Eosinophilic Meningitis in a Previously Healthy 13-year-old Child
‡Centers for Disease Control and Prevention, Atlanta, GAThe Pediatric Infectious Disease Journal (Impact Factor: 3.14). 02/2013; 32(2):194. DOI: 10.1097/INF.0b013e31827c9726
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ABSTRACT: Laboratory diagnosis of angiostrongyliasis relies on serological techniques, since definitive diagnosis is insensitive. Modern antibody detection methods focus on antibodies to the 29 and 31 kDa proteins of the parasite. Antigen detection may ultimately prove to be more reliable than antibody detection but no method has been adopted for clinical diagnostic use. Diagnosis using PCR amplification of DNA sequences specific to Angiostrongylus cantonensis have been developed but have not yet been validated for clinical use. Diagnostic tests have not been developed commercially and in the United States tests developed experimentally by non-commercial laboratories have to be approved by the Food and Drug Administration before they can be sold to other laboratories for diagnostic purposes.06/2013; 72(6 Suppl 2):55-7.
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ABSTRACT: Angiostrongylus cantonensis, the causative agent of human rat lungworm disease, is the most common cause of eosinophilic meningitis worldwide and is endemic throughout Asia Pacific. It is acquired through the consumption of infected freshwater mollusks or contaminated produce. Human angiostrongyliasis is usually a self-limited disease presenting with headache and various neurologic sequelae varying from cranial nerve palsies to radiculitis and/or paresthesias. Fatal cases are rare, and manifest as fulminant meningomyeloencephalitis. The diagnosis is made through the use of clinical history, exam, and laboratory data including peripheral blood counts, cerebrospinal fluid (CSF) examinations, and serologic or molecular diagnostic techniques. Medical therapy is largely focused on symptomatic relief, and includes analgesics, lumbar puncture, and corticosteroids. In resource-limited settings, prevention is key, and the use of analgesics can provide symptomatic relief after infection. Efforts to increase disease awareness have been made in endemic areas, as evidenced by the recent Rat Lungworm Disease Scientific Workshop which was held in Honolulu in 2011. The proceedings of the workshop were published in a supplement to this journal (Hawaii J Med Public Health. Jun 2013;72(6):Supp 2). However, wilderness medicine and travel medicine specialists must also be aware of the disease, how it is contracted, its presentation, and treatment options should they encounter a patient who is in or has returned from an endemic area. This brief review highlights eosinophilic meningitis caused by A. cantonensis, including an example case, an overview of its clinical presentation, treatment options, and prevention.
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