EOSINOPHILIC MENINGITIS CAUSED BY ANGIOSTRONGYLUS CANTONENSIS ASSOCIATED WITH EATING RAW SNAILS: CORRELATION OF BRAIN MAGNETICRESONANCE IMAGING SCANS WITH CLINICAL FINDINGS

HUNG-CHIN TSAI Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Internal Medicine, Ohio State University, Columbus, Ohio; Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung General Veterans Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

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YUNG-CHING LIU Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Internal Medicine, Ohio State University, Columbus, Ohio; Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung General Veterans Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

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CALVIN M. KUNIN Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Internal Medicine, Ohio State University, Columbus, Ohio; Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung General Veterans Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

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PING-HONG LAI Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Internal Medicine, Ohio State University, Columbus, Ohio; Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung General Veterans Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

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SUSAN SHIN-JUNG LEE Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Internal Medicine, Ohio State University, Columbus, Ohio; Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung General Veterans Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

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YAO-SHEN CHEN Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Internal Medicine, Ohio State University, Columbus, Ohio; Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung General Veterans Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

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SHUE-REN WANN Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Internal Medicine, Ohio State University, Columbus, Ohio; Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung General Veterans Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

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WEI-RU LIN Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Internal Medicine, Ohio State University, Columbus, Ohio; Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung General Veterans Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

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CHUN-KAI HUANG Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Internal Medicine, Ohio State University, Columbus, Ohio; Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung General Veterans Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

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LUO-PING GER Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Internal Medicine, Ohio State University, Columbus, Ohio; Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung General Veterans Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

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HSI-HSUN LIN Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Internal Medicine, Ohio State University, Columbus, Ohio; Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung General Veterans Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

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MUH-YONG YEN Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Internal Medicine, Ohio State University, Columbus, Ohio; Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung General Veterans Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

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DOI:
https://doi.org/10.4269/ajtmh.2003.68.281
Volume/Issue:
Volume 68: Issue 3
Page(s):
281–285
Restricted access
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Angiostrongylus cantonensis is the most common cause of eosinophilic meningitis worldwide. Human infection occurs after ingestion of the worms in raw snails or fish that serve as intermediate hosts. Two outbreaks of central nervous system infection with A. cantonensis occurred in Kaoshiung, Taiwan, during 1998 and 1999 among Thai laborers who ate raw snails. A detailed clinical studies of 17 of these patients was conducted, including study of 13 patients who underwent magnetic resonance imaging (MRI) scans of the brain. The MRI scans revealed high signal intensities over the globus pallidus and cerebral peduncle on TI-weighted imaging, leptomeningeal enhancement, ventriculomegaly, and punctate areas of abnormal enhancement within the cerebral and cerebellar hemisphere on gadolinium-enhancing T1 imaging, and a hyperintense signal on T2-weighted images. There was a significant correlation between severity of headache, cerebrospinal fluid (CSF) pleocytosis, and CSF and blood eosinophilia with MRI signal intensity in T1-weighted imaging (P < 0.05). Eosinophilic meningitis produced by A. cantonensis needs to added to the list of causes of hyperintense basal ganglia lesions found on T1-weighted MRI scans in tropical countries.

Author Notes

Reprint requests: Yung-Ching Liu, Section of Infectious Diseases and Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung, Taiwan, Telephone: 886-7-3468096, Fax: 886-7-3468292, E-mail: ycliu@isca.vghks.gov.tw
Copyright:
Copyright 2003 The American Society of Tropical Medicine 2003
Received:
19 Jun 2001
|
Accepted:
18 Nov 2002
|
Published Online:
Mar 2003
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
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