RESUMEN
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.
Asunto(s)
Eosinofilia/diagnóstico , Hiperestesia/diagnóstico , Meningitis/diagnóstico , Cuadriplejía/diagnóstico , Infecciones por Strongylida/diagnóstico , Retención Urinaria/diagnóstico , Corticoesteroides/uso terapéutico , Albendazol/uso terapéutico , Angiostrongylus cantonensis/efectos de los fármacos , Angiostrongylus cantonensis/patogenicidad , Angiostrongylus cantonensis/fisiología , Animales , Antihelmínticos/uso terapéutico , Diagnóstico Diferencial , Eosinofilia/tratamiento farmacológico , Eosinofilia/parasitología , Eosinofilia/patología , Humanos , Hiperestesia/tratamiento farmacológico , Hiperestesia/parasitología , Hiperestesia/patología , Imagen por Resonancia Magnética , Masculino , Meningitis/tratamiento farmacológico , Meningitis/parasitología , Meningitis/patología , Prednisolona/uso terapéutico , Cuadriplejía/tratamiento farmacológico , Cuadriplejía/parasitología , Cuadriplejía/patología , Índice de Severidad de la Enfermedad , Infecciones por Strongylida/tratamiento farmacológico , Infecciones por Strongylida/parasitología , Infecciones por Strongylida/patología , Retención Urinaria/tratamiento farmacológico , Retención Urinaria/parasitología , Retención Urinaria/patología , Adulto JovenAsunto(s)
Ascariasis/diagnóstico , Retención Urinaria/diagnóstico , Retención Urinaria/parasitología , Adulto , Albendazol/uso terapéutico , Animales , Antihelmínticos/uso terapéutico , Ascariasis/complicaciones , Ascariasis/tratamiento farmacológico , Ascaris lumbricoides/aislamiento & purificación , Femenino , Humanos , Resultado del Tratamiento , Cateterismo UrinarioRESUMEN
Child meningomyeloradiculitis is a rare complication form of schistosomiasis, even in hyperendemic area. Its diagnosis is very difficult, especially if there are not history or signs of Schistosoma mansoni or hematobium infections. It must be evocated in case of acute flask paralysis occurring in children living in Schistosoma infections endemic area. The authors report a 14-year-old boy's case and suggest etiopathogeny of the disease.