A blind passenger: a rare case of documented seroconversion in an Angiostrongylus cantonensis induced eosinophilic meningitis in a traveler visiting friends and relatives - PubMed (original) (raw)

Case Reports

A blind passenger: a rare case of documented seroconversion in an Angiostrongylus cantonensis induced eosinophilic meningitis in a traveler visiting friends and relatives

Tobias Brummaier et al. Trop Dis Travel Med Vaccines. 2019.

Abstract

Background: Eosinophilic meningitis (EOM) is a rare condition that is caused by various communicable and non-communicable factors. The rat-lungworm Angiostrongylus cantonensis, which is associated with consumption of raw or undercooked paratenic or intermediate hosts, is the most common cause of parasitic eosinophilic meningitis worldwide. While the majority of A. cantonensis cases are reported from endemic regions, cases in travelers pose a challenge to clinicians in non-endemic countries. Here we report a rare case of eosinophilic meningitis caused by A. cantonensis in a Swiss traveler who was diagnosed after returning from Thailand.

Case presentation: A 33-year old woman with a travel history to rural north-eastern Thailand presented to an emergency department in Switzerland with severe headache and vomiting. Eosinophilic meningitis was confirmed as the cause of the symptoms; however, serologic investigations failed to confirm an A. cantonensis infection on the first evaluation. Nevertheless, empirical treatment with an anthelminthic and steroid regimen led to a rapid alleviation of symptoms. Repeated serology confirmed seroconversion 2 weeks after treatment initiation.

Discussion: Parasitic etiology must be considered in returning travelers who present with symptoms compatible with a central nervous system infection. A thorough medical history, including types of food consumed, is paramount and can often suggest differential diagnosis. Neuroangiostrongyliasis is rare and might be missed if serology does not cover possible seroconversion.

Keywords: Angiostrongylus cantonensis; Eosinophilic meningitis; Seroconversion; Switzerland; Visiting friends and relatives.

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Conflict of interest statement

Not applicableWritten informed consent was obtained from the patient described in this manuscript.The authors declare that they do not have any competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

Fig. 1

Geographical distribution of cerebral angiostrongyliasis. Legend: Map created by Rosalie Zimmermann, adapted from Wang QP et al. Lancet Infect Dis 2008;8:621–630 and Barratt J et al. Parasitology 2016;143:1087–1118

Fig. 2

Fig. 2

Cerebrospinal fluid smear of our patient. Legend: Pappenheim (May-Grünwald-Giemsa) stain, magnification × 60. Black arrows indicate eosinophil granulocytes with mostly bilobed, occasionally trilobed nucleus and normal eosinophilic granulation

Fig. 3

Fig. 3

Predominant symptoms in parasitic CNS infections. Legend: Adapted from Carpio et al., Expert Rev. Neurother. 2016;16 (4):401–4,142,016

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