Angiostrongylus cantonesis causes fever of unknown origin in children: a case report
Main Article Content
Abstract
Fever of unknown origin (FUO) in children is frequently caused by infectious diseases. Angiostrongylus cantonesis, while a primary cause of eosinophilic meningitis, is a rare cause of FUO. We report a 17-month-old patient admitted with FUO, no sign and symptom of meningococcal disease, but had elevated peripheral eosinophils count (32%). We performed lumbar puncture to find the cause of FUO. The results was greater than 2000 leukocytes/μl (32% eosinophils), Elisa serum and CSF was positive with Angiostrongylus cantonesis . The patient was diagnosed with eosinophilic meningitis caused by Angiostrongylus cantonesis and responded well with treatment. Conclusion: In young children, symptoms of parasites infections may be atypical. In children with FUO and elevated peripheral blood eosinophils, the physicians need to carefully review the medical history and examine patients to identify parasites infection, with special focus on central nervous system infection.
Article Details
Keywords
Fever of unknown origin (FUO), eosinophilic meningitis, Angiostrongylus cantonesis.
References
2. Marshall GS. Prolonged and recurrent fevers in children. Journal of Infection 2014; 68(Suppl 1): S83–93. doi: 10.1016/j.jinf.2013.09.017.
3. Catherine E.F, Erin G.N, Angela C.C, et al. Angiostrongylus cantonensis Infection: A Cause of Fever of Unknown Origin in Pediatric Patients. Infectious Diseases Society of America 2016;63(11): 1475 - 1478. doi:10.1093/cid/ciw606.
4. Monteiro MD, de Carvalho Neto EG, Dos Santos IP, et al. Eosinophilic meningitis outbreak related to religious practice. Parasitol Int 2020;78:102158. doi: 10.1016/j.parint.2020.102158.
5. Barratt J, Chan D, Sandaradura I, et al. Angiostrongylus cantonensis: a review of its distribution, molecular biology and clinical significance as a human pathogen. Parasitology 2016;143:1087. doi: 10.1017/S0031182016000652.
6. Tsai HC, Lee SS, Huang CK, et al. Outbreak of eosinophilic meningitis associated with drinking raw vegetable juice in southern Taiwan. Am J Trop Med Hyg 2004;71:222. DOI:10.4269/ajtmh.2004.71.222
7. Ansdell V, Kenton J, Jourdan K, et al. Guidelines for the diagnosis and treatment of neuroangiostrongyliasis: updated recommendations: updated recommendations. Parasitology 2021;148, 227–233. doi: 10.1017/S0031182020001262.
8. Joseph E. Angiostrongyliasis Cantonensis (Eosinophilic Meningitis): Historical Events in its Recognition as a New Parasitic Disease of Man. Journal of the Washington Academy of Sciences 1988;78(1): 38 - 46.
9. Waugh CA, Lindo JF, Lorenzo - Morales J, et al. An epidemiological study of A. cantonensis in Jamaica subsequent to an outbreak of human cases of eosinophilic meningitis in 2000. Parasitology 2016;143:1211. doi: 10.1017/S0031182016000640.
10. Wang QP, Lai DH, Zhu XQ, et al. Human angiostrongyliasis. The Lancet infectious diseases 2008;8(10): 621 - 630. doi: 10.1016/S1473 - 3099(08)70229 - 9.
11. Centers for Disease Control and Prevention. Parasites - Angiostrongyliasis (also known as Angiostrongylus Infection): Disease. https://www.cdc.gov/parasites/angiostrongylus/disease.html (Accessed on September 29, 2017).
12. Murphy GS and Johnson S. Clinical aspects of eosinophilic meningitis and meningoencephalitis caused by Angiostrongylus cantonensis, the rat lungworm. Hawaii J Med Public Health 2013,72: 35–4
13. Martinsa YC, Tanowitza HB, Kazacosb KR. Central nervous system manifestations of Angiostrongylus cantonensis infection. Acta Trop 2015;141PA: 46–53. doi: 10.1016/j.actatropica.2014.10.002
14. Chotmongkol V, Kittimongkolma S, Niwattayakul K, et al. Comparison of prednisolone plus albendazole with prednisolone alone for treatment of patients with eosinophilic meningitis. Am J Trop Med Hyg 2009;81:443.