Eosinophilic Radiculomyeloencephalitis: An Angiostrongyliasis Outbreak in American Samoa Related to Ingestion of Achatina fulica Snails

Michael M. KliksDepartment of Tropical Medicine and Medical Microbiology and Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Lyndon B. Johnson Tropical Medical Center, American Samoa, and Tripler Army Medical Center, Honolulu, Hawaii 96822

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Kurt KroenkeDepartment of Tropical Medicine and Medical Microbiology and Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Lyndon B. Johnson Tropical Medical Center, American Samoa, and Tripler Army Medical Center, Honolulu, Hawaii 96822

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John M. HardmanDepartment of Tropical Medicine and Medical Microbiology and Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Lyndon B. Johnson Tropical Medical Center, American Samoa, and Tripler Army Medical Center, Honolulu, Hawaii 96822

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Abstract. For the first time in American Samoa an outbreak of eosinophilic radiculomye-loencephalitis was related to eating giant African snails (Achatina fulica) infected with Angiostrongylus cantonensis. Among 24 Korean fisherman sharing the same infective meal, 16 who ate raw or partially cooked snails became ill; five who ate boiled snails and three who ate none remained well. The ensuing illnesses began within 1–6 days, persisted up to 10 weeks, and were characterized by both peripheral blood and spinal fluid eosinophilia, severe pains, weakness and hyporeflexia of the legs, and dysfunction of the bladder and bowels. Eight patients also had transient hypertension and/or lethargy, and three became comatose. One man died 17 days after eating the infected snails, and maturing larvae of A. cantonensis were found in his spinal cord. Enzyme-linked immunosorbent assay titers for antigens of A. cantonensis were elevated to 1:64 or greater (mean 1:128) in all 10 patients tested. Treatment with thiabendazole had no appreciable effect on the clinical course of the illness.

Author Notes

Present address: Box 338, Martin Army Hospital, Fort Benning, Georgia 31905.

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