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Definition

Angiostrongyliasis is an infection by a roundworm of the Angiostrongylus type. Symptoms may vary from none, to mild, to even possibly meningitis.[1] 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 central nervous system or death.[2][3]

Signs and symptoms

Infection first presents with severe abdominal pain, nausea, vomiting, and weakness, and progresses to fever, and then to central nervous system symptoms and severe headache.[4][5]Symptoms of eye invasion include visual impairment, pain, keratitis, and retinal edema. Worms usually appear in the anterior chamber and vitreous and can sometimes be removed surgically.[5][6]

Cause

A. cantonensis is a nematode roundworm with three outer protective collagen layers, and a simple stomal opening or mouth with no lips or buccal cavity leading to a fully developed gastrointestinal tract.[5]Humans are incidental hosts; the larvae cannot reproduce in humans and therefore humans do not contribute to the A. cantonensis life cycle.[2]

Transmission

Transmission of the parasite is usually from eating raw or undercooked snails or other vectors. Infection is also frequent from ingestion of contaminated water or unwashed salad that may contain small snails and slugs, or have been contaminated by them.[5][7]

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 eosinophilic meningitis and history of exposure to snail hosts.[8]

Treatment

Treatment of angiostrongyliasis is not well defined, however most strategies include a combination of anti-parasitics to kill the worms, steroids to limit inflammation as the worms die, and pain medication to manage the symptoms of meningitis.[9][10]

Epidemiology

A. cantonensis and its vectors are endemic to Southeast Asia and the Pacific Basin.[11][12]

References

  1. Liu, EW; Schwartz, BS; Hysmith, ND; DeVincenzo, JP; Larson, DT; Maves, RC; Palazzi, DL; Meyer, C; Custodio, HT; Braza, MM; Al Hammoud, R; Rao, S; Qvarnstrom, Y; Yabsley, MJ; Bradbury, RS; Montgomery, SP (3 August 2018). "Rat Lungworm Infection Associated with Central Nervous System Disease - Eight U.S. States, January 2011-January 2017". MMWR. Morbidity and Mortality Weekly Report. 67 (30): 825–828. doi:10.15585/mmwr.mm6730a4. PMC 6072054. PMID 30070981.
  2. 2.0 2.1 David, John T. and Petri, William A Jr. Markell and Voge's Medical Parasitology. St. Louis, MO: El Sevier, 2006
  3. Wang, Qiao-Ping; Lai, De-Hua; Zhu, Xing-Quan; Chen, Xiao-Guang; Lun, Zhao-Rong (October 2008). "Human angiostrongyliasis". The Lancet. Infectious Diseases. 8 (10): 621–630. doi:10.1016/S1473-3099(08)70229-9. ISSN 1473-3099. Retrieved 1 January 2023.
  4. "Angiostrongyliasis (Concept Id: C0392662) - MedGen - NCBI". www.ncbi.nlm.nih.gov. Archived from the original on 22 December 2022. Retrieved 22 December 2022.
  5. 5.0 5.1 5.2 5.3 Sohal, Raman J.; Gilotra, Tarvinder S.; Lui, Forshing (2022). "Angiostrongylus Cantonensis". StatPearls. StatPearls Publishing. Retrieved 2 January 2023.
  6. Diao, Zongli; Wang, Jing; Qi, Haiyu; Li, Xiaoli; Zheng, Xiaoyan; Yin, Chenghong (April 2011). "Human ocular angiostrongyliasis: a literature review". Tropical Doctor. 41 (2): 76–78. doi:10.1258/td.2010.100294. ISSN 1758-1133. Retrieved 20 December 2022.
  7. Cowie, RH (June 2013). "Pathways for transmission of angiostrongyliasis and the risk of disease associated with them". Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health. 72 (6 Suppl 2): 70–4. PMID 23901388. Archived from the original on 14 December 2022. Retrieved 17 December 2022.
  8. "Angiostrongyliasis - Infectious Diseases". Merck Manuals Professional Edition. Retrieved 6 January 2023.
  9. Sawanyawisuth, Kanlayanee; Sawanyawisuth, Kittisak (October 2008). "Treatment of angiostrongyliasis". Transactions of the Royal Society of Tropical Medicine and Hygiene. 102 (10): 990–996. doi:10.1016/j.trstmh.2008.04.021. ISSN 1878-3503. Archived from the original on 15 December 2022. Retrieved 19 December 2022.
  10. Ortega, Ynés R.; Sterling, Charles R. (24 January 2018). Foodborne Parasites. Springer. p. 145. ISBN 978-3-319-67664-7. Archived from the original on 21 December 2022. Retrieved 21 December 2022.
  11. Baheti, N. N.; Sreedharan, M.; Krishnamoorthy, T.; Nair, M. D.; Radhakrishnan, K. (1 March 2008). "Eosinophilic meningitis and an ocular worm in a patient from Kerala, south India". Journal of Neurology, Neurosurgery & Psychiatry. 79 (3): 271–271. doi:10.1136/jnnp.2007.122093. ISSN 0022-3050. Retrieved 8 January 2023.
  12. Chopra, Jagjit; Sawhney, Indermohan (10 November 2015). Neurology in Tropics (e-Book). Elsevier Health Sciences. p. 293. ISBN 978-81-312-4233-9. Retrieved 8 January 2023.