Correspondence
Angiostrongylus cantonensis Infection from Eating Raw Snails
N Engl J Med 1995; 332:1105-1106April 20, 1995
- Article
To the Editor:
Eosinophilic meningitis caused by Angiostrongylus cantonensis is widespread in the Pacific basin and has been reported in Cuba, Réunion, and the Ivory Coast.1 To our knowledge, however, no human infection with A. cantonensis has been reported in North America to date. We report a case of autochthonous A. cantonensis infection in a child in New Orleans.
An 11-year-old boy presented to Children's Hospital in New Orleans on June 24, 1993, with myalgia (which he had had for seven days), headache, low-grade fever, vomiting (for six days), and a stiff neck (for five days). He had always lived in Louisiana and had not traveled abroad.
Examination revealed pain on flexion of the neck but no rigidity. There were nonfocal findings on neurologic examination, and the rest of the examination was unremarkable. The complete blood count showed 10,600 leukocytes, with 51 percent polymorphonuclear leukocytes, 1 percent bands, 36 percent lymphocytes, 4 percent monocytes, 6 percent eosinophils, and 2 percent basophils. The cerebrospinal fluid showed 3 erythrocytes and 215 leukocytes, with 68 percent lymphocytes, 16 percent monocytes, and 16 percent eosinophils.
Cerebrospinal fluid cultures were negative, but ceftriaxone was given empirically. The blood eosinophilia increased to 26 percent of 10,900 leukocytes on the third day of hospitalization. The boy's symptoms resolved over a period of six days, and thereafter he remained well.
Serologic tests for Toxocara canis and T. cati were negative. Serum IgG for Toxoplasma gondii was undetectable. On specific questioning, the boy admitted that he had, on a dare, eaten a raw snail from the street some weeks earlier. A serologic test for A. cantonensis was positive by enzyme immunoassay. (Dr. K.P. Hwang, Department of Parasitology, Kaohsiung Medical College, Taiwan, performed seroassays for A. cantonensis.)
The history of consumption of a raw snail was critical to the diagnosis. Although the species of snail could not be determined, many gastropods in New Orleans are competent hosts for A. cantonensis. 2 Reports of A. cantonensis in rats in New Orleans2 and in primates at the Audubon Zoo3 indicate that a reservoir of infection is present in New Orleans.
The patient recovered without treatment, as is usual. Anthelminic drugs have not been recommended for eosinophilic meningitis4 because of the risk of a reaction to the dying parasites; however, albendazole and levamisole have been used in Taiwan, with good results.5
A. cantonensis infection will probably not become highly endemic in North America, since raw gastropods are not a usual component of the American diet. In cases of eosinophilic meningitis on the Gulf coast, however, the diagnosis of A. cantonensis infection should be entertained and questions asked about the consumption of raw snails or slugs.
5 ReferencesDaniel New, M.D., M.P.H.&T.M.
SUNY at Stony Brook, Stony Brook, NY 11794M.D. Little, Ph.D.
Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112John Cross, Ph.D.
Uniformed Services University of the Health Sciences, Bethesda, MD 208891
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Qiao-Ping Wang, De-Hua Lai, Xing-Quan Zhu, Xiao-Guang Chen, Zhao-Rong Lun. (2008) Human angiostrongyliasis. The Lancet Infectious Diseases 8:10, 621-630
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Vincent Lo Re III, Stephen J. Gluckman. (2001) Eosinophilic Meningitis Due to Angiostrongylus cantonensis in a Returned Traveler: Case Report and Review of the Literature. Clinical Infectious Diseases 33:9, e112-e115
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Paul Prociv, David M. Spratt, Melissa S. Carlisle. (2000) Neuro-angiostrongyliasis: unresolved issues. International Journal for Parasitology 30:12-13, 1295-1303
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L. R. R. Costa, J. J. McClure, T. G. Snider III, T. B. Stewart. (2000) Verminous meningoencephalomyelitis by Angiostrongylus (=Parastrongylus) cantonensis in an American Miniature Horse. Equine Veterinary Education 12:1, 2-6
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Francis D. Pien, Brian C. Pien. (1999) Angiostrongylus cantonensis eosinophilic meningitis. International Journal of Infectious Diseases 3:3, 161-163
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Simpson, Thomas W., . (1995) More on Angiostrongylus cantonensis Infection. New England Journal of Medicine 333:13, 882-882
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