Angiostrongyliasis (Angiostrongylus Cantonensis Infection)

Angiostrongyliasis is a parasitic infection caused by a rat lungworm, Angiostrongylus cantonensis. Infections are mainly seen in endemic areas and in travelers, and meningitis, encephalitis, as well as ocular and gastrointestinal infection are recognized forms of angiostrongyliasis.


Presentation

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].

Skin
Eruptions
  • Amebiasis (Medical Encyclopedia) Amebic liver abscess (Medical Encyclopedia) Ascariasis (Medical Encyclopedia) Creeping eruption (Medical Encyclopedia) Stool ova and parasites exam (Medical Encyclopedia) Taeniasis (Medical Encyclopedia) [ Read More ][icdlist.com]
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  • psychiatrical
    Distractibility
    • 10 tips to clear your brain fog. 12 reasons you're distracted.[webmd.com]
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  • Workup

    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].

    Treatment

    Prognosis

    Complications

    Eosinophilic Meningoencephalitis
    • Angiostrongyliasis (eosinophilic meningoencephalitis) is an infestation of the brain and surrounding membranes (meninges) by the nematode worm Angiostrongylus cantonensis .[afairgo.net]
    • The larvae migrate to the brain where they cause an eosinophilic meningoencephalitis. » Schistosomiasis » Schistosoma mansoni » Schistosoma haematobium » Schistosoma japonicum » Schistosomes Found Uncommonly in Man » The intestinal flukes » Fasciolopsiasis[medical-photographs.com]
    • Applicable To Eosinophilic meningoencephalitis due to Parastrongylus cantonensis Type 2 Excludes Type 2 Excludes Help A type 2 excludes note represents "not included here".[icd10data.com]
    • Parameswaran K (2006) Case series of eosinophilic meningoencephalitis from South India.[journals.plos.org]
    • In humans, Angiostrongylus is the most common cause of eosinophilic meningitis : Migrating infective larvae or young adult worms die in and around blood vessels and arteries in the brain and provoke an eosinophilic meningoencephalitis, with a low mortality[diagnose-me.com]
    Myelitis
    • , myelitis and encephalomyelitis ( B01.1- ) rubella encephalitis, myelitis and encephalomyelitis ( B06.01 ) toxoplasmosis encephalitis, myelitis and encephalomyelitis ( B58.2 ) zoster encephalitis, myelitis and encephalomyelitis ( B02.0 ) Angiostrongyliasis[icd10data.com]
    Congenital Toxoplasmosis
    • .- ) suppurative otitis media ( H66.01- H66.4 ) trichinellosis ( B75 ) Type 1 Excludes adenoviral encephalitis, myelitis and encephalomyelitis ( A85.1 ) congenital toxoplasmosis encephalitis, myelitis and encephalomyelitis ( P37.1 ) cytomegaloviral encephalitis[icd10data.com]
    Systemic Lupus Erythematosus
    • lupus erythematosus ( M32.19 ) enteroviral encephalitis, myelitis and encephalomyelitis ( A85.0 ) eosinophilic meningoencephalitis ( B83.2 ) herpesviral [herpes simplex] encephalitis, myelitis and encephalomyelitis ( B00.4 ) listerial encephalitis, myelitis[icd10data.com]
    Pregnancy
    • .- ) infectious and parasitic diseases complicating pregnancy, childbirth and the puerperium ( O98.- ) infectious and parasitic diseases specific to the perinatal period ( P35-P39 ) influenza and other acute respiratory infections ( J00 - J22 ) Use Additional[icd10data.com]
    Lupus Erythematosus
    • erythematosus ( M32.19 ) enteroviral encephalitis, myelitis and encephalomyelitis ( A85.0 ) eosinophilic meningoencephalitis ( B83.2 ) herpesviral [herpes simplex] encephalitis, myelitis and encephalomyelitis ( B00.4 ) listerial encephalitis, myelitis[icd10data.com]

    Etiology

    Causes

    Parasite
    • Parasitic Diseases Parasites are living things that use other living things - like your body - for food and a place to live.[icdlist.com]
    • […] human parasitic pathogens is an indispensable tool for upcoming and experienced medical, veterinary, and industrial laboratory scientists engaged in parasite characterization.[books.google.de]
    • ( B81.1 ) Other helminthiases ICD-10-CM B83.2 is grouped within Diagnostic Related Group(s) (MS-DRG v 35.0): 867 Other infectious and parasitic diseases diagnoses with mcc 868 Other infectious and parasitic diseases diagnoses with cc 869 Other infectious[icd10data.com]
    • Both are parasites of rats that can infect humans.[diagnose-me.com]
    • (See also Approach to Parasitic Infections. ) Angiostrongylus are parasites of rats (rat lung worms).[merckmanuals.com]

    Epidemiology

    Sex distribution
    Age distribution

    Pathophysiology

    Prevention

    Summary

    Patient Information

    Other symptoms

    Acute Respiratory Infection
    • .- ) infectious and parasitic diseases specific to the perinatal period ( P35-P39 ) influenza and other acute respiratory infections ( J00 - J22 ) Use Additional code to identify resistance to antimicrobial drugs ( Z16.- ) Certain infectious and parasitic[icd10data.com]
    Puerperium
    • .- ) infectious and parasitic diseases complicating pregnancy, childbirth and the puerperium ( O98.- ) infectious and parasitic diseases specific to the perinatal period ( P35-P39 ) influenza and other acute respiratory infections ( J00 - J22 ) Use Additional[icd10data.com]
    Encephalomyelitis
    • ( B00.4 ) listerial encephalitis, myelitis and encephalomyelitis ( A32.12 ) meningococcal encephalitis, myelitis and encephalomyelitis ( A39.81 ) mumps encephalitis, myelitis and encephalomyelitis ( B26.2 ) postchickenpox encephalitis, myelitis and encephalomyelitis[icd10data.com]
    Chloramphenicol
    • The patient was treated with Gt Pred forte 1% 2 hourly, Gt Chloramphenicol four times a day, and Gt Levobunolol twice daily.[nature.com]

    Self-assessment

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    References

    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.

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