Introduction
In endemic areas, eosinophilic meningitis is mainly caused by Angiostrongylus cantonensis. We describe a series of this poorly-known condition.
Methods
Retrospective cohort study (2000–2012) including all patients diagnosed with eosinophilic meningitis in French Polynesia.
Results
Forty-two patients (males: 61.9%, age: 22 (IQR 17–32)) were diagnosed with a serologically proven (n = 13) or probable A. cantonensis meningitis, mostly during the dry season (66.6%) and following the consumption of or prolonged contact with an intermediate/paratenic host (64.3%). No differential diagnosis was found in probable cases, in whom serological tests were performed earlier (7.5 days (6.5–10)) compared to positive patients (7.5 (6.5–10) versus 11 (7–30) days, p = 0.02). The most commonly reported symptom was headache (92.8%). Fever (7.1%) and biological inflammatory syndrome (14.3%) were rare. Blood eosinophil count was 1200/mm3 (900–2548). Cerebrospinal fluid (CSF) analysis disclosed a protein level of 0.9 g/L (0.7–1.1), a CSF/plasma glucose ratio of 0.50 (0.40–0.55), and 500 leucocytes/mm3 (292–725; eosinophils: 42.0% (29.5–60); lymphocytes: 46.5% (32.5–59.0)). Thirteen cases (31.0%) were severe, with 11 focal neurological deficits. A delayed hospital referral (OR 1.13, p = 0.05) was associated with severity.
Conclusions
A. cantonensis meningitis must be evocated in young patients with meningitic syndrome, severe headache, and CSF inflammation with predominance of eosinophils.
IntroductionIn endemic areas, eosinophilic meningitis is mainly caused by Angiostrongylus cantonensis. We describe a series of this poorly-known condition.MethodsRetrospective cohort study (2000–2012) including all patients diagnosed with eosinophilic meningitis in French Polynesia.ResultsForty-two patients (males: 61.9%, age: 22 (IQR 17–32)) were diagnosed with a serologically proven (n = 13) or probable A. cantonensis meningitis, mostly during the dry season (66.6%) and following the consumption of or prolonged contact with an intermediate/paratenic host (64.3%). No differential diagnosis was found in probable cases, in whom serological tests were performed earlier (7.5 days (6.5–10)) compared to positive patients (7.5 (6.5–10) versus 11 (7–30) days, p = 0.02). The most commonly reported symptom was headache (92.8%). Fever (7.1%) and biological inflammatory syndrome (14.3%) were rare. Blood eosinophil count was 1200/mm3 (900–2548). Cerebrospinal fluid (CSF) analysis disclosed a protein level of 0.9 g/L (0.7–1.1), a CSF/plasma glucose ratio of 0.50 (0.40–0.55), and 500 leucocytes/mm3 (292–725; eosinophils: 42.0% (29.5–60); lymphocytes: 46.5% (32.5–59.0)). Thirteen cases (31.0%) were severe, with 11 focal neurological deficits. A delayed hospital referral (OR 1.13, p = 0.05) was associated with severity.ConclusionsA. cantonensis meningitis must be evocated in young patients with meningitic syndrome, severe headache, and CSF inflammation with predominance of eosinophils.
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