The third International Symposium on Angiostrongylus and Angiostrongyliasis was held
April 8–9, 2010, at the Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok, Thailand. Twenty-nine researchers from 7 countries attended the symposium.
The symposium’s theme was “Advances in the disease, control, diagnosis and molecular
genetics of the genus Angiostrongylus and angiostrongyliasis.”
In discussing the epidemiology of the disease, it was noted the first reported case
of human angiostrongyliasis came from Taiwan in 1945. Since then, several outbreaks
and >2,800 cases of this disease have been reported worldwide. However, the number
of cases is probably underestimated given that many physicians might be unaware of
angiostrongyliasis because of its rarity; thus, numerous cases might have gone unreported
or unrecognized.
Although angiostrongyliasis was mainly prevalent in the Pacific islands and Southeast
Asia, increasing numbers of natural foci of the disease have been reported because
of increased global trade and travel. Pilar Foronda Rodriguez, University of La Laguna,
Spain, reported Angiostrongylus cantonensis in Rattus rattus in Tenerife, Canary Islands,
and confirmed the island as a natural focus of this disease (
1
). Lv Shan, Chinese Center for Disease Control and Prevention, reported natural infection
by A. cantonensis in 7 provinces in China, including Fujian, Zhejiang, Hunan, Guangdong,
Guangxi, and Hainan, and confirmed these provinces as natural foci.
Diagnosis of the infection can be difficult. Recovery of the nematode from an infected
patient confirms human angiostrongyliasis. However, the frequency of detecting these
nematodes is low. Presumptive diagnosis can be based on clinical symptoms, medical
history, and laboratory findings in blood and cerebrospinal fluid. A history of eating
intermediate hosts is also crucial for diagnosis of angiostrongyliasis.
In 2006, a total of 160 persons, 100 of whom were hospitalized, were associated with
an angiostrongyliasis outbreak in Beijing, China. This finding is comparable with
the total number of infections recorded in China over the past decade. Chenghong Yin
of Beijing Friendship Hospital, Capital Medical University, China, reported the diagnosis
criteria of angiostrongyliasis used during the outbreak. The criteria included the
following indices: 1) epidemiology, 2) clinical symptoms, 3) complete blood count,
4) cerebrospinal fluid investigation, 5) immunologic examination, 6) imaging examination,
and 7) etiologic examination. Etiologically and clinically positive patients were
further defined. Any patient showing larvae was definitively etiologically positive,
and displaying indices 1–4 were considered clinically positive, and those with indices
5 and/or 6 were considered to be displaying auxiliary signs consistent with angiostrongyliasis.
In recent years, immunologic detection of this infection has been rapidly developed.
Xiaoguang Chen, Southern Medical University, China, purified the major antigenic protein
AC32 from adult A. cantonensis, and constructed an AC32-ELISA kit to detect specific
immunoglobulin (Ig) G in serum samples of patients. AC32 of A. cantonensis was subsequently
found to be a valuable candidate antigen with high sensitivity and specificity for
immunodiagnosis of angiostrongyliasis. Xiaoxian Gan, Zhejiang Academy of Medical Sciences,
China, and Praphathip Eamsobhan, Mahidol University, Thailand reported a simple and
rapid dot-immunogold filtration assay to detect a specific IgG against A. cantonensis
that uses crude extracts from adult A. cantonensis as the antigen and protein A conjugated
with colloid gold as the detection marker. This immunoassay was highly sensitive (90.5%,
19/21) and specific (98.0%, 98/100). However, some cross-reactivity against serum
samples from patients with Trichinella spiralis infection and schistosomiasis was
observed. No cross-reactivity against serum samples from patients with other infections
of helminthiasis (e.g., cysticercosis, clonorchiasis, and fasciolopsiasis) or tuberculosis
was reported. Therefore, this assay is not only rapid and simple without requiring
special instrumentation, but also rather sensitive and specific for the detection
of IgG against A. cantonensis infection.
There is no specific treatment for angiostrongyliasis. Treatment predominantly relies
on symptomatic relief, such as antiinflammatory corticosteroid therapy. Kittisak Sawanyawisuth,
Khon Kaen University, Thailand reported a series of studies on the treatment of this
disease. In 2000, Sawanyawisuth et al. conducted a prospective, placebo-controlled
and double-blind study to assess prednisolone treatment of angiostrongyliasis. Patients
in the treatment group were given a 2-week course of prednisolone (60 mg/day), and
patients in the control group were given placebo. Results suggested that a 2-week
course of prednisolone was beneficial in relieving headache in patients with eosinophilic
meningitis. In 2007, a prospective, randomized, double-blind and placebo-controlled
study indicated that a 2-week course of albendazole appeared to reduce the duration
of headache in angiostrongyliasis. In 2009, they conducted a prospective, randomized
and controlled study to compare the efficacy of combined prednisolone/albendazole
and prednisolone alone therapies for the treatment of angiostrongyliasis. One hundred
four patients were divided into combined treatment and prednisolone alone groups,
53 and 51 patients, respectively. The dosages of prednisolone and albendazole were
60 mg/day taken orally in 3 divided doses and 15 mg/kg/day taken as 2 divided doses
after meals for 2 weeks, respectively. However, the results indicated that combined
prednisolone/albendazole treatment of patients with angiostrongyliasis was no better
than prednisolone alone (
2
). In conclusion, the corticosteroid treatment was beneficial for the patients, although
the role of anthelmintic agents remains inconclusive. Therefore, it was not recommended
that albendazole alone should be used for the treatment of angiostrongyliasis.
In addition to discussing these recent findings, a cooperative network among researchers
and clinicians was established to share data from current and future research projects
for the prevention, control and treatment of human angiostrongyliasis. We look forward
to the 2012 International Symposium on Angiostrongylus and Angiostrongyliasis, which
will be held in Guangzhou, China.