Neuroangiostrongyliasis: Global Spread of an Emerging Tropical Disease

Robert H. CowiePacific Biosciences Research Center, University of Hawaii, Honolulu, Hawaii;

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Vernon AnsdellJohn A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii;

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Claire Panosian DunavanDavid Geffen School of Medicine, University of California, Los Angeles, California;

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Randi L. RollinsPacific Biosciences Research Center, University of Hawaii, Honolulu, Hawaii;
School of Life Sciences, University of Hawaii, Honolulu, Hawaii

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Neuroangiostrongyliasis (NAS) is an emerging parasitic disease caused by the neurotropic nematode Angiostrongylus cantonensis. Since it was first discovered, in rats in southern China in the 1930s, this tropical to subtropical parasite has spread to much of Southeast Asia, the Pacific Islands (including Hawaii), Australia, Japan, South America, the southeastern United States, the Caribbean, Africa, the Canary Islands, and the Balearic Islands. The parasite completes its natural life cycle in snails and slugs (intermediate hosts), and rats (definitive hosts). Humans become accidental hosts after ingesting infective third-stage larvae contained within uncooked or undercooked intermediate or paratenic hosts, an event that sometimes results in NAS, also known as rat lungworm disease. Although A. cantonensis larvae cannot complete their life cycle in humans, their migration into the brain and spinal cord combined with a powerful inflammatory reaction often leads to eosinophilic meningitis and can, in rare instances, lead to coma, paralysis, and death or, in other cases, chronic, disabling neurologic sequelae. Symptoms of NAS are diverse, which often makes it difficult to diagnose. Treatment may include administration of analgesics, corticosteroids, anthelminthics, and repeat lumbar punctures to reduce intracranial pressure. Unfortunately, few medical providers, even in endemic areas, are familiar with A. cantonensis or its epidemiology, diagnosis, and treatment. As the parasite continues to spread and NAS affects more people, medical practitioners, as well as the general public, must become more aware of this emerging zoonosis and the potentially devastating harm it can cause.

Author Notes

Address correspondence to Robert H. Cowie, Pacific Biosciences Research Center, University of Hawaii, 3050 Maile Way, Gilmore 408, Honolulu, HI 96822. E-mail: cowie@hawaii.edu

Authors’ addresses: Robert H. Cowie, Pacific Biosciences Research Center, University of Hawaii, Honolulu, HI, E-mail: cowie@hawaii.edu. Vernon Ansdell, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, E-mail: vernonansdell@gmail.com. Claire Panosian Dunavan, David Geffen School of Medicine, University of California, Los Angeles, CA, E-mail: cpanosian@mednet.ucla.edu. Randi L. Rollins, School of Life Sciences, University of Hawaii, Honolulu, HI, E-mail: rrollins@hawaii.edu.

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