Kwon Edward, Ferguson Tomas M, Park Sarah Y, Manuzak Augustina, Qvarnstrom Yvonne, Morgan Stephen, Ciminera Paul, Murphy Gerald S
Departments of Family Practice, Tripler Army Medical Center, Honolulu, HI, USA.
Hawaii J Med Public Health. 2013 Jun;72(6 Suppl 2):41-5.
Angiostrongylus eosinophilic meningitis is caused by infection with larvae of the rat lungworm, Angiostrongylus cantonensis. We report the case of an adult who ingested a raw, giant African snail (Achatina fulica) on the island of O'ahu in Hawa'i and developed an eosinophilic meningoencephalitis with severe headache, confusion, sixth cranial nerve palsy, ataxia, limb weakness, and paresthesia. He was treated with lumbar punctures to relieve pressure, high dose corticosteroids, and 14 days of albendazole. He had a prolonged convalescence, requiring 3 months of prednisone, and still had evidence of motor nerve weakness 4 months after exposure. A field investigation at the site of exposure yielded 5 of 9 Achatina fulica snails with evidence of A. cantonensis DNA by PCR. Cerebrospinal fluid samples from the patient were negative acutely but positive on day 15 of symptoms, using an investigational, real-time PCR assay. We discuss clinical management of this case in light of the current medical literature.
嗜酸性粒细胞性脑膜炎由广州管圆线虫（Angiostrongylus cantonensis）的幼虫感染引起。我们报告了一例成年人病例，该患者在夏威夷瓦胡岛食用了一只生的非洲大蜗牛（Achatina fulica），随后患上嗜酸性粒细胞性脑膜脑炎，出现严重头痛、意识模糊、第六颅神经麻痹、共济失调、肢体无力和感觉异常。他接受了腰椎穿刺以缓解压力、大剂量皮质类固醇治疗以及14天的阿苯达唑治疗。他恢复缓慢，需要3个月的泼尼松治疗，接触后4个月仍有运动神经无力的迹象。在接触地点进行的现场调查显示，9只非洲大蜗牛中有5只通过聚合酶链反应（PCR）检测出广州管圆线虫DNA。患者的脑脊液样本急性期呈阴性，但在症状出现第15天时，采用一种试验性的实时PCR检测呈阳性。我们根据当前医学文献讨论了该病例的临床处理。
