35F, 3 wks HA, paresthesias, ⬇️L hearing
Lived in Indonesia+Philippines past yr
LP: OP 25, 300 WBC (10%N, 60%L, 18%Eos), 5 RBC, prot 100
Altho any eos in CSF is abnl, eosinophilic meningitis is more precisely defined as presence of
Most define eos meningitis (EM): >=10 eos or >10% in CSF
🚨THREE key parasitic inf on the ddx for EosM🚨
Exhaustive list below fr our own Dr.Weller+adapted for UpToDate!
Let’s briefly review these top 3. Abbreviations for the following tweets!
🗺️=Classic endemic areas, but maps included with full distribution
RF = risk factors
Tx = Treatment
CDC life cycle images included
- Angiostrongylus cantonensis (rat lungworm)
🗺️SE Asia, Pacific Basin
🔹RF: Eat raw snail/slug, contaminated ground veggies, children play in dirt
🔹Larvae neurotropic-migrate to neuro, ocular tissue
🔹Severe HA, may need CSF removal for sxs
🔹Tx: supportive(larv die over time)
2. Baylisascariasis (roundworm)
🗺️Widely in US
🔹RF: ingestion of contaminated soil
🔹Migration to variety of tissues results in visceral larva migrains/ocular LM syndromes, similar to toxocariasis. EosM rare
🔹Tx: supportive vs. albendazole?
🔹RF: Eat raw fish, poultry
🔹Present:migratory cutaneous swelling, EosM, visceral mass
🔹🧠Larv penetrate/migrate up nerve➡️sudden severe radicular pain/HA➡️can cause cerebral hemorrhage
🔹Tx: Supportive. Utility CNS tx ? Cutane➡️Albend
Dx of these are difficult and primarily clinical — based on CSF eosinophilic pleocytosis +/- peripheral eosinophilia +/- exposures/the right history. Larvae are often not recovered and serologies rarely available outside of highly endemic areas
Other parasite eggs/larv can localize w/i CNS + elicit eos pleocytosis, such as:
Cerebral, spinal schisto
Cerebral, spinal paragonimiasis
For nonparasitic: Cocci, crypto
Noninfectious etiologies noted in tweet #2!
These infections/presentations are quite rare for us and often textbook reviews, but we know there are ID friends, @ID_fellows all over the globe on #IDTwitter. Let us know if you have tips or pearls for eosinophilic meningitis or these parasitic infections!!
CDC for life cycles