Angiostrongylus cantonensis Infection on Mayotte Island, Indian Ocean, 2007-2012 - PubMed (original) (raw)

Angiostrongylus cantonensis Infection on Mayotte Island, Indian Ocean, 2007-2012

Loïc Epelboin et al. PLoS Negl Trop Dis. 2016.

Abstract

Introduction: Human angiostrongyliasis (HA) is a neurological helminthic disease caused by the lung worm Angiostrongylus cantonensis. It is suspected in the combination of travel or a residence in an endemic area and eosinophilic meningitis. In Mayotte, an island in the Indian Ocean, cases are rare but regular. The main objective of our study was to describe the epidemiological and diagnosis clues of HA in Mayotte. The secondary objectives were to evaluate the contribution of Real-Time Polymerase Chain Reaction (RT- PCR) for the diagnosis of HA, delineate the characteristics of the local transmission and ascertain the presence of A. cantonensis in Achatina fulica, the potential vector of the disease.

Materials and methods: Between 2007 and 2012, all cases of eosinophilic meningitis were retrospectively included and investigated by RT- PCR in the CSF. Descriptive analysis was conducted for clinical, biological and radiological features, and were analyzed for all patients together with the search for prognostic factors for mortality. Concurrently, geolocalization and temporal parameters were studied to correlate the occurrence of the cases with rainfall seasons and snails were collected to enhance a parasitic carriage with real time PCR.

Results: During the 6-year period of the study, 14 cases were identified (2.3 cases/year) and 9 among 10 remaining CSF were positive in PCR. Among 14 cases of EM, 13 were less than 2 year-old children. The 1 year mortality rate was 5/14 (35.7%). Among survivors, 3/7 (42.8%) presented neurological sequelae. Factors associated with mortality were dysfunction of cranial nerves, abnormal brain imaging, and CSF glucose level inferior to 2 mmol/l. Occurrence of cases was temporarily and spatially correlated to the rainy season. Among the 64 collected giant snails, 6 (9.4%) were positive with A. cantonensis PCR. The likely main route of transmission was the children licking snails, carriers of the parasite.

Conclusion: In Mayotte, HA was mainly found in paediatric cases under 2 years old, and evidenced a life-threatening disease. PCR seems to be a promising tool in the definitive diagnosis of HA. Population should be aware of the role of A. fulica, and not let the children have direct contact with the snails.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1

Fig 1. Flow chart of the study.

Ac: Angiostrongylus cantonensis; CSF: Cerebrospinal fluid; PCR: Polymerase Chain Reaction. * Eosinophilic meningitis: ≥ 10 eosinophils /mm3 in CSF or ≥10% WBC). ** Meningitis: ≥ 10 WBC in CSF.

Fig 2

Fig 2. Amplification curves of six patients positive by Polymerase Chain Reaction and the positive control.

Fig 3

Fig 3. Map of the island of Mayotte representing the number and location of occurrence of the cases of angiostrongyliasis and the pluviometry curves.

Figure 3 was created using Illustrator CS5 (Adobe Systems, Inc.).

Fig 4

Fig 4. Monthly repartition of the cases and average pluviometry.

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References

    1. Chen HT. A new pulmonary nematode in Canton's rats, Pulmonem A. cantonensis n.g., n. sp. [in French]. Ann Parasitol. 1935;13:312–7.
    1. Rosen L, Laigret J, Bories S. Observations on an outbreak of eosinophilic meningitis on Tahiti, French Polynesia. American journal of hygiene. 1961;74:26–42. - PubMed
    1. Wang QP, Lai DH, Zhu XQ, Chen XG, Lun ZR. Human angiostrongyliasis. Lancet Infect Dis. 2008;8(10):621–30. 10.1016/S1473-3099(08)70229-9 - DOI - PubMed
    1. Malvy D, Ezzedine K, Receveur MC, Pistone T, Crevon L, Lemardeley P, et al. Cluster of eosinophilic meningitis attributable to Angiostrongylus cantonensis infection in French policemen troop returning from the Pacific Islands. Travel Med Infect Dis. 2008;6(5):301–4. 10.1016/j.tmaid.2008.06.003 - DOI - PubMed
    1. Thiengo SC, Simoes Rde O, Fernandez MA, Maldonado A Jr. Angiostrongylus cantonensis and rat lungworm disease in Brazil. Hawaii J Med Public Health. 2013;72(6 Suppl 2):18–22. - PMC - PubMed

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