Guidelines for the diagnosis and treatment of neuroangiostrongyliasis: updated recommendations.

A subcommittee of the Hawaii Governor's Joint Task Force on Rat Lungworm Disease developed preliminary guidelines for the diagnosis and treatment of neuroangiostrongyliasis (NAS) in 2018 (Guidelines, 2018). This paper reviews the main points of those guidelines and provides updates in areas where our understanding of the disease has increased. The diagnosis of NAS is described, including confirmation of infection by real-time polymerase chain reaction (RTi-PCR) to detect parasite DNA in the central nervous system (CNS). The treatment literature is reviewed with recommendations for the use of corticosteroids and the anthelminthic drug albendazole. Long-term sequelae of NAS are discussed and recommendations for future research are proposed.

Role of Gastropod Mucus in the Transmission of Angiostrongylus cantonensis, a Potentially Serious Neurological Infection.

Angiostrongylus cantonensis, the rat lungworm, is endemic to Hawaii. A recent increase in the number of cases has drawn intense local and national media attention. As a result there is an increased fear of acquiring the disease from local produce, which has the potential to adversely affect the income of local farmers. The most common means of transmission is by the ingestion of an infected intermediate host. Other modes of transmission have been suggested including infectious larvae being released into the mucus trail of gastropods. This literature review indicates that mucus trails from infected gastropods poses a minimal risk to humans.

The role of eosinophils in angiostrongyliasis: multiple roles for a versatile cell?

Human infection with the rat lungworm, Angiostrongylus cantonensis, is characterized by a vigorous eosinophil response that gives the disease its name, eosinophilic meningitis. The actual role eosinophils play, both protective and destructive, in this infectious process is still largely a mystery. Research since 2002 has indicated that eosinophils are a multifaceted granulocyte that contributes to a wide range of physiological and pathological processes depending on their location and activation status. This article suggests an expanded role for eosinophils as both classic antiparasitic effector cells and as immune regulatory cells in eosinophilic meningitis caused by Angiostrongylus cantonensis.

Workshop on research priorities for management and treatment of angiostrongyliasis(1).

In a concluding session of the workshop, the participants developed a list of 115 research and outreach needs, outlining the top 5-7 needs in each of 8 areas (Table). For complete information, including presenter details and abstracts, visit the workshop website at www.hawaii.edu/cowielab/Angio%20website%20home.htm.