Angiostrongyliasis

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Annotated Information

Classification and Resources

ID 86
ICD-10
ICD-9-CM
OMIM
SNOMED-CT
Orphanet
MeSH
DO

Defination

Angiostrongyliasis is an infection by a nematode from the Angiostrongylus genus of kidney and alimentary tract roundworms For example, infection with Angiostrongylus cantonensis can occur after consuming raw Giant African land snails, Great Grey Slugs, or other mollusks~In humans, Angiostrongylus is the most common cause of eosinophilic meningitis or meningoencephalitis 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 it can cause permanent damage to the CNS or death~

Synonyms

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Etiology

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Diagnosis

Diagnosis of Angiostrongyliasis is complicated due to the difficulty of presenting the angiostrongylus larvae themselves, and will usually be made based on the presence of eosiniphilic meningitis and history of exposure to snail hosts Eosiniphilic meningitis is generally characterized as a meningitis with > eosiniphils/μL in the CSF or at least % eosiniphils in the total CSF leukocyte count Occasionally worms found in the cerebrospinal fluid or surgically removed from the eye can be identified in order to diagnose Angiostrongyliasis~Lumbar puncture[edit]~Lumbar puncture should always be done is cases of suspected meningitis In cases of eosiniphilc meningitis it will rarely produce worms even when they are present in the CSF, because they tend to cling to the end of nerves Larvae are present in the CSF in only -% of cases However, as a case of eosiniphilic meningitis progresses, intracranial pressure and eosiniphil counts should rise Increased levels of eosinophils in the CSF is a trademark of the eosiniphilic meningitis~Brain imaging[edit]~Brain lesions, with invasion of both gray and white matter, can be seen on a CT or MRI However MRI findings tend to be inconclusive, and usually include nonspecific lesions and ventricular enlargement Sometimes a hemorrhage, probably produced by migrating worms, is present and of diagnostic value~Serology[edit]~In patients with elevated eosiniphils, serology can be used to confirm a diagnosis of Angiostrongylias rather than infection with another parasite There are a number of immunoassays that can aid in diagnosis, however serologic testing is available in few labs in the endemic area, and is frequently too non-specific Some cross reactivity has been reported between A cantonensis and trichinosis, making diagnosis less specific~The most definitive diagnosis always arises from the identification of larvae found in the CSF or eye, however due to this rarity a clinical diagnosis based on the above tests is most likely~

Symptoms

Diagnosis of Angiostrongyliasis is complicated due to the difficulty of presenting the angiostrongylus larvae themselves, and will usually be made based on the presence of eosiniphilic meningitis and history of exposure to snail hosts Eosiniphilic meningitis is generally characterized as a meningitis with > eosiniphils/μL in the CSF or at least % eosiniphils in the total CSF leukocyte count Occasionally worms found in the cerebrospinal fluid or surgically removed from the eye can be identified in order to diagnose Angiostrongyliasis~Lumbar puncture[edit]~Lumbar puncture should always be done is cases of suspected meningitis In cases of eosiniphilc meningitis it will rarely produce worms even when they are present in the CSF, because they tend to cling to the end of nerves Larvae are present in the CSF in only -% of cases However, as a case of eosiniphilic meningitis progresses, intracranial pressure and eosiniphil counts should rise Increased levels of eosinophils in the CSF is a trademark of the eosiniphilic meningitis~Brain imaging[edit]~Brain lesions, with invasion of both gray and white matter, can be seen on a CT or MRI However MRI findings tend to be inconclusive, and usually include nonspecific lesions and ventricular enlargement Sometimes a hemorrhage, probably produced by migrating worms, is present and of diagnostic value~Serology[edit]~In patients with elevated eosiniphils, serology can be used to confirm a diagnosis of Angiostrongylias rather than infection with another parasite There are a number of immunoassays that can aid in diagnosis, however serologic testing is available in few labs in the endemic area, and is frequently too non-specific Some cross reactivity has been reported between A cantonensis and trichinosis, making diagnosis less specific~The most definitive diagnosis always arises from the identification of larvae found in the CSF or eye, however due to this rarity a clinical diagnosis based on the above tests is most likely~

Treatment

Symptomatic treatment is indicated for symptoms such as nausea, vomiting, headache, and in some cases, chronic pain due to nerve damage or muscle atrophy~

Labs working on this disease

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References

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