Particularidades de la meningoencefalitis eosinofílica en la era del caracol gigante africano / Particular features of eosinophilic meningoencephalitis in the age of the giant African snail

Introducción: la meningoencefalitis eosinofílica es una enfermedad inflamatoria infecciosa reportada en Cuba desde la década de los ochenta del siglo pasado y actualmente extendida al continente americano. Es producida por el parásito Angiostrongylus cantonensis. Objetivo: determinar si existen diferencias entre los pacientes que sufrieron meningoencefalitis eosinofílica antes y después de la introducción del caracol gigante africano. Métodos: se estudiaron un total de 19 muestras de líquido cefalorraquídeo y suero tomadas simultáneamente a cada paciente diagnosticados con meningoencefalitis eosinofílica, perteneciente a la seroraquioteca del Laboratorio Central del Líquido Cefalorraquídeo (LABCEL). Para la determinación de las proteínas albúmina e IgG se empleó como método de laboratorio la inmunodifusión radial. Resultados: el 14 por ciento de los pacientes fueron adultos antes de la aparición de este molusco, en contraste con el momento actual, donde el 50 por ciento son pacientes con edades superiores a 18 años. El porcentaje de síntesis de IgG intratecal media fue mayor en los enfermos actuales, aunque no de manera significativa. Conclusiones: . existen diferencias antes y después de la aparición del caracol gigante africano dado por la respuesta de síntesis intratecal en los pacientes asociados con el molusco que denota una mayor agresividad del parásito. La edad promedio mayor de los enfermos confirma que estos son los que más manipulan y dispersan el molusco(AU)

Introduction: eosinophilic meningoencephalitis is an infectious inflammatory disease reported in Cuba since the 1980s and currently extended to the American continent. This condition is caused by the parasite Angiostrongylus cantonensis. Objective: determine whether there are differences between the patients suffering from eosinophilic meningoencephalitis before and after the introduction of the giant African snail. Methods: a study was conducted of a total 19 cerebrospinal fluid and serum samples taken simultaneously from each of the patients diagnosed with eosinophilic meningoencephalitis and kept at the sample collection of the Central Cerebrospinal Fluid Laboratory (LABCEL). Radial immunodiffusion was the laboratory method used for determination of the proteins albumin and IgG. Results: of the patients studied, 14 percent were adults before the appearance of this mollusc, in contrast with the present moment, when 50 percent are patients aged over 18 years. The percentage of mean intrathecal synthesis of IgG was higher in the current sufferers, though not significantly. Conclusions: there are differences before and after the appearance of the giant African snail, given the intrathecal synthesis response of patients associated to the mollusc, which denotes greater aggressiveness by the parasite. The higher mean age of sufferers confirms that these are the ones who most often handle and disperse the mollusc(AU)

Factores de riesgo asociados a la meningitis eosinofílica causada por Angiostrongylus cantonensis (Nematoda: Metastrongylidae) en Chone, Ecuador / Risk factors associated to eosinophilic meningitis caused by Angiostrongylus cantonensis (Nematoda: Metastrongylidae) in Chone, Ecuador

Introducción: El parásito Angiostrongylus cantonensis es el principal causante de meningitis eosinofílica. En el 2008 se reportó el primer caso en Ecuador y un estudio reciente en la Ciudad de Chone, Manabí, Ecuador determinó una alta prevalencia del parásito en el caracol africano (Achatina fulica). Objetivo: Identificar los factores de riesgo asociados a la meningitis eosinofílica causada por A. cantonensis en la ciudad de Chone. Métodos: Se entrevistaron a 500 personas residentes en la ciudad de Chone y se revisaron las historias clínicas del Hospital General de Chone. Resultados: Se observó que la población de Chone, está expuesta a los siguientes factores de riesgos: consumo de caracoles crudos (7,40 por ciento), el frecuente contacto de las personas con el caracol africano en la casa (67 por ciento), como en el trabajo (51,20 por ciento), el contacto que tienen los niños con caracoles, al jugar en el jardín (76,80 por ciento) y la incorrecta limpieza de los alimentos (54,40 por ciento). En el entorno de la población, se evidenció la presencia del caracol africano cerca de las casas en el 35,20 por ciento y las ratas, en el 50,80 por ciento. Además, el 34 por ciento de la muestra de estudio presentó sintomatología relacionada con meningitis eosinofílica. Se encontró que existía asociación entre la presencia de vectores cerca de las casas y la cantidad de síntomas manifestados por las personas. Conclusiones: Se evidenció que la población de Chone, manifiesta hábitos que exponen a la gente de esta localidad a un alto riesgo de contagio de meningitis eosinofílica(AU)

Introduction: The parasite Angiostrongylus cantonensis is the main causative agent of eosinophilic meningitis. The first case in Ecuador was reported in 2008, and a recent study conducted in the city of Chone, Manabí, Ecuador, determined a high prevalence of the parasite in the African snail (Achatina fulica). Objective: Identify the risk factors associated to eosinophilic meningitis caused by A. cantonensis in the city of Chone. Methods: Interviews were conducted with 500 residents from the city of Chone and a review was carried out of the medical records at Chone General Hospital. Results: It was found that the population of Chone is exposed to the following risk factors: eating raw snails (7.40 percent), frequent contact between people and African snails both at home (67 percent) and at work (51.20 percent), contact between children and snails while playing in gardens (76.80 percent) and washing food items incorrectly (54.40 percent). In the areas surrounding people's households the African snail was found in 35.20 percent and rats in 50.80 percent . Additionally, 34 percent of the study sample had symptoms of eosinophilic meningitis. An association was found between the presence of vectors near the houses and the number of symptoms occurring in people. Conclusions: It was evident that the population of Chone has habits which expose them to a high risk for eosinophilic meningitis(AU)

Characterisation of the vascular pathology in Sigmodon hispidus (Rodentia: Cricetidae) following experimental infection with Angiostrongylus costaricensis (Nematoda: Metastrongylidae)

BACKGROUND Angiostrongylus costaricensis is a nematode that causes human abdominal angiostrongyliasis, a disease found mainly in Latin American countries and particularly in Brazil and Costa Rica. Its life cycle involves exploitation of both invertebrate and vertebrate hosts. Its natural reservoir is a vertebrate host, the cotton rat Sigmodon hispidus. The adult worms live in the ileo-colic branches of the upper mesenteric artery of S. hispidus, causing periarteritis. However, there is a lack of data on the development of vasculitis in the course of infection. OBJECTIVE To describe the histopathology of vascular lesions in S. hispidus following infection with A. costaricensis. METHODS Twenty-one S. hispidus were euthanised at 30, 50, 90 and 114 days post-infection (dpi), and guts and mesentery (including the cecal artery) were collected. Tissues were fixed in Carson’s Millonig formalin, histologically processed for paraffin embedding, sectioned with a rotary microtome, and stained with hematoxylin-eosin, resorcin-fuchsin, Perls, Sirius Red (pH = 10.2), Congo Red, and Azan trichrome for brightfield microscopy analysis. FINDINGS At 30 and 50 dpi, live eggs and larvae were present inside the vasa vasorum of the cecal artery, leading to eosinophil infiltrates throughout the vessel adventitia and promoting centripetal vasculitis with disruption of the elastic layers. Disease severity increased at 90 and 114 dpi, when many worms had died and the intensity of the vascular lesions was greatest, with intimal alterations, thrombus formation, iron accumulation, and atherosclerosis. CONCLUSION In addition to abdominal angiostrongyliasis, our data suggest that this model could be very useful for autoimune vasculitis and atherosclerosis studies.

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.

Optic neuritis caused by intraocular angiostrongyliasis.

A 21-year-old Thai man first presented with eosinophilic meningitis. One week later he developed visual impairment of the left eye with a visual acuity of 20/600. He had a Marcus Gunn pupil, constricted visual field, prolongation of visual evoked potential and the presence of inflammatory cells in the vitreous cavity of the affected eye. On funduscopic examination there was disc swelling with hyperemia of the left eye. These ocular findings are compatible with optic neuritis. The causative agent, Angiostrongylus cantonensis, was identified in the vitreous cavity. To our knowledge this is the first case of optic neuritis caused by intraocular angiostrongyliasis. Ten days after administration of corticosteroid his severe headache was resolved, and by 4 weeks the disk swelling of the left eye subsided. Eight months after treatment the visual acuity of the left eye had not improved due to permanent damage to the retinal pigment epithelium caused by the intraocular parasite.

Abdominal angiostrongyliasis: a case with severe evolution

É relatado um caso de abdome agudo causado por angiostrongilíase abdominal. Um paciente de 42 anos, previamente hígido, apresentou queixa de nove dias de dor abdominal, constipação, disúria, febre e uma massa palpável na fossa ilíaca direita. Uma laparotomia exploradora foi realizada. Após o tratamento cirúrgico o paciente apresentou graves complicações.

Intravitreal angiostrongyliasis: report of 2 cases.

Two male patients presented with unilateral blurred vision. A small motile worm was found in the vitreous cavity in both cases. In one case, another dead, disintegrated worm was noted in the inferior portion of the vitreous cavity. On each eye, vitreous surgery was performed and the worm was removed by an aspirator. Both worms were identified as Angiostrongylus cantonensis. Since both patients had no signs of meningitis, lumbar puncture was not done. Long-term follow-up confirmed the benefit and safety of the vitreous surgery. Fluorescein angiography revealed severe pigmentary alteration, probably from inflammation of the choroid and retina due to subretinal migration of the worm prior to access into the vitreous cavity.

Jejunal perforation caused by abdominal angiostrongyliasis

The authors describe a case of abdominal angiostrongyliasis in an adult patient presenting acute abdominal pain caused by jejunal perforation. The case was unusual, as this affliction habitually involves the terminal ileum, appendix, cecum or ascending colon. The disease is caused by the nematode Angiostrongylus costaricensis, whose definitive hosts are forest rodents while snails and slugs are its intermediate hosts. Infection in humans is accidental and occurs via the ingestion of snail or slug mucoid secretions found on vegetables, or by direct contact with the mucus. Abdominal angiostrongyliasis is clinically characterized by prolonged fever, anorexia, abdominal pain in the right-lower quadrant, and peripheral blood eosinophilia. Although usually of a benign nature, its course may evolve to more complicated forms such as intestinal obstruction or perforation likely to require a surgical approach. Currently, no efficient medication for the treatment of abdominal angiostrongyliasis is known to be available. In this study, the authors provide a review on the subject, considering its etiopathogeny, clinical picture, diagnosis and treatment

Horizontal conjugate gaze palsy in eosinophilic meningitis.

Two cases of eosinophilic meningitis who presented with headache and strabismus are reported. Pertinent physical examination revealed unilateral horizontal conjugate gaze palsy with absence of doll's eye maneuver and hemiparesis. The etiologic agent of eosinophilic meningitis is presumed to be Angiostrongylus cantonensis and the infected location that produce horizontal conjugate gaze palsy was a pontine lesion.