Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand.
Curr Opin Infect Dis. 2018 Oct;31(5):399-408. doi: 10.1097/QCO.0000000000000481.
Angiostrongylus cantonensis eosinophilic meningitis is a neglected, yet important emerging disease, which has been increasingly recognized in travelers. In this review, we describe the occurrence of the disease in travelers, sources of infection, clinical manifestations, diagnosis, and currently recommended treatment.
Various intermediate hosts and/or paratenic hosts can be the source of infection in humans. Serological tests for antibody may be negative early in the course of the disease but PCR for antigen detection in the CSF has recently been developed and may help to make the diagnosis at an earlier stage. High-dose corticosteroids (e.g. prednisolone 60 mg per day for at least 1-2 weeks) are currently the recommended treatment. Efficacy and safety of antihelminthic drugs for treatment remains controversial because of theoretical concerns that they may worsen the inflammatory response to dead and dying worms. Previous clinical trials were conducted with small numbers of participants and were underpowered. Further well designed clinical trials are urgently needed.
Awareness about increasing numbers of A. cantonensis eosinophilic meningitis in travelers is very important. Travelers should be advised about possible sources of infection. Diagnosis should be confirmed by antigen or antibody detection in blood or CSF. High-dose corticosteroids are the recommended treatment. The efficacy of various antihelminthic drugs is unproven. A large-scale, double-blind, randomized, controlled trial of antihelminthic drug involving antihelminthic drugs such as albendazole is necessary to prove the efficacy before formally advocating their use on a regular basis.
广州管圆线虫嗜酸性粒细胞性脑膜炎是一种被忽视但重要的新发传染病，在旅行者中越来越受到关注。在这篇综述中，我们描述了该病在旅行者中的发生情况、感染源、临床表现、诊断和目前推荐的治疗方法。
各种中间宿主和/或副宿主都可能是人类感染的来源。在疾病早期，血清抗体检测可能呈阴性，但最近已开发出用于检测脑脊液中抗原的 PCR 技术，可能有助于更早地做出诊断。目前推荐使用大剂量皮质类固醇（例如泼尼松龙每天 60mg，至少 1-2 周）进行治疗。抗蠕虫药物治疗的疗效和安全性仍存在争议，因为理论上担心它们可能会加重对死虫和垂死蠕虫的炎症反应。以前的临床试验规模较小，且效力不足。迫切需要进一步进行设计良好的临床试验。
提高对旅行者中广州管圆线虫嗜酸性粒细胞性脑膜炎病例不断增加的认识非常重要。应向旅行者告知可能的感染源。诊断应通过血液或脑脊液中的抗原或抗体检测来确认。大剂量皮质类固醇是推荐的治疗方法。各种抗蠕虫药物的疗效尚未得到证实。需要进行大规模、双盲、随机、对照试验来评估抗蠕虫药物（如阿苯达唑）的疗效，以在正式常规提倡使用之前证明其疗效。
