Real-Time Polymerase Chain Reaction Detection of Angiostrongylus cantonensis DNA in Cerebrospinal Fluid from Patients with Eosinophilic Meningitis

Yvonne Qvarnstrom Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Life Source Biomedical LLC, Herndon, Virginia; Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Hawaii Department of Health, Honolulu, Hawaii; Hawaii Permanente Medical Group, Honolulu, Hawaii; Kaiser Permanente Regional Laboratory, Honolulu, Hawaii; Centers for Disease Control and Prevention Influenza Program, Cambodia Country Office, Phnom Penh, Cambodia; World Health Organization Cambodia, Phnom Penh, Cambodia; Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia; Loyola University Medical Center, Chicago, Illinois; Edward Hines Jr. VA Hospital, Chicago, Illinois

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Maniphet Xayavong Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Life Source Biomedical LLC, Herndon, Virginia; Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Hawaii Department of Health, Honolulu, Hawaii; Hawaii Permanente Medical Group, Honolulu, Hawaii; Kaiser Permanente Regional Laboratory, Honolulu, Hawaii; Centers for Disease Control and Prevention Influenza Program, Cambodia Country Office, Phnom Penh, Cambodia; World Health Organization Cambodia, Phnom Penh, Cambodia; Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia; Loyola University Medical Center, Chicago, Illinois; Edward Hines Jr. VA Hospital, Chicago, Illinois

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Ana Cristina Aramburu da Silva Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Life Source Biomedical LLC, Herndon, Virginia; Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Hawaii Department of Health, Honolulu, Hawaii; Hawaii Permanente Medical Group, Honolulu, Hawaii; Kaiser Permanente Regional Laboratory, Honolulu, Hawaii; Centers for Disease Control and Prevention Influenza Program, Cambodia Country Office, Phnom Penh, Cambodia; World Health Organization Cambodia, Phnom Penh, Cambodia; Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia; Loyola University Medical Center, Chicago, Illinois; Edward Hines Jr. VA Hospital, Chicago, Illinois

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Sarah Y. Park Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Life Source Biomedical LLC, Herndon, Virginia; Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Hawaii Department of Health, Honolulu, Hawaii; Hawaii Permanente Medical Group, Honolulu, Hawaii; Kaiser Permanente Regional Laboratory, Honolulu, Hawaii; Centers for Disease Control and Prevention Influenza Program, Cambodia Country Office, Phnom Penh, Cambodia; World Health Organization Cambodia, Phnom Penh, Cambodia; Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia; Loyola University Medical Center, Chicago, Illinois; Edward Hines Jr. VA Hospital, Chicago, Illinois

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A. Christian Whelen Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Life Source Biomedical LLC, Herndon, Virginia; Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Hawaii Department of Health, Honolulu, Hawaii; Hawaii Permanente Medical Group, Honolulu, Hawaii; Kaiser Permanente Regional Laboratory, Honolulu, Hawaii; Centers for Disease Control and Prevention Influenza Program, Cambodia Country Office, Phnom Penh, Cambodia; World Health Organization Cambodia, Phnom Penh, Cambodia; Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia; Loyola University Medical Center, Chicago, Illinois; Edward Hines Jr. VA Hospital, Chicago, Illinois

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Precilia S. Calimlim Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Life Source Biomedical LLC, Herndon, Virginia; Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Hawaii Department of Health, Honolulu, Hawaii; Hawaii Permanente Medical Group, Honolulu, Hawaii; Kaiser Permanente Regional Laboratory, Honolulu, Hawaii; Centers for Disease Control and Prevention Influenza Program, Cambodia Country Office, Phnom Penh, Cambodia; World Health Organization Cambodia, Phnom Penh, Cambodia; Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia; Loyola University Medical Center, Chicago, Illinois; Edward Hines Jr. VA Hospital, Chicago, Illinois

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Rebecca H. Sciulli Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Life Source Biomedical LLC, Herndon, Virginia; Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Hawaii Department of Health, Honolulu, Hawaii; Hawaii Permanente Medical Group, Honolulu, Hawaii; Kaiser Permanente Regional Laboratory, Honolulu, Hawaii; Centers for Disease Control and Prevention Influenza Program, Cambodia Country Office, Phnom Penh, Cambodia; World Health Organization Cambodia, Phnom Penh, Cambodia; Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia; Loyola University Medical Center, Chicago, Illinois; Edward Hines Jr. VA Hospital, Chicago, Illinois

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Stacey A. A. Honda Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Life Source Biomedical LLC, Herndon, Virginia; Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Hawaii Department of Health, Honolulu, Hawaii; Hawaii Permanente Medical Group, Honolulu, Hawaii; Kaiser Permanente Regional Laboratory, Honolulu, Hawaii; Centers for Disease Control and Prevention Influenza Program, Cambodia Country Office, Phnom Penh, Cambodia; World Health Organization Cambodia, Phnom Penh, Cambodia; Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia; Loyola University Medical Center, Chicago, Illinois; Edward Hines Jr. VA Hospital, Chicago, Illinois

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Karen Higa Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Life Source Biomedical LLC, Herndon, Virginia; Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Hawaii Department of Health, Honolulu, Hawaii; Hawaii Permanente Medical Group, Honolulu, Hawaii; Kaiser Permanente Regional Laboratory, Honolulu, Hawaii; Centers for Disease Control and Prevention Influenza Program, Cambodia Country Office, Phnom Penh, Cambodia; World Health Organization Cambodia, Phnom Penh, Cambodia; Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia; Loyola University Medical Center, Chicago, Illinois; Edward Hines Jr. VA Hospital, Chicago, Illinois

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Paul Kitsutani Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Life Source Biomedical LLC, Herndon, Virginia; Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Hawaii Department of Health, Honolulu, Hawaii; Hawaii Permanente Medical Group, Honolulu, Hawaii; Kaiser Permanente Regional Laboratory, Honolulu, Hawaii; Centers for Disease Control and Prevention Influenza Program, Cambodia Country Office, Phnom Penh, Cambodia; World Health Organization Cambodia, Phnom Penh, Cambodia; Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia; Loyola University Medical Center, Chicago, Illinois; Edward Hines Jr. VA Hospital, Chicago, Illinois

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Nora Chea Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Life Source Biomedical LLC, Herndon, Virginia; Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Hawaii Department of Health, Honolulu, Hawaii; Hawaii Permanente Medical Group, Honolulu, Hawaii; Kaiser Permanente Regional Laboratory, Honolulu, Hawaii; Centers for Disease Control and Prevention Influenza Program, Cambodia Country Office, Phnom Penh, Cambodia; World Health Organization Cambodia, Phnom Penh, Cambodia; Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia; Loyola University Medical Center, Chicago, Illinois; Edward Hines Jr. VA Hospital, Chicago, Illinois

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Seng Heng Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Life Source Biomedical LLC, Herndon, Virginia; Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Hawaii Department of Health, Honolulu, Hawaii; Hawaii Permanente Medical Group, Honolulu, Hawaii; Kaiser Permanente Regional Laboratory, Honolulu, Hawaii; Centers for Disease Control and Prevention Influenza Program, Cambodia Country Office, Phnom Penh, Cambodia; World Health Organization Cambodia, Phnom Penh, Cambodia; Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia; Loyola University Medical Center, Chicago, Illinois; Edward Hines Jr. VA Hospital, Chicago, Illinois

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Stuart Johnson Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Life Source Biomedical LLC, Herndon, Virginia; Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Hawaii Department of Health, Honolulu, Hawaii; Hawaii Permanente Medical Group, Honolulu, Hawaii; Kaiser Permanente Regional Laboratory, Honolulu, Hawaii; Centers for Disease Control and Prevention Influenza Program, Cambodia Country Office, Phnom Penh, Cambodia; World Health Organization Cambodia, Phnom Penh, Cambodia; Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia; Loyola University Medical Center, Chicago, Illinois; Edward Hines Jr. VA Hospital, Chicago, Illinois

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Carlos Graeff-Teixeira Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Life Source Biomedical LLC, Herndon, Virginia; Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Hawaii Department of Health, Honolulu, Hawaii; Hawaii Permanente Medical Group, Honolulu, Hawaii; Kaiser Permanente Regional Laboratory, Honolulu, Hawaii; Centers for Disease Control and Prevention Influenza Program, Cambodia Country Office, Phnom Penh, Cambodia; World Health Organization Cambodia, Phnom Penh, Cambodia; Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia; Loyola University Medical Center, Chicago, Illinois; Edward Hines Jr. VA Hospital, Chicago, Illinois

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LeAnne M. Fox Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Life Source Biomedical LLC, Herndon, Virginia; Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Hawaii Department of Health, Honolulu, Hawaii; Hawaii Permanente Medical Group, Honolulu, Hawaii; Kaiser Permanente Regional Laboratory, Honolulu, Hawaii; Centers for Disease Control and Prevention Influenza Program, Cambodia Country Office, Phnom Penh, Cambodia; World Health Organization Cambodia, Phnom Penh, Cambodia; Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia; Loyola University Medical Center, Chicago, Illinois; Edward Hines Jr. VA Hospital, Chicago, Illinois

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Alexandre J. da Silva Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Life Source Biomedical LLC, Herndon, Virginia; Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Hawaii Department of Health, Honolulu, Hawaii; Hawaii Permanente Medical Group, Honolulu, Hawaii; Kaiser Permanente Regional Laboratory, Honolulu, Hawaii; Centers for Disease Control and Prevention Influenza Program, Cambodia Country Office, Phnom Penh, Cambodia; World Health Organization Cambodia, Phnom Penh, Cambodia; Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia; Loyola University Medical Center, Chicago, Illinois; Edward Hines Jr. VA Hospital, Chicago, Illinois

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Angiostrongylus cantonensis is the most common infectious cause of eosinophilic meningitis. Timely diagnosis of these infections is difficult, partly because reliable laboratory diagnostic methods are unavailable. The aim of this study was to evaluate the usefulness of a real-time polymerase chain reaction (PCR) assay for the detection of A. cantonensis DNA in human cerebrospinal fluid (CSF) specimens. A total of 49 CSF specimens from 33 patients with eosinophilic meningitis were included: A. cantonensis DNA was detected in 32 CSF specimens, from 22 patients. Four patients had intermittently positive and negative real-time PCR results on subsequent samples, indicating that the level of A. cantonensis DNA present in CSF may fluctuate during the course of the illness. Immunodiagnosis and/or supplemental PCR testing supported the real-time PCR findings for 30 patients. On the basis of these observations, this real-time PCR assay can be useful to detect A. cantonensis in the CSF from patients with eosinophilic meningitis.

Author Notes

* Address correspondence to Yvonne Qvarnstrom, Centers for Disease Control and Prevention, MS-D64, 1600 Clifton Road, Atlanta, GA 30329. E-mail: bvp2@cdc.gov

Financial support: This study was funded by the U.S. National Food Safety Initiative and a CDC Epidemiology and Laboratory Capacity Cooperative Agreement.

Authors' addresses: Yvonne Qvarnstrom and LeAnne M. Fox, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: bvp2@cdc.gov and llf4@cdc.gov. Maniphet Xayavong, Life Source Biomedical LLC, Herndon, VA, E-mail: max1@cdc.gov. Ana Cristina Aramburu da Silva and Carlos Graeff-Teixeira, Laboratório de Parasitologia Molecular, Instituto de Pesquisas Biomédicas da PUCRS, Porto Alegre, Brazil, and Laboratório de Biologia Parasitária, Faculdade de Biociências da PUCRS, Porto Alegre, Brazil, E-mails: anacristina@pucrs.br and graeff.teixeira@gmail.com. Sarah Y. Park, Hawaii Department of Health, Honolulu, HI, E-mail: sarah.park@doh.hawaii.gov. A. Christian Whelen, Precilia S. Calimlim, and Rebecca H. Sciulli, Hawaii Department of Health, Pearl City, HI, E-mails: chris.whelen@doh.hawaii.gov, precilia.calimlim@doh.hawaii.gov, and rebecca.sciulli@doh.hawaii.gov. Stacey A. A. Honda, Hawaii Permanente Medical Group, Honolulu, HI, E-mail: stacey.honda@kp.org. Karen Higa, Kaiser Permanente Regional Laboratory, Honolulu, HI, E-mail: karen.higa@kp.org. Paul Kitsutani, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, E-mail: paul.kitsutani@nih.gov. Nora Chea, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: xdc7@cdc.gov. Seng Heng, Communicable Disease Department, Ministry of Health, Phnom Penh, Cambodia, E-mail: senghengmoh@gmail.com. Stuart Johnson, Loyola University Medical Center, Chicago, IL, and Edward Hines Jr. VA Hospital, Chicago, IL, E-mail: stuart.johnson2@va.gov. Alexandre J. da Silva, Center for Food Safety and Applied Nutrition, Food and Drug Administration, Laurel, MD, E-mail: alexandre.dasilva@fda.hhs.gov.

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