Angiostrongyliasis

Abstract

The rat lungworm Angiostrongylus cantonensis causes outbreaks of eosinophilic meningitis in parts of Southeast Asia, East Asia, Oceania, and the Caribbean. Human infections follow ingestion of raw snails (the primary intermediate hosts), food contaminated by snail mucus, or one of several paratenic hosts. Clinical manifestations include headache, meningism, vomiting, cranial nerve, ocular, lesions, and rarely seizures. Lumbar puncture reveals eosinophilic meningitis and sometimes larval worms. Treatment is usually with prednisolone alone, or with albendazole and prednisolone. Mortality is usually below 2%. Prevention is by avoidance of raw high-risk dietary items and unwashed salads. Another species A. costaricensis causes granulomatous bowel and hepatic lesions in some tropical American countries. Rats are the definiitive hosts, human infection follows ingestion of small slugs. Treatment is surgical.