1/37. A fatal case of angiostrongyliasis in an 11-month-old infant. An 11-month-old boy developed flaccid quadriparesis after two months in fiji, and was transferred to australia, where a diagnosis of postinfectious myelitis was made. Despite peripheral blood eosinophilia, eosinophils were not detected in the cerebrospinal fluid, and an infective aetiology was not identified. The patient died of progressive bulbar dysfunction. At autopsy, numerous nematodes, identified as angiostrongylus cantonensis, were seen in vessels of the lungs, brain and spinal cord, associated with pulmonary abscesses and eosinophilic meningitis. A notable feature was the presence of adult nematodes in the lung. ( info) |
2/37. Eosinophilic meningitis. An unusual cause of headache. Human parasitic infections are uncommon outside the tropical north but common in animals throughout australia. The rat lung worm, angiostrongylus cantonensis, can invade the human brain to cause a chronic meningitis with prolonged headache. This condition can be diagnosed by finding a high eosinophil count in cerebrospinal fluid (CFS), the lumbar puncture also provides symptomatic relief. The outcome is usually benign but death has been reported. ( info) |
| Four patients are described with a strongyloides stercoralis infection. Several techniques to diagnose this infection are discussed. The so-called Baermann method is emphasised. Especially in chronic infections the combination of serology and the Baermann method seems the best diagnostic approach. Treatment with albendazole or ivermectin are suggested treatments. ( info) |
4/37. 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. ( info) |
5/37. 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. ( info) |
| Eosinophilic meningoencephalitis is prevalent and widely distributed in thailand, especially in the northeastern and central parts of the country. Angiostrongylus cantonensis is one of the causative agents of fatal eosinophilic meningoencephalitis. The nematodes produce extensive tissue damage by moving through the brain and inducing an inflammatory reaction. We report the clinical features and the findings revealed by MR imaging and MR spectroscopy in six patients with eosinophilic meningoencephalitis. The clinical presentation included severe headache, clouded consciousness, and meningeal irritation. Abnormal findings on MR images included prominence of the Virchow-Robin spaces, subcortical enhancing lesions, and abnormal high T2 signal lesions in the periventricular regions. Proton brain MR spectroscopy was performed in three patients and was abnormal in one severe case, showing decreased choline in a lesion. Small hemorrhagic tracts were found in one case. Lesions thought to be due to microcavities and migratory tracts were found in only one case. We believe the MR imaging and MR spectroscopy findings are of diagnostic value and helpful in understanding the pathogenetic mechanisms of the disease. ( info) |
7/37. Screening for Strongyloides infection among the institutionalized mentally disabled. BACKGROUND: strongyloidiasis is an intestinal helminthic infection common among the mentally disabled population and can cause persistent occult infection before resulting in disseminated, possibly fatal disease. methods: Two cases of strongyloidiasis are described. The literature was searched using the key words "Strongyloides" and "mass screening." RESULTS AND CONCLUSION: strongyloidiasis is clinically important and well documented in the mentally disabled populations both in endemic and nonendemic regions of north america. It has a substantial latent phase during which screening can be conducted, and its treatment with thiabendazole is convenient, effective, and reasonably well tolerated. Although strongyloidiasis is usually incidentally detected by findings of eosinophilia during routine blood screening, peripheral eosinophilia occurs only in 50% to 80% of infected persons and is extremely nonspecific for Strongyloides infection. Given the high cost of critical care for a patient with disseminated disease, screening mentally disabled populations in institutional settings for strongyloidiasis by administering the strongyloides stercoralis antibody ELISA appears justifiable, particularly if risk factors for hyperinfection syndrome are used to select a subpopulation to be screened. ( info) |
| angiostrongylus cantonensis, the rat lungworm, is the principal cause of eosinophilic meningitis worldwide, and the increase in world travel and shipborne dispersal of infected rat vectors has extended this parasite to regions outside of its traditional geographic boundaries. We report a case of eosinophilic meningitis due to A. cantonensis in a patient who recently returned from a trip in the Pacific. ( info) |
9/37. Third report of ocular parastrongyliasis (angiostrongyliasis) from sri lanka. A further case of ocular parastrongyliasis has been seen in a patient from sri lanka. As it is a juvenile female worm it could not be identified to the species, but it is probably Parastrongylus (= Angiostrongylus) cantonensis which is the commonly reported species in the country. This is the third authentic case of such an infection in sri lanka in recent years. ( info) |
10/37. Ocular angiostrongyliasis without meningitis symptoms in Okinawa, japan. A 62-year-old female farmer presented with retinal detachment in her left eye, and an angiostrongylus cantonensis worm was recovered by vitreous surgery. The case did not show typical clinical symptoms indicating meningitis, although the patient complained of a mild headache, a low-grade fever, and slight ataxia. The symptoms were treated as influenza before the onset of the retinal detachment. The present case is the first confirmed of ocular angiostrongyliasis in japan. ( info) |