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Eosinophilic Meningoencephalitis


Presentation

  • Abstract The youngest patient with eosinophilic meningoencephalitis to be reported from Australia, an 11-month-old girl, is presented here.[ncbi.nlm.nih.gov]
  • Most of them presented with subacute to chronic headache and fever, followed by acute coma. Cerebrospinal fluid abnormalities were similar to alert patients with eosinophilic meningitis.[ncbi.nlm.nih.gov]
  • The clinical presentation included severe headache, clouded consciousness, and meningeal irritation.[ncbi.nlm.nih.gov]
  • He presented with localized peritonitis and then developed eosinophilic meningoencephalitis. Angiostrongylus cantonensis was the causative agent. This was confirmed by the positive serology test.[ncbi.nlm.nih.gov]
  • The objective of the present paper is to present the association between MBL deficiency and meningoencephalitis due to Angiostrongylus cantonensis in three children.[link.springer.com]
Fever
  • Most of them presented with subacute to chronic headache and fever, followed by acute coma. Cerebrospinal fluid abnormalities were similar to alert patients with eosinophilic meningitis.[ncbi.nlm.nih.gov]
  • The major clinical features of the patients, who were 2-60 years old, were low grade fever, headache, mild meningeal signs, right facial palsy or hemiplegia. Eosinophilia in the peripheral blood and eosinophilic pleocytosis were prominent.[ncbi.nlm.nih.gov]
  • Abstract A 42-year-old man was admitted to our hospital with a history of fever, headache and disorientation. His cerebrospinal fluid revealed eosinophilia and his serum had an antibody against Angiostrongylus cantonensis (A. cantonensis).[ncbi.nlm.nih.gov]
  • Abstract A 42-year-old man was admitted to our hospital with a history of fever, headache and disorientation. His cerebrospinal fluid revealed eosinophilia and his serum had an antibody against Angiostrongylus cantonensis ( A. cantonensis ).[jstage.jst.go.jp]
  • He had low-grade fever lasting few days at the onset. He consulted several physicians and ENT surgeons during that one-month period for his recent onset of severe headache.[annalsofian.org]
Asymptomatic
  • Bass JI, Blocker R, Eppes BM, Glickman LT, Mehta KA (1987) Asymptomatic Toxocariosis in children: a prospective study and treatment trial. Clin Pediatr 26:441–446 Google Scholar 2.[springerlink.com]
  • All patients recovered and became asymptomatic within three to four days of initiating therapy.[annalsofian.org]
Antipsychotic Agent
  • This case report demonstrates the efficacy and safety of antipsychotic agents during the acute phase of meningoencephalitis.[ncbi.nlm.nih.gov]
Intravenous Administration
  • After intravenous administration of gadolinium chelate (Gd-DTPA) repeated T1-weighted images were obtained. MRI features of the lesions in the brain and meninges were analyzed and recorded after observing initial and follow-up MR images.[ncbi.nlm.nih.gov]
Recurrent Infection
  • This patient had previously a recurrent infection that caused bacterial diarrhoea and some sepsis symptoms as well as dehidratation. During the illness produced by A. cantonensis , he had severe brain edema.[link.springer.com]
Vomiting
  • The clinical diagnosis of the illness was fever, vomiting and irritation, together with a cerebrospinal fluid analysis with the presence of eosinophils and high cellular countdown in this biological liquid.[link.springer.com]
  • Case 9 A forty four-year-old lady presented with fever, severe holocranial headache, vomiting and generalized body ache of one week duration. She had chronic deforming seropositive rheumatoid arthritis for the last the twenty years.[annalsofian.org]
  • As with meningitis caused by other infections, people who develop symptomatic EM from these parasites can have headache, stiff neck, nausea, vomiting, photophobia (sensitivity to light), and/or altered mental status (confusion).[cdc.gov]
  • Three days before hospitalization, the patient had a fever (37.5-38ºC), and a continuous headache with nausea but no vomiting. He had no myotonia or convulsion.[medsci.org]
Nausea
  • As with meningitis caused by other infections, people who develop symptomatic EM from these parasites can have headache, stiff neck, nausea, vomiting, photophobia (sensitivity to light), and/or altered mental status (confusion).[cdc.gov]
  • Three days before hospitalization, the patient had a fever (37.5-38ºC), and a continuous headache with nausea but no vomiting. He had no myotonia or convulsion.[medsci.org]
  • A 51-year-old man of Tongan ethnicity presented to the Emergency Department with a 3-week history of right-sided headache and two episodes of nausea and vomiting on the day of presentation.[nzma.org.nz]
  • With the exception of a slight sense of feeling sick, which was interpreted by the patient as a flu-like infection, no further clinical symptoms, in particular no signs of meningeal irritation such as photophobia, increased noise sensitivity, nausea,[karger.com]
Diplopia
  • Some patients have stiff neck, numbness of face or limbs, photophobia and diplopia. Symptoms at the acute stage may last from one week to 2 months or even longer.[medsci.org]
Urinary Retention
  • Although a symptom he had been suffering from at the time of his admission was urinary retention, this symptom disappeared as his general condition improved.[ncbi.nlm.nih.gov]
Headache
  • Most of them presented with subacute to chronic headache and fever, followed by acute coma. Cerebrospinal fluid abnormalities were similar to alert patients with eosinophilic meningitis.[ncbi.nlm.nih.gov]
  • The major clinical features of the patients, who were 2-60 years old, were low grade fever, headache, mild meningeal signs, right facial palsy or hemiplegia. Eosinophilia in the peripheral blood and eosinophilic pleocytosis were prominent.[ncbi.nlm.nih.gov]
  • The clinical presentation included severe headache, clouded consciousness, and meningeal irritation.[ncbi.nlm.nih.gov]
  • Abstract A 42-year-old man was admitted to our hospital with a history of fever, headache and disorientation. His cerebrospinal fluid revealed eosinophilia and his serum had an antibody against Angiostrongylus cantonensis (A. cantonensis).[ncbi.nlm.nih.gov]
  • The major symptoms of the patients had severe headache and pain in the trunk and limbs. Increased eosinophlic count in peripheral blood and cerebrospinal fluid was noted.[ncbi.nlm.nih.gov]
Neglect
  • Further research into neglected diseases and conditions will uncover information that sheds light on more general topics of interest to the neuroscience research community.[books.google.com]
  • PLoS Neglected Tropical Diseases. 2009; 3(9): e520 [Pubmed][annalsofian.org]
Neck Stiffness
  • There was photophobia and neck stiffness but neurological examination was otherwise normal. Initial CT brain imaging was normal. CSF examination revealed raised protein of 0.89 and 640 mononuclear cells.[jnnp.bmj.com]
Neurologic Manifestation
  • Neurological manifestations of gnathostomiasis. J Neurol Sci 1977;31:279–91. 8.Rusnak JM, Lucey DR. Clinical gnathostomiasis: case report and review of the English-language literature. Clin Infect Dis 1993;16:33–50.[nzma.org.nz]
Cervical Radiculopathy
  • One patient (Case 4) had feature of lumbar and cervical radiculopathy additionally. All patients had peripheral eosinophilia [Table - 2]. Other metabolic and biochemical work up were negative. All had CSF eosinophilia (30-80%).[annalsofian.org]

Workup

Cerebrospinal Fluid Abnormality
  • Cerebrospinal fluid abnormalities were similar to alert patients with eosinophilic meningitis. None of them had received antihelmintic drug and seven patients were treated with corticosteroids. Ten patients died and one patient is still in a coma.[ncbi.nlm.nih.gov]
Paragonimus Westermani
  • Tested by enzyme-linked immunoadsorbent assay (ELISA), sera were specifically IgG-antibody positive against Angiostrougylus cantonensis antigen, but were negative against other parasitic antigens such as Paragonimus westermani, Cysticerus, Cellulosae[ncbi.nlm.nih.gov]
  • Serological test for or angiostrongylosis cantonensis, Gnathostoma spinegera or Paragonimus westermani were not done due to lack of availability.[annalsofian.org]
Ischemic Changes
  • These are nonspecific findings that may indicate demyelination, small vessel ischemic changes or gliosis. We report ten patients with EM possibly due to angiostrongylus cantonensis.[annalsofian.org]

Treatment

  • The presence of acute psychotic symptoms in EM, however, has not previously been reported, and there is no literature to guide its treatment and management.[ncbi.nlm.nih.gov]
  • Initial treatment with thiabendazole was ineffective. After marked improvement in clinical and laboratory results were achieved using albendazole and corticosteroids, the child was discharged.[ncbi.nlm.nih.gov]
  • Treatment usually requires the concomitant administration of corticoids and anthelminthic drugs, yet new compounds and their extensive and detailed clinical evaluation are much needed.[ncbi.nlm.nih.gov]
  • His consciousness did not recover after supportive treatment. The MRI of the brain showed diffuse enlargement of the ventricular system two weeks after the diagnosis was made.[ncbi.nlm.nih.gov]
  • Coverage includes major updates on genetics of diseases, new diagnostic techniques, and the newest treatment options. This third volume covers degenerative, metabolic, infectious, inflammatory, and demyelinating diseases.[books.google.com]

Etiology

  • Thus, distinctive identification of eosinophils in fluids is a necessary component in the etiologic diagnosis of CNS infections.[ncbi.nlm.nih.gov]
  • Parasitic infection of the CNS is the most common cause of EM although rarely it can be due to other etiologies [Table - 3].[annalsofian.org]
  • Therefore, we diagnosed eosinophilic meningitis, but at this point, the etiology was uncertain. No parasitic organism was found in the feces.[karger.com]

Epidemiology

  • METHODS: The clinical and laboratory data as well as the epidemiological information concerning 18 patients with eosinophilic meningoencephalitis caused by Angiostrongylus cantonensis were analyzed.[ncbi.nlm.nih.gov]
  • Many questions remain unanswered about the host-parasite relationship, its epidemiology and public health significance. Veterinarians and clinicians are interested in its importance as a zoonosis.[books.google.com]
  • Eosinophilic meningitis in Thailand: Epidemiologic studies of 484 typical cases and the etiologic role of Angiostrongylus cantonensis. Am J Trop Med Hyg 1970;19:950-8. [ PUBMED ] 6.[annalsofian.org]
  • Epidemiology The patient had worked for two years in a seafood restaurant as a cooker. He liked to eat raw seafood and before becoming ill he frequently ate snail. Physical examination The patient had no defect in speech.[medsci.org]
Sex distribution
Age distribution

Prevention

  • Author information 1 Department of Medicine and Therapeutics, Control and Prevention of Infectious Diseases (First Department of Internal Medicine), Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.[ncbi.nlm.nih.gov]
  • Get optimal test results with guidance on error detection, correction, and prevention as well as cost-effective test selection.[books.google.com]
  • Dr Sanket Patel Medical Consultant - Bajna Medical Centre A forest is a challenging environment and it is important people know how to stay healthy and safe, so as an additional service I provide first aid courses, snakebite awareness and heat stress prevention[internationalsos.com]
  • Prevention is especially important. There are no vaccines for parasitic diseases. Some medicines are available to treat parasitic infections.[icdlist.com]
  • Prevention Please visit CDC’s websites listed in the Related Links section below to learn how to prevent infection with these and other parasites. Top of Page[cdc.gov]

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