Human infection by Angiostrongylus cantonensis occurs through consumption of raw or undercooked food and vegetables that contain larvae or eggs of this parasite [1]. Rats or monitor lizards are primary hosts that shed the parasite through feces, while snails, prawns, freshwater shrimps, fish and crabs (depending on the geographic area) serve as paratenic (intermediate) hosts [1] [2] [3]. The Pacific and the Carribean islands, Latin America and Southeast Asia are considered to be the endemic regions of this parasite, but sporadic cases in travelers and the local population have been reported worldwide [3] [4]. The incubation period of infection may be quite long, ranging from several days to several months [4], and three clinical syndromes have been described - central nervous system (CNS), ocular and gastrointestinal infection [1] [3] [4] [5] [6]. Eosinophilic meningitis is a term used to describe the main subtype of infection, and presents with acute severe headaches, whereas seizures and acute loss of consciousness and even coma are typical for eosinophilic encephalitis, a more dangerous, and even fatal form of the disease [5]. On the other hand, blurred vision may be the only symptom of ocular angiostrongyliasis [7]. Gastrointestinal infection manifests as relapsing abdominal pain, tenderness, vomiting, fever (although rare), and a mass in the right lower abdominal quadrant, which may often mimic appendicitis or intestinal perforation [4] [6].

• Fatigue

  Headache, myalgia and fatigue were the most common symptoms. Blood samples from 5 patients were positive for antibodies to A. cantonensis. [ncbi.nlm.nih.gov]

  Blastomycosis Botulism Brain abscess Brucellosis Bunyaviridae infections misc Campylobacteriosis Candidiasis Capillariasis intestinal Chancroid Chlamydia infections misc Chlamydophila pneumoniae infection Cholecystitis cholangitis Cholera Chromomycosis Chronic fatigue [books.google.de]

  Typical symptoms in children include fever, abdominal pain, vomiting, irritability, poor appetite, muscle weakness, fatigue, and lethargy. Lumbar puncture (LP) is an essential part of the evaluation of suspected neuroangiostrongyliasis. [health.hawaii.gov]

• Aspiration

  Tests for parasite-specific immunoglobulin G (IgG) antibodies are reliable. [ 4 ] Management Eosinophilic meningitis There is no effective curative treatment. [ 5 ] Treatment is supportive, including adequate analgesia, therapeutic CSF aspiration and [patient.info]

  The nematode was removed intact using an irrigating/aspirating cannula through a paracentesis. The patient was treated with Gt Pred forte 1% 2 hourly, Gt Chloramphenicol four times a day, and Gt Levobunolol twice daily. [nature.com]

• Nausea

  Patients presented with headache (100%), neck stiffness (20%), fever (40%), nausea (87%), vomiting (73%), paresthesia (7%), and muscle weakness (7%). [ncbi.nlm.nih.gov]

  Patients develop a severe headache, fever, neck stiffness, nausea, vomiting and abnormal nerve sensations. The worms may spread into the eye and cause blindness. CT and MRI scans may show the presence of worms in brain. [afairgo.net]

  Infection first presents with severe abdominal pain, nausea, vomiting, and weakness, which gradually lessens and progresses to fever, and then to central nervous system (CNS) symptoms and severe headache and stiffness of the neck. [en.wikipedia.org]

  Typical symptoms in adults include severe headaches, neck stiffness, nausea, paresthesias, and limb pains. [health.hawaii.gov]

  Symptoms include severe headaches, nausea, vomiting, neck stiffness, seizures, and neurologic abnormalities. Occasionally, ocular invasion occurs. Eosinophilia is present in most of cases. Most patients recover fully. [cdc.gov]

• Abdominal Pain

  The authors describe a case of abdominal angiostrongyliasis in an adult patient presenting acute abdominal pain caused by jejunal perforation. [ncbi.nlm.nih.gov]

  Abdominal angiostrongyliasis This presents with acute abdominal pain in the right lower quadrant, associated with prolonged fever, anorexia and eosinophilia. Infection usually involves the terminal ileum, appendix or ascending colon. [patient.info]

• Severe Abdominal Pain

  Infection first presents with severe abdominal pain, nausea, vomiting, and weakness, which gradually lessens and progresses to fever, and then to central nervous system (CNS) symptoms and severe headache and stiffness of the neck. [en.wikipedia.org]

  Signs and Symptoms Infection first presents with severe abdominal pain, nausea, vomiting, and weakness, which gradually lessens and progresses to fever, and then to CNS symptoms and severe headache and stiffness of the neck. [diagnose-me.com]

• Intestinal Perforation

  Gastrointestinal infection manifests as relapsing abdominal pain, tenderness, vomiting, fever (although rare), and a mass in the right lower abdominal quadrant, which may often mimic appendicitis or intestinal perforation. [symptoma.com]

  The final events of this injury may vary between intestinal infarct, intestinal perforation, formation of pseudotumor or acute appendicitis 2,3. Otherwise, liver involvement is unusual, with publications restricted to case reports 7,11,16. [scielo.br]

• Headache

  Median duration of headache was 3 days; 8% had headache; no serious side-effects. 28 34 (age ≥15) Albendazole (15 mg/kg). Mean duration of headache was 8.9 days; 21% of headaches persisted; no serious side-effects. 32 (age ≥15) Placebo. [antimicrobe.org]

  Compared with the controls, the patients given the combination were less likely to have headaches after 7 days (P = 0·038), tended to have headaches that cleared quicker (P = 0·010), and received fewer doses of acetaminophen (P = 0·036). [ncbi.nlm.nih.gov]

  Among the workers, 6 developed severe symptoms, including fever, headache and stiffness and they respectively sought medical attention on March 4 and 5. [outbreaknewstoday.com]

  Studies suggest that a two-week regimen of a combination of mebendazole and prednisolone significantly shortened the course of the disease and length of associated headaches without observed harmful side effects. [en.wikipedia.org]

• Mild Cognitive Impairment

  CNS symptoms begin with mild cognitive impairment and slowed reactions, and in a very severe form often progress to unconsciousness. Patients may present with neuropathic pain early in the infection. [en.wikipedia.org]

  The CNS symptoms begin with mild cognitive impairment and slowed reactions, and in very severe cases can progress to unconsciousness. Patients may present with neuropathic pain early in the infection. [diagnose-me.com]

• Neglect

  Last, important indicators might have been neglected due to low levels of awareness about angiostrongyliasis among medical staff. [journals.plos.org]

The diagnosis of angiostrongyliasis may be difficult to attain, given the fact that the incubation period may be quite long, but the majority of studies have confirmed that symptoms develop in a matter of weeks after ingestion of the parasite [3] [4]. Having in mind these findings, an adequately obtained patient history may be the most valuable procedure in the diagnostic workup, during which information about recent travel and possible consumption of foods that could have been contaminated by parasitic eggs or larvae are obtained. Severely ill patients (especially those suffering from CNS infection) may not be able to provide such data, requiring additional tests to confirm angiostrongyliasis as the underlying cause. The terms "eosinophilic meningitis" and "eosinophilic encephalitis" are used because lumbar punctures reveal a high eosinophil count in the vast majority of patients since eosinophils are produced in the defense against parasitic infection [3]. Although serological testing for this parasite exists, being both highly specific and sensitive [3], its availability is scarce [5], implying that the diagnosis rests on patient data and results from lumbar punctures. Some patients may be diagnosed post-operatively when histopathological examination of the removed tissue reveal the presence of parasites, and so far, the gastrointestinal system, but also the liver and the testes, were organs from which the parasite was isolated [4].

Tests for parasite-specific immunoglobulin G (IgG) antibodies are reliable. [ 4 ] Management Eosinophilic meningitis There is no effective curative treatment. [ 5 ] Treatment is supportive, including adequate analgesia, therapeutic CSF aspiration and [patient.info]

Currently, no efficient medication for the treatment of abdominal angiostrongyliasis is known to be available. In this study, the authors provide a review on the subject, considering its etiopathogeny, clinical picture, diagnosis and treatment. [ncbi.nlm.nih.gov]

(Outcomes/Resolutions) The prognosis of Angiostrongyliasis is typically good, as most affected individuals recover fully without treatment after about 6 weeks Supportive treatments can successfully alleviate symptoms associated with this infection Additional [dovemed.com]

[…] been recommended because of their potential for harm from the inflammatory response provoked by antigen release after the death of the parasite. [ 6 ] Abdominal angiostrongyliasis There is no effective treatment for abdominal angiostrongyliasis. [ 5 ] Prognosis [patient.info]

Prognosis; Complications Frequently the infection will resolve without treatment or serious consequences, but in cases with a heavy load of parasites the infection can be so severe that even with treatment there will be death or permanent damage to the [diagnose-me.com]

(Etiology) Angiostrongyliasis is caused by varied species of nematodes (worms) belonging to the genus Angiostrongylus. The following are specific modes of infection: Angiostrongylus cantonensis is transmitted via rats and mollusks (slugs or snails). [dovemed.com]

Successively, in the year 1971 they identified the new species Angiostrongylus costaricensis as the etiologic agent of the previously described human disease 12. [scielo.br]

Epidemiologic studies of 484 typical cases and the etiologic role of Angiostrongylus cantonensis. Am J Trop Med Hyg 19: 950–958. View Article Google Scholar 4. [journals.plos.org]

Epidemiologic studies of 484 typical cases and the etiologic role of Angiostrongylus cantonensis. Am J Trop Med Hyg. 1970; 19 :950–958. [ PubMed ] [ Google Scholar ] 3. Benjapongse W. [ncbi.nlm.nih.gov]

This study confirms the known clinical manifestations of abdominal angiostrongyliasis and demonstrates the diversity of its epidemiology. [ncbi.nlm.nih.gov]

The topics on epidemiology, diagnosis, and clinical aspects emphasize the knowledge gaps that limit a full understanding of these zoonoses, and target where greater research investments on these parasitic diseases should be focused. [books.google.de]

However, the immunologic pathophysiology especially in relation to the eosinophilic inflammation is still unknown. We measured the CSF concentrations of eotaxin and eotaxin-2 of 30 patients and 10 controls. [ncbi.nlm.nih.gov]

Infections can be prevented by cooking snails, crustaceans, and slugs thoroughly so that the parasite is killed. [encyclopedia.com]

Parasites A-Z ; Centers for Disease Control and Prevention Angiostrongyliasis ; DPDx, Centers for Disease Control and Prevention New D, Little MD, Cross J ; Angiostrongylus cantonensis infection from eating raw snails. [patient.info]

Prevention Strategies Since Angiostrongyliasis can easily be prevented by thorough cooking and washing of foods, public health prevention and education measures include education on proper food preparation techniques, and control of infection mollusks [web.stanford.edu]

1. Wang QP, Wu ZD, Wei J, Owen RL, Lun ZR. Human Angiostrongylus cantonensis: an update. Eur J Clin Microbiol Infect Dis. 2012;31(4):389-395.
2. Wang QP, Lai DH, Zhu XQ, Chen XG, Lun ZR. Human angiostrongyliasis. Lancet Infect Dis. 2008;8:621–630.
3. Lv S, Zhang Y, Chen SR, et al. Human Angiostrongyliasis Outbreak in Dali, China. PLoS Negl Trop Dis. 2009;3(9):520.
4. Kramer MH, Greer GJ, Quiñonez JF, et al. First reported outbreak of abdominal angiostrongyliasis. Clin Infect Dis. 1998;26(2):365-372.
5. Sawanyawisuth K, Takahashi K, Hoshuyama T, et al. Clinical factors predictive of encephalitis caused by Angiostrongylus cantonensis. Am J Trop Med Hyg. 2009;81(4):698-701.
6. Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.
7. Sinawat S, Sanguansak T, Angkawinijwong T, et al. Ocular angiostrongyliasis: clinical study of three cases. Eye (Lond). 2008;22(11):1446-1448.