ID Fellows Cup Question 24

Correct Answer: Angiostrongylus.

This question highlights a case of eosinophilic meningitis. Eosinophilic meningitis is defined as >10 eosinophils/mm3 in the CSF or >10% of CSF WBCs.

The differential diagnosis is relatively narrow and shown below.

Angiostrongylus catonensis is usually found in Southeast asia and the Pacific basin but may also be found in Australia, the Caribbean, Hawaii, and Louisiana. Primary risk factors include ingestion of raw or undercooked infected snails/slugs or exposure to snail/slug slime (can occur with uncleaned garden produce).

There is no specific treatment given self-limited course other than supportive care. Anthelminthic agents may elicit an inflammatory response due to dying organisms and exacerbation of neurologic symptoms.

Corticosteroids may relieve symptoms, one randomized trial demonstrated some improvement of headache and intracranial pressure.

Exposures to be aware of for other parasites:

  • Gnathostomiasis is associated with undercooked fish, poultry or snake meat. Primarily seen in Southeast Asia.
  • Baylisascaris is associated with ingestion of eggs shed by raccoons and dogs, usually contracted by playing in dirt. Primarily seen in the United States.

Question written by Nico Herrera at UAB

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This question was uploaded on 4/13/2022

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