A Case Report of Slug Ingestion Causing Eosinophilic Meningitis, Papilledema, and Pronounced Motor Weakness in a US Marine.

Angiostrongyliasis is the most common cause of eosinophilic meningitis worldwide and is primarily characterized by eosinophilic meningitis, meningoencephalitis, or myelitis. It is caused by ingestion of the nematode Angiostrongylus cantonensis, the rat lungworm (or apple snail). The most common route of infection is by ingestion of parts of the intermediate hosts like mollusks or food contaminated with infective third stage larvae. Following ingestion, the larvae migrate through the intestinal walls into the bloodstream and further into the central nervous system where they cause meningo-encephalo-myelitis and can have a variety of ocular manifestations. We present a case of a Caucasian United States Marine who suffered severe meningo-encephalo-myelitis with papilledema following ingestion of a raw Giant African Snail (Lissachatina lutica) while stationed in Japan. He developed eosinophilic meningoencephalitis, polyneuropathy, motor weakness, and papilledema. We describe the unique clinical features of this disease in our patient.

Combining Ab Interno Kahook Trabeculectomy with Gonioscopy-Assisted Transluminal Trabeculotomy Reduces Intraocular Pressure.

Minimally invasive glaucoma surgery (MIGS) provides a safe option for individuals with mild to moderate open-angle glaucoma to reduce their need for pharmacologic therapy or more extensive ab externo surgeries. In this report, we describe a surgical technique using both the Kahook Dual Blade and Gonioscopy-assisted transluminal trabeculotomy (GATT), to treat a 23-year-old active duty female with idiopathic uveitis and subsequent corticosteroid-induced glaucoma who presented with consistently elevated intraocular pressure (IOP) measurements despite maximal pharmacologic interventions. This combination was effective in consistently lowering intraocular pressure for at least 12 months in a young, phakic, active duty patient with uveitis and steroid-responsive open-angle glaucoma.

Genomic variant representation in a Chlamydia population is dynamic and adaptive with dependence on in vitro and in vivo passage.

We have previously shown that Chlamydia muridarum has multiple genomic variants that concomitantly vary in their in vitro and in vivo phenotype. Herein, we used real-time polymerase chain reaction-based genotyping assays to query plaque-cloned isolates of C. muridarum for the frequency of eight selected polymorphisms. These strains had no history of passage in vivo since their original isolation from laboratory mice. There was significant variance in the frequency of two of the eight polymorphisms assessed with the remaining exhibiting a low rate of variance. To determine if any of these polymorphisms were more favorable for in vivo conditions, we blindly passaged non-clonal C. muridarum three times at 7-day intervals through the urogenital tract of mice. Seven of the eight polymorphisms varied in frequency following in vivo passage and four of these varied between C. muridarum strains. Selected isolates displayed variable growth rates and cytopathic effect in vitro. We conclude that multiple genotypic variants are present within the existing known C. muridarum strains and that the frequency of these variants changes upon introduction into the mouse host. These findings lend support to the concept that genotypic proportional representation in a chlamydial population is dynamic and adaptive.