• 1.

    Wang Q-P, Lai D-H, Zhu X-Q, Chen X-G, Lun Z-R, 2008. Human angiostrongylosis. Lancet Infect Dis 8: 621630.

  • 2.

    Barratt J, Chan D, Sandaradura I, Malik R, Spielman D, Lee R, Marriott D, Harkness J, Ellis J, Stark D, 2016. Angiostrongylus cantonensis: a review of its distribution, molecular biology and clinical significance as a human pathogen. Parasitology 143: 10871118.

    • Search Google Scholar
    • Export Citation
  • 3.

    Prociv P, Spratt DM, Carlisle MS, 2000. Neuro-angiostrongyliasis: unresolved issues. Int J Parasitol 30: 12951303.

  • 4.

    Mackerras MJ, Sandars DF, 1955. The life history of the rat lung-worm, Angiostrongylus cantonensis (Chen) (Nematoda: Metastrongylidae). Aust J Zool 3: 121.

    • Search Google Scholar
    • Export Citation
  • 5.

    Prociv P, 1989. Observations on the post-mortem migration of nematode larvae and its role in tissue digesting techniques. J Helminthol 63: 281287.

    • Search Google Scholar
    • Export Citation
  • 6.

    Cipriani P, Acerra V, Bellisario B, Sbaraglia GL, Cheleschi R, Nascetti G, Mattiucci S, 2016. Larval migration of the zoonotic parasite Anisakis pegreffii (Nematoda: Anisakidae) in European anchovy, Engraulis encrasicolus: implications to seafood safety. Food Control 59: 148157.

    • Search Google Scholar
    • Export Citation
  • 7.

    Jindrak K, 1970. The pathology of intracranial angiostrongylosis in rats. J Comp Pathol 80: 287297.

  • 8.

    Prociv P, 1999. Eosinophilic meningitis—crossing paths with the rat lungworm, Angiostrongylus cantonensis. Med J Aust 170: 517518.

  • 9.

    Cross JH, 1979. Experimental studies on Angiostrongylus species and strains in monkeys and laboratory animals. Studies on Angiostrongyliasis in Eastern Asia and Australia. Taipei, Taiwan: US Naval Medical Research Unit No. 2, 118137.

  • 10.

    Cooke-Yarborough CM, Kornberg AJ, Hogg GG, Spratt DM, Forsyth JRL, 1999. A fatal case of angiostrongyliasis in an 11-month-old infant. Med J Aust 170: 541543.

    • Search Google Scholar
    • Export Citation
  • 11.

    Morton NJ, Britton P, Palasanthiran P, Bye A, Sugo E, Kesson A, Ardern-Holmes S, Snelling TL, 2013. Severe hemorrhagic meningoencephalitis due to Angiostrongylus cantonensis among young children in Sydney, Australia. Clin Infect Dis 57: 11581161.

    • Search Google Scholar
    • Export Citation
  • 12.

    Senanayake SN, Pryor DS, Walker J, Konecny P, 2003. First report of human angiostrongyliasis acquired in Sydney. Med J Aust 179: 430431.

  • 13.

    Blair NF, Orr CF, Delaney AP, Herkes GK, 2013. Angiostrongylus meningoencephalitis: survival from minimally conscious state to rehabilitation. Med J Aust 198: 440442.

    • Search Google Scholar
    • Export Citation
  • 14.

    Gosnell WL, Kramer KJ, 2013. The role of eosinophils in angiostrongyliasis: multiple roles for a versatile cell? Hawaii J Med Public Health 72 (Suppl 2): 4951.

    • Search Google Scholar
    • Export Citation
  • 15.

    Prociv P, 1997. Pathogenesis of human hookworm infection: insights from a “new” zoonosis. Freedman DO, ed. Chemical Immunology: Immunopathogenetic Aspects of Disease induced by Helminth Parasites. Basel, Switzerland: Karger AG, S, 6298.

  • 16.

    Hwang KP, Chen ER, 1988. Larvicidal effect of albendazole against Angiostrongylus cantonensis in mice. Am J Trop Med Hyg 39: 191195.

  • 17.

    Caumes E, 2000. Treatment of cutaneous larva migrans. Clin Infect Dis 30: 811814.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

Neuroangiostrongyliasis: The “Subarachnoid Phase” and Its Implications for Anthelminthic Therapy

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  • 1 Department of Microbiology and Parasitology, University of Queensland, Mount Mellum, Queensland, Australia;
  • | 2 Sullivan Nicolaides Pathology, Brisbane, Brisbane, Queensland, Australia
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Infection with the Rat Lungworm Angiostrongylus cantonensis is the leading cause of human eosinophilic meningoencephalitis worldwide. From its origins in southeastern Asia, the parasite was spread extensively throughout the twentieth century and is now established in many of the world’s warmer regions. Its clinical effects range from mild and transient symptoms, usually headache with peripheral nerve dysfunction, to severe and permanent central nervous system (CNS) damage, occasionally fatal. The severity and prognosis of disease are determined by the larval dose, acquired by ingesting infected intermediate hosts (slugs and snails) or, less often, paratenic hosts, such as crabs, shrimps, frogs, and monitor lizards. Early diagnosis is critical for treatment and depends on clinical suspicion, for laboratory confirmation from blood and cerebrospinal fluid can be delayed and unreliable. Treatment is fraught with difficulty, compounded by conflicting published results. Corticosteroids play a useful role in suppressing early CNS inflammation, but their duration for maintenance becomes problematic in severe infections. Because most of the pathogenesis results from host immuno-inflammatory responses to migrating and dead larvae in the CNS, anthelminthic therapy remains controversial: if effective, it kills viable larvae, arresting them in the CNS and so exacerbating the pathology. In human infections, it is now clear that many larvae do leave the CNS and reach the pulmonary arteries, sometimes with clinical consequences. Pioneering life-cycle studies in rats demonstrated a “subarachnoid phase” in larval development and migration; recent autopsy findings, outlined here, show it also occurs in humans and has some bearing on treatment. One new and four previously reported cases of human infection are analyzed here, with findings indicating that anthelminthic treatment is effective only when given early and should not be commenced beyond 3 weeks after exposure to infection. In endemic areas, treatment should start as soon as this infection is suspected, even without a clear history of exposure, given the unacceptable risks of waiting for diagnostic laboratory confirmation.

Author Notes

Address correspondence to Paul Prociv, 506 Mt Mellum Rd, Mount Mellum, Queensland 4550, Australia. E-mail: pmprociv@bigpond.com

Authors’ addresses: Paul Prociv, 506 Mt Mellum Rd Mount Mellum, Australia, E-mail: pmprociv@bigpond.com. Megan Turner, Sullivan Nicolaides Pathology, Brisbane, Australia, E-mail: megan_turner@snp.com.au.

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