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].

• 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]

  PAIN FREE CYCLING! NO MORE ACHES & PAINS! [outbreaknewstoday.com]

  The patient was first assisted in a doctor's office complaining of vague pain in the right upper abdominal quadrant, associated with general muscle pain and malaise in the last four weeks. Physical examination revealed painful hepatomegaly. [scielo.br]

  Pain management may require early consultation with a pain specialist. [health.hawaii.gov]

• Inflammation

  Ocular angiostrongyliasis is very rare and causes a permanent visual impairment and a wide range of ocular inflammation, depending on the worm's route. It can occur with or without EoM. [ncbi.nlm.nih.gov]

  A parasite was found in the anterior chamber without intraocular inflammation (Figure 1a). Relative afferent papillary defect (RAPD) was positive on the left side. [nature.com]

• Weakness

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

  Cases of severe infection will eventually lead to increasing weakness, tetraparesis, areflexia, respiratory failure, and muscle atrophy – and to death if not treated. [diagnose-me.com]

  Children may experience more fever, irritability, somnolence, lethargy, gastrointestinal symptoms, muscle twitching, convulsions, and extremity weakness. [health.hawaii.gov]

• Fishing

  Avoiding raw or undercooked molluscs, crustaceans, and fish, etc. Provision of clean drinking water. [patient.info]

  NG patients always presented with motor weakness, migratory swelling, radicular pain and had history of eating uncooked poultry or fish. Specific antigenic bands in immunoblot tests are helpful tools to differentiate the two diseases. [ncbi.nlm.nih.gov]

  All rights reserved. angiostrongyliasis Infestation with the rat worm parasites Angiostrongylus cantonensis and A. costaricensis usually acquired by eating snails, shrimps or fish, the intermediate hosts. [medical-dictionary.thefreedictionary.com]

• 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]

  Non-specific symptoms include fever, light sensitivity, muscle pain, fatigue, and insomnia. [health.hawaii.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]

• Cough

  (%) Headache 44 (93.6) 8 (100) Nuchal rigidity or neck pain 0 6 (75.0) Fatigue 7 (14.9) 7 (87.5) Vomiting 9 (19.1) 8 (100) Paresthesias 30 (63.8) 3 (37.5) Muscle pain 43 (91.5) 8 (100) Fever 27 (57.4) 3 (37.5) Cough 4 (8.5) 0 Somnolence 4 (8.5) 7 (87.5 [ncbi.nlm.nih.gov]

  Larvae are coughed up, swallowed, and passed in the feces. The life cycle is completed when larvae infect snails, which in turn are eaten by humans. [diagnose-me.com]

  While the nematode moves through the lung, cough, rhinorrhoea, sore throat, malaise and fever can develop. [msdsonline.com]

  Clinical signs associated with A. vasorum are related to right-sided heart failure and include malaise, coughing, dyspnea, anemia, pulmonary hypertension [10] and pneumonia. [vetbook.org]

  Larval migration in mammalian host organs may cause many clinical signs, e.g. in the liver it usually causes hepatomegaly (70), while in lung it results in coughing, rhinorrhea, sore throat, malaise and fever. [antimicrobe.org]

• Respiratory Distress

  Death may ensue with severe infestations, primarily due to a DIC -related systemic coagulopathy [11] and consequential acute respiratory distress syndrome. [vetbook.org]

• Dyspnea

  Clinical signs associated with A. vasorum are related to right-sided heart failure and include malaise, coughing, dyspnea, anemia, pulmonary hypertension [10] and pneumonia. [vetbook.org]

• Hemoptysis

  Some dogs develop additional signs such as hemoptysis [18], scleral hemorrhage, forelimb paresis, cranial nerve palsies, altered mentation, coma and seizures. [vetbook.org]

• Vomiting

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

  Adult worms reside in arterioles of the ileocecal area, and eggs can be released into the intestinal tissues, resulting in local inflammation with abdominal pain, vomiting, and fever; this infection can mimic appendicitis. [merckmanuals.com]

  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. [phsource.us]

  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]

• 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]

• 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]

  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. [phsource.us]

  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]

  He denied changes in visual acuity, discharge, pain, or systemic concerns (eg, headache, fever, nausea/vomiting, or nuchal rigidity). He denied traveling out of the country and contact with animals or animal feces, although he did note he ate sushi. [jamanetwork.com]

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

• Diarrhea

  […] infection Diphtheria Diphyllobothriasis Dipylidiasis Dirofilariasis Dracunculiasis Echinococcosis unilocular Endocarditis infectious Enterobiasis Enterovirus infection Epidural abscess Erysipelas or cellulitis Erysipeloid Erythrasma Escherichia coli diarrhea [books.google.de]

  †No patients had visual disturbance or photophobia, hyperesthesias, muscle weakness, or diarrhea. ‡Two larvae were found in cerebrospinal fluid. [ncbi.nlm.nih.gov]

  The patient had no pathological history and complained of 15 days of abdominal pain, predominantly in the right iliac fossa; abdominal cramps, diarrhea, stools without blood, vomits of ingested content and fever. [scielo.br]

  The symptoms of the following prodromal stage are mild, and may include fever, headache, dizziness, abdominalgia, diarrhea and lack of strength. In some patients, the symptoms can resolve without any treatment. [medsci.org]

• Meningism

  Eosinophilic meningitis: cerebrospinal fluid (CSF) is abnormal with elevated pressure, proteins, and eosinophilia. On rare occasions, larvae have been found in the CSF. [patient.info]

  Eosinophilic meningitis due to Angiostrongylus cantonensis in a returned traveler: case report and review of the literature. Clin Infect Dis 2001; 33:e112–e115. [PubMed] 39. Lo Re V, III, Gluckman SJ. Eosinophilic meningitis. [antimicrobe.org]

  Other causes of eosinophilic meningitis are neurocysticercosis, cerebral paragonimiasis, Toxoplasma canis, Baylisascaris, tuberculous meningitis, and cryptococcal meningitis. [ncbi.nlm.nih.gov]

• 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]

• Seizure

  Comorbid seizures are managed routinely. 162 Adapted from: Goldstein MA and Harden CL. Infectious states. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;83-133. [epilepsy.com]

  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. [phsource.us]

  Clinical manifestations include headache, meningism, vomiting, cranial nerve lesions, and (less commonly) other neurological features such as seizures. Ocular lesions are quite common. [oxfordmedicine.com]

  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 [symptoma.com]

  Symptoms include severe headaches, nausea, vomiting, neck stiffness, seizures, and paraesthesiae. Eye involvement can occur but ocular angiostrongyliasis is very rare. [ 3 ] Eosinophilia is present in most cases. [patient.info]

• Paresis

  The first reports of animals infected with A cantonensis were made by Mason in 1976 when he described a syndrome occurring in puppies in the Brisbane area, characterised by urinary incontinence, hind limb paresis and hyperaesthesia, often associated with [aspergillus.org.uk]

  Some dogs develop additional signs such as hemoptysis [18], scleral hemorrhage, forelimb paresis, cranial nerve palsies, altered mentation, coma and seizures. [vetbook.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].

• Dirofilaria Immitis

  A differential diagnosis would include other cardiopulmonary parasites such as Aelurostrongylus abstrusus, Eucoleus aerophilus, Crenosoma vulpis and Dirofilaria immitis. [vetbook.org]

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]

Zheng RY Jin R Lin BC Pan CW Xue DY Probing and demonstrating etiological factors for outbreak of Angiostrongyliasis cantonensis in Wenzhou. Sh J Prev Med. 2001; 13: 105-107 29. [thelancet.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. 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]

To prevent angiostrongyliasis, don’t eat raw or undercooked snails or slugs, and if you handle snails or slugs, be sure to wear gloves and wash your hands. [health.hawaii.gov]

These results highlight the need to increase awareness of this disease and implement public health programs in the region to prevent human cases of angiostrongyliasis and improve management of eosinophilic meningitis patients. [ncbi.nlm.nih.gov]

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.