Clinical manifestations and outcome of patients with severe eosinophilic meningoencephalitis presumably caused by Angiostrongylus cantonensis

The clinical manifestations and outcome of patients with severe eosinophilic meningoencephalitis has never been reported. We reported 11 comatose patients with eosinophilic meningoencephalitis. Most of them presented with subacute to chronic headache and fever, followed by acute coma. Cerebrospinal fluid abnormalities were similar to alert patients with eosinophilic meningitis. None of them had received antihelmintic drug and seven patients were treated with corticosteroids. Ten patients died and one patient is still in a coma. Corticosteroids seem to be ineffective in severe eosinophilic meningitis.     

Evaluation of human IgG subclass antibodies in the serodiagnosis of angiostrongyliasis

Immunoglobulin G subclass antibody (IgG1, IgG2, IgG3, and IgG4) responses to the rat lungworm, Angiostrongylus cantonensis, were analyzed using the immunoblotting technique in an attempt to further improve the sensitivity and specificity for the serodiagnosis of human angiostrongyliasis. Serum samples from patients with proven angiostrongyliasis and from clinically suspected cases of angiostrongyliasis with eosinophilic meningitis were tested. Sera from patients with other parasitic illnesses and from healthy volunteers were also analyzed. The results indicate that the immunoblotting used to detect IgG4 antibodies to the antigenic band of an approximate molecular mass of 29 kDa from young adult somatic extract of A. cantonensis is the most reliable test. It gives accuracy, sensitivity, specificity, and positive and negative predictive values of 89.2%, 75%, 95%, 85.7% and 90.4%, respectively. More importantly, the test can discriminate between human angiostrongyliasis, gnathostomiasis and cysticercosis, three diseases that produce eosinophilic meningitis.     

Immunoblot evaluation of the specificity of the 29-kDa antigen from young adult female worms Angiostrongylus cantonensis for immunodiagnosis of human angiostrongyliasis

The antigenic components of Angiostrongylus cantonensis young adult female worm somatic extract (FSE) were revealed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting. The sera tested were from patients with proven angiostrongyliasis, other parasitic diseases, and healthy adults. Both the sera and cerebrospinal fluid (CSF) were tested from patients with clinical angiostrongyliasis. The CSF from patients with other neurological diseases were also included. Using SDS-PAGE, we found that the FSE comprised more than 30 polypeptides. Immunoblot analysis revealed at least 12 or 13 antigenic bands in patients with proven or clinical angiostrongyliasis, respectively. The patterns of reactivity recognized by the serum and CSF antibodies against FSE were similar. These antigenic components had molecular masses ranging from less than 14.4 to more than 94 kDa. The prominent antigenic band of 29-kDa might serve as a reliable marker for the diagnosis of angiostrongyliasis. The sensitivity, specificity, positive and negative predictive values of immunoblot analysis in this antigenic band were 55.6%, 99.4%, 83.3% and 97.4%, respectively.     

Abdominal angiostrongyliasis caused by Angiostrongylus cantonensis: A possible cause of eosinophilic infiltration in human digestive tract

We report the pathological findings of a serologically proven case of Angiostrongylus cantonensis presenting with localized peritonitis followed by eosinophilic meningoencephalitis. The neurological involvement developed 3 days after the occurrence of gastrointestinal symptoms. Similarly to the life cycle in rats, it takes about 2 or 3 days for the larvae to reach the nervous system. The pathological section of the sigmoid colon showed focal eosinophilic infiltration with serosal vessel invasion. In the case reported here, we describe a new possible cause of eosinophilic infiltration in the human digestive tract.     

Treatment of tuberculous meningitis with 6-month course of chemotherapy.

The results of a 6-month course of chemotherapy for treatment of 29 patients with tuberculous meningitis were analyzed. There were 7 patients in stage 1, 12 patients in stage 2 and 10 patients in stage 3. The result was recovery of 20 patients, death of 4 patients, while 4 patients were lost to the study and 1 patients dropped out from serious side effects. Three patients had residual neurological deficits.     

Benign form of herpes simplex encephalitis

A 34-year-old woman who presented with only severe headache for 12 days was reported. She was initially diagnosed with cerebral infarction of the right temporal lobe and treated with aspirin, without improvement. On admission, she had bilateral papilledema. Other findings were unremarkable. CT scan and MRI of the brain revealed an area of cerebritis at the right temporal lobe. Lumbar puncture showed high opening pressure with normal CSF profiles. The patient was treated with intravenous acyclovir which gave a favorable outcome.