Department of Internal Medicine, Naval Medical Center San Diego, San Diego, CA, USA.
Department of Internal Medicine, Scripps Green Hospital, La Jolla, CA, USA.
Lancet Infect Dis. 2019 Apr;19(4):e132-e142. doi: 10.1016/S1473-3099(18)30434-1. Epub 2018 Nov 16.
Angiostrongylus cantonensis is the most common cause of eosinophilic meningitis worldwide. Infection typically occurs through ingestion of undercooked molluscs or vegetables contaminated by infective larvae. Endemic regions were previously limited to southeast Asia and the Pacific basin; however, this parasite is seeing an alarming increase in global distribution with reported cases in more than 30 countries, including several states in the USA. Although infection typically results in meningitis, a broad spectrum of CNS involvement and severity is emerging as diagnostic methods (such as real-time PCR) continue to improve diagnosis. In this Grand Round, we report a case of a 20-year-old active duty US marine serving in Okinawa, Japan, afflicted with severe CNS angiostrongyliasis marked by radiculomyelitis with quadriparesis, hyperaesthesia, and urinary retention. We present this case to highlight that no clear guidelines exist for the treatment of severe CNS angiostrongyliasis and provide our consensus recommendation that treatment algorithms include use of dual corticosteroids plus anthelmintics when radicular symptoms are present. In this Grand Round we review the clinical features, epidemiology, advances to diagnostic techniques, and available data on current treatment options for CNS angiostrongyliasis. This diagnosis should be highly considered in the differential diagnosis of a patient presenting with meningeal symptoms, paraesthesia or hyperaesthesia, and CSF eosinophilia so that treatment can be started early, which is particularly important in children, because of their increased risk of severe disease and mortality. We recommend combined therapy with albendazole and prednisolone, with consideration for increased steroid dosing in severe cases.
广州管圆线虫是全世界最常见的嗜酸性粒细胞性脑膜炎病因。感染通常通过摄入未煮熟的贝类或受感染幼虫污染的蔬菜而发生。以前，流行地区仅限于东南亚和太平洋盆地；然而，随着包括美国几个州在内的 30 多个国家报告病例，这种寄生虫的全球分布令人震惊地增加。尽管感染通常导致脑膜炎，但随着诊断方法（如实时 PCR）的不断改进，中枢神经系统（CNS）广泛受累和严重程度的情况正在出现。在本次大查房中，我们报告了一名 20 岁的美国现役海军陆战队队员的病例，他在日本冲绳服役，患有严重的中枢神经系统血管圆线虫病，表现为神经根炎伴四肢瘫痪、感觉过敏和尿潴留。我们提出这个病例是为了强调，目前对于严重的中枢神经系统血管圆线虫病尚无明确的治疗指南，并提供我们的共识建议，即当存在神经根症状时，治疗方案包括使用双重皮质类固醇加驱虫药。在本次大查房中，我们回顾了中枢神经系统血管圆线虫病的临床特征、流行病学、诊断技术的进展以及现有治疗选择的数据。对于出现脑膜症状、感觉异常或感觉过敏和 CSF 嗜酸性粒细胞增多的患者，应高度考虑这一诊断，以便及早开始治疗，这在儿童中尤为重要，因为他们患重病和死亡的风险增加。我们建议联合使用阿苯达唑和泼尼松龙治疗，并考虑在严重病例中增加类固醇剂量。
