Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
J Microbiol Immunol Infect. 2011 Oct;44(5):382-9. doi: 10.1016/j.jmii.2011.01.034. Epub 2011 Jan 20.
With the improvement of public health, eosinophilic meningitis associated with Angiostrongylus cantonensis infection is now seldom reported in Taiwan. Eosinophilic meningitis typically occurred sporadically in children. This study aims to analyze the clinical manifestations and change in the contemporary epidemiology of eosinophilic meningitis in Taiwan.
This is a retrospective study of patients diagnosed with eosinophilic meningitis at Kaohsiung Veterans General Hospital, from December 1991 to September 2009. The demographic characteristics, clinical presentations, laboratory data, radiographic imaging, and treatment and clinical outcome were analyzed. A PubMed search with the keywords of eosinophilic meningitis, A cantonensis, and Taiwan was performed to retrieve cases of eosinophilic meningitis caused by A cantonensis since 1960.
Thirty-seven patients were diagnosed to have eosinophilic meningitis during a period of 18 years. The median age was 32 years (range, 2-80 years). Ninety five percent (35/37) of the patients were adults. The median incubation period was 10.5 days (range, 3-80 days). Most of the patients presented with headache (29, 78%), fever (25, 68%), and 11(30%) had hyperesthesia. Patients with hyperesthesia had longer incubation period (55 vs. 7 days, p=0.004), lower serum immunoglobulin E levels (127.5 vs. 1295 IU/mL, p<0.001), and longer duration between symptom onset and spinal taps (14 vs. 5 days, p=0.011). Three patients presented initially with lymphocytic meningitis, and eosinophilia only appeared on a second lumbar puncture. Magnetic resonance imaging of the brain disclosed leptomeningeal enhancement (17/26, 65%) and increased signal intensity (10/26, 38%) on T2-weighted and fluid-attenuated inversion recovery images. There were eight relapses and two patients died. No sequela was noted except in one 2-year-old toddler, who had weakness of both lower limbs.
The epidemiology of eosinophilic meningitis has changed during the past two decades in Taiwan and occurs mainly in adults in the setting of outbreaks. Hyperesthesia; repeated lumbar puncture in cases with lymphocytic meningitis of uncertain cause; and a detailed history, including food consumption, are important to establish an accurate diagnosis.
随着公共卫生水平的提高，台湾地区与广州管圆线虫感染相关的嗜酸性粒细胞性脑膜炎已很少见。嗜酸性粒细胞性脑膜炎通常散发性发生于儿童。本研究旨在分析台湾地区嗜酸性粒细胞性脑膜炎的临床表现和当代流行病学变化。
这是一项对高雄荣民总医院于 1991 年 12 月至 2009 年 9 月间诊断为嗜酸性粒细胞性脑膜炎的患者进行的回顾性研究。分析了患者的人口统计学特征、临床表现、实验室数据、影像学表现以及治疗和临床转归。通过在 PubMed 上以嗜酸性粒细胞性脑膜炎、广州管圆线虫和台湾为关键词进行检索，获取了自 1960 年以来由广州管圆线虫引起的嗜酸性粒细胞性脑膜炎病例。
在 18 年的时间里，共诊断出 37 例嗜酸性粒细胞性脑膜炎患者。中位年龄为 32 岁（范围，2-80 岁）。95%（35/37）的患者为成年人。中位潜伏期为 10.5 天（范围，3-80 天）。大多数患者表现为头痛（29 例，78%）、发热（25 例，68%）和 11 例（30%）感觉异常。有感觉异常的患者潜伏期更长（55 天 vs. 7 天，p=0.004），血清免疫球蛋白 E 水平更低（127.5 IU/mL vs. 1295 IU/mL，p<0.001），症状发作与腰椎穿刺之间的时间间隔更长（14 天 vs. 5 天，p=0.011）。有 3 例患者最初表现为淋巴细胞性脑膜炎，仅在第二次腰椎穿刺时出现嗜酸性粒细胞增多。脑磁共振成像显示软脑膜强化（17/26，65%）和 T2 加权像和液体衰减反转恢复图像上的信号强度增加（10/26，38%）。有 8 例复发，2 例患者死亡。除 1 例 2 岁幼儿下肢无力外，无其他后遗症。
在过去 20 年中，台湾地区嗜酸性粒细胞性脑膜炎的流行病学发生了变化，主要发生在暴发期间的成年人中。感觉异常；对原因不明的淋巴细胞性脑膜炎患者进行多次腰椎穿刺；以及详细的病史，包括食物摄入情况，对于做出准确诊断非常重要。
