[Peculiarities of meningoencephalitis caused by Angiostrongylus cantonensis in America]. / Peculiaridades de la meningoencefalitis por Angiostrongylus cantonensis en América.

INTRODUCTION: 25 years ago was first reported in Cuba and in the western hemisphere an emergent disease: eosinophilic meningoencephalitis due to Angiostrongylus cantonensis larvae. AIM: To collect in a summary form the accumulated experience and the findings of the study of this parasitosis during the period in the Western hemisphere. DEVELOPMENT AND CONCLUSIONS: There have been collected the first evidences, the parasitological and malacological findings, the experimental and molecular studies on immunology and neuroimmunology, the clinic-pathological findings in children and adults with the particularities of this diseases in our environment with special emphasis in the never-before scientific findings reported. It has been documented the testimony, the main findings among the malacological studies, the role of the immunoglobulin E and the mechanism involved in the central nervous system, the intrathecal synthesis patterns of immunoglobulins and the clinical elements in children and adults.

[Eosinophilic meningoencephalitis in Villa Clara (Cuba). A study of 17 patients]. / Meningoencefalitis eosinofílica en Villa Clara (Cuba). Estudio de 17 pacientes.

INTRODUCTION: Infection by Angiostrongylus cantonensis is caused by eating snails and slugs or contaminated vegetables, and is the commonest cause of eosinophilic meningoencephalitis throughout the world. OBJECTIVES: To make a further study of this condition, analyze the clinical behaviour and evaluate the cerebrospinal fluid findings and response to treatment. PATIENTS AND METHODS: We made a retrospective, descriptive study by reviewing the clinical histories of a series of 17 adult patients attended in two university hospitals in the province of Villa Clara (Cuba), between December 1991 and January 2000. We recorded the characteristics of the clinical picture, results of the complementary investigations, treatment given and clinical course and the necropsy findings of the three patients who died. The data was collected from questionnaires. RESULTS: Headache was a constant symptom. Twelve patients had high temperatures and seven had stiff necks. Motor deficit and coma were seen in the three patients who died. In two patients the cranial nerves were involved. Spinal fluid pleocytosis varied between 48 and 2570 cells/mm3. Initially there was lymphocyte predominance in 10 patients and subsequently eosinophil conversion. The peripheral eosinophilia, seen in all patients, varied between 7% and 61%. Of the 14 patients cured, eight received symptomatic treatment and six antihelminth drugs. Steroids were given to only one patient. Of the three patients who died, two had received antihelminth drugs. CONCLUSIONS: Motor deficit and coma worsen the prognosis, which is generally good. There is no relation between cerebrospinal fluid pleocytosis and raised protein levels in the cerebrospinal fluid, nor between blood eosinophilia and prognosis. The most difficult differential diagnosis in our patients was with leptospirosis. No differences were seen in clinical evolution in relation to the treatment given.