aparición del parásito en Ecuador, así como la amplia distribución geográfica de sus hospederos intermediarios en el territorio nacional. Además, se notifican los brotes de meningitis eosinofilica por Angiostrongylus cantonensis y un caso de angiostrongyliosis ocular, informados oficialmente por el Ministerio de Salud Pública. Conclusiones: Angiostrongylus cantonensis es un parásito emergente en Ecuador, cuyo diagnóstico en la actualidad es clínico y epidemiológico, de ahí la importancia de contar con métodos de laboratorio que lo oriente. Por otra parte, es importante que se promuevan campañas de promoción y prevención de salud que contribuyan a romper la cadena de transmisión de la enfermedad.

Introduction: the presence of Angiostrongylus cantonensis and the first cases of eosinophilic meningitis, an emerging disease caused by its larvae, were first reported in Ecuador in the year 2008. Methods: a review was conducted of the basic and current bibliography on general aspects of Angiostrongylus cantonensis both worldwide and in Ecuador, including parasitological, clinical and malacological findings. Results: initial findings are reported about the emergence of the parasite in Ecuador, as well as the broad geographic distribution of its intermediate hosts in the national territory. Information is also provided about outbreaks of eosinophilic meningitis due to Angiostrongylus cantonensis and a case of ocular angiostrongylosis, based on official reports by the Ministry of Public Health. Conclusions: Angiostrongylus cantonensis is an emerging parasite in Ecuador whose diagnosis is currently based on clinical and epidemiological findings. Hence the importance of developing relevant laboratory methods. On the other hand, it is important to foster health promotion and prevention campaigns aimed at stopping the transmission of the disease.

Molecular diagnosis of eosinophilic meningitis due to Angiostrongylus cantonensis (Nematoda: Metastrongyloidea) by polymerase chain reaction-DNA sequencing of cerebrospinal fluids of patients

Cerebrospinal fluid (CSF) samples from clinically diagnosed patients with detectable Angiostrongylus canto-nensis-specific antibodies (n = 10), patients with clinically suspected cases that tested negative for A. cantonensis-an-tibodies (n = 5) and patients with cerebral gnathostomiasis (n = 2) and neurocysticercosis (n = 2) were examined by a single-step polymerase chain reaction (PCR) method using the AC primers for the 66-kDa native protein gene. The PCR method detected A. cantonensis DNA in CSF samples from four of 10 serologically confirmed angiostrongyliasis cases. The PCR results were negative for the remaining CSF samples. The nucleotide sequences of three positive CSF-PCR samples shared 98.8-99.2% similarity with the reference sequence of A. cantonensis. These results indicate the potential application of this PCR assay with clinical CSF samples for additional support in the confirmation of eosinophilic meningitis due to A. cantonensis.

Clinical Manifestations of Eosinophilic Meningitis Due to Infection with Angiostrongylus cantonensis in Children

Eosinophilic meningitis, caused by the nematode Angiostrongylus cantonensis, is prevalent in northeastern Thailand, most commonly in adults. Data regarding clinical manifestations of this condition in children is limited and may be different those in adults. A chart review was done on 19 eosinophilic meningitis patients aged less than 15 years in Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. Clinical manifestations and outcomes were reported using descriptive statistics. All patients had presented with severe headache. Most patients were males, had fever, nausea or vomiting, stiffness of the neck, and a history of snail ingestion. Six patients had papilledema or cranial nerve palsies. It was shown that the clinical manifestations of eosinophilic meningitis due to A. cantonensis in children are different from those in adult patients. Fever, nausea, vomiting, hepatomegaly, neck stiffness, and cranial nerve palsies were all more common in children than in adults.

Specificity of immunoblotting analyses in eosinophilic meningitis

Angiostrongylus cantonensis and Gnathostoma spinigerum are the two most common causative parasites of eosinophilic meningitis (EOM). Serological tests are helpful tools for confirming the identity of the pathogen. Recent reports determined the specificity of such tests by using normal healthy controls. There have been limited studies done to rule out the cross-reactivity between these two causative parasites of EOM. This study aims to assess the specificity of the serological test in EOM by using each condition as a control for the other. Thirty-three patients with a diagnosis of EOM were enrolled. Sera from 22 patients with a positive 29-kDa antigenic diagnostic band of A. cantonensis were tested for the 21 and 24-kDa antigenic bands of G. spinigerum. Similarly, sera of 11 gnathostomiasis patients were tested for the 29-kDa diagnostic band for A. cantonensis. Only one patient in the angiostrongyliasis group had a positive result for the 21 and 24-kDa antigenic bands of G. spinigerum, while no gnathostomiasis patients showed a positive result for the 29-kDa antigenic band of A. cantonensis. The specificity of the 21 and 24-kDa antigenic bands for gnathostomiasis and the 29-kDa antigenic band for A. cantonensis was 95.5 percent and 100 percent, respectively. The antigenic bands for the diagnosis of gnathostomiasis and angiostrongyliasis in EOM were highly specific.

Meningitis eosinofílica por angiostrongylus cantonensis: reporte de caso de autopsia / Eosinophilic meningitis caused by angiostrongylus cantonensis: report of a case of autopsy

El Angiostrongylus Cantonensis también conocido como el parásito pulmonar de la rata, en donde el hombre puede ser un hospedero accidental cuando consume moluscos con larvas viables, produce una meningoencefalitis que se caracteriza por un elevado número de eosinófilos en el líquido cefaloraquídeo. La angioestrongiloidiasis poco frecuente en nuestro medio, tiene dos especies de Angiostrongylus que producen dos enfermedades características en el hombre: la meningitis eosinofílica, por el A. Cantonensis y la angioestrongiloidiasis abdominal; producida por el A. Costarricensis, reportada en Ecuador por primera vez en 1974. La meningitis eosinofílica por A. cantonensis es una enfermedad endémica del sudeste asiático desde 1.935; en el continente americano, Cuba reportó los primeros casos en 1981; en Ecuador nunca antes se había informado esta parasitosis, considerándola hasta entonces como una enfermedad exótica. El reporte de este caso tiene por objetivo informar a la comunidad médica de la existencia de esta parasitosis en nuestro medio ambiente, así como revisar los hallazgos anatomopatológicos de esta enfermedad.

Angiostrongylus cantonense also known as pulmonary parasite of rats, of which men can be accidental hosts when ingesting molluscs with viable larvae, meningoencephalitis appears. It is characterized by a high amount of eosinophil in the cephalospinal fluid. Angiostrongiliasis, which is not very common in our environment, has two species of angiostrongylus which produce two characteristic diseases in men: eosinophilic meningitis produced by A. Cantonensis and abdominal Angioestrongiloidiasis; produced by A. Costa Rican, reported in Ecuador for the first time in 1974. Eosinophilic meningitis by A. Cantonese is a South-east Asian endemic disease since 1935; in the American continent, Cuba reported the first cases in 1981; Ecuador had never reported this parasitosis before, considered then, an exotic disease. The report of this case is meant to inform the community of the existence of this parasitosis in our environment, as well as to check the anatomic-patholigical findings of this disease.

A Case of Eosinophilic Meningitis Associated with Idiopathic Hypereosinophilic Syndrome

Idiopathic hypereosinophilic syndrome (IHES) is a rare disease characterized by peripheral blood eosinophilia and eosinophilic infiltration of multiple organs, including the nervous system. The neurologic manifestations in hypereosinophilic syndrome are variable, but eosinophilic meningitis as a manifestation has not been well documented in IHES. We report a case of eosinophilic meningitis associated with IHES, which showed a good response to steroid treatment.

Eosinophilic meningitis due to Angiostrongylus cantonensis.

We report a 23 year old female who presented with a history of headache. She was admitted to a hospital in Nakornrachasrima province. Eosinophilic meningitis was diagnosed. However, releasing pressure of cerebrospinal fluid (CSF) by lumbar puncture, supportive and symptomatic treatment were performed resulting in appropriate treatment. The patient was referred to Siriraj Hospital due to the persisted headache. Multidisciplinary investigation such as imaging modalities, cytology and serological test for specific antibodies were carried out. Antibody against an A. cantonensis-specific 31-kDa antigen was detected in the serum sample obtained from this patient. In conclusion, A. cantonensis is the possible causative agent of headache in this patient.