Eosinophilic Meningoencephalitis Caused by Angiostrongyliasis in Thailand

Autopsy Report

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  • Department of Pathology, Chulalongkorn Hospital Medical College, Department of Pathology, School of Medicine, University of North Carolina, Department of Tropical Medicine and Public Health, Tulane University, School of Medicine, Bangkok, Thailand


Autopsy of a 28-year-old Thai woman who died with eosinophilic meningoencephalitis revealed five worms in four of 10 blocks of brain tissue taken for routine microscopic examination. Small areas of disrupted brain tissue containing necrotic-tissue debris and scattered inflammatory cells, mostly histiocytes and neutrophils, were interpreted as tracks of the moving worm. The worms were identified as Angiostrongylus, probably A. cantonensis. Three of the worms apparently dead in the tissues for some days before fixation were encased in a dense exudate and surrounded by a granulomatous reaction, whereas worms with well-preserved tissues and apparently alive at the time of autopsy were free in the tissues. The presence of large numbers of Charcot-Leyden crystals in meninges indicated a massive response by eosinophils to the dead parasites. In addition, vascular congestion was a prominent feature.

Author Notes

Dr. Nye's work was in part supported by U.S. Army Medical Research and Development Command, Contract No. DA DA 17-67-C-0022. His former address: Department of Pathology, U.S. Army Component, SEATO Medical Research Laboratory, SEATO Headquarters, Bangkok, Thailand.