Meningococcal Disease Caused By Angiostrongylus Cantonensis

Illness caused by the nematode of Angiostrongylus cantonensis locates and causes disease in the meninges, invasion of the brain can lead to death.
The causative agent of meningitis
Adult worms live in the pulmonary artery of mice, worm eggs are laid in the blood, to the alveolar walls will form embryos within 6 days. The larvae hatch out along the bronchi, are swallowed by the rat in the gastrointestinal tract and out in the stool. The larvae can live for days in water, but die quickly when they are dry.
It is swallowed by snails living on land or snails on land and half underwater, it can actively crawl through the snail's skin to enter the body

. The most frequently infected snail species is Achatina fulica. In the muscles of snails, the worm develops to stage III larvae as the stage of infection. Shrimp, crabs or plate discs can swallow snails and worm infections So there have been cases after finishing eating snails died
When mice swallow snails, the larvae follow the bloodstream to the brain and quickly become young worms (after 7 hours) It stays here for about 2 weeks, then follows the blood flow to the lungs and matures at the pulmonary artery.
When people eat snails, raw vegetables (with worm larvae released when snails die), shrimp, crabs or leeches, the larvae will follow the bloodstream to the brain and brain membranes, causing inflammation.



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Epidemiology of meningitis caused by Angiostrongylus cantonensis
Parasites are found in the Far East, Southeast Asia, Australia, some Pacific Islands (Tahiti, New Caledonie, Hawaii ...), Cuba, Reunion, Côte d'Ivoire, Malaysia, Thailand, China, Australia. The disease is found in both North and South Vietnam
In Malaysia and Thailand, people are infected with worms by eating chopped Pila ampullaceal snails with lemon juice, salt, color and legumes In Tahiti, people are infected with worms by eating taioro shrimp water mixed with coconut milk. In Hawaii, people of Japanese descent eat raw snails for healing.
Clinical symptoms of meningitis caused by Angiostrongylus cantonensis
The disease may present either as an acute meningitis syndrome with clear or cloudy CSF, eosinophils, or as a brain tumor with symptoms of increased intracranial pressure.
The patient may have a severe headache, usually with a mild fever or without, only about 15% of patients have signs of meningeal irritation.



. After that, the headache subsides and heals randomly after a few days or weeks. Sometimes, patients with additional nerve palsy VII; visual acuity, paresthésie, paralysis or loss of tendon reflex. The patient may die, but this is unlikely.
Diagnosis of meningitis caused by Angiostrongylus cantonensis
- Periodic blood tests are necessary
Most cases of A cantonensis are difficult to diagnose with certainty because the worm cannot be captured as a gold standard diagnosis.
Perhaps a high specificity and accuracy test is needed to determine the cause diagnosis, unfortunately this is still ahead and in the research phase; Clinical practice of A. cantonensis disease is determined when the worms are caught in cerebrospinal fluid, which is rarely done.
Therefore, in the world, many indirect but specific diagnostic techniques such as immune serological techniques (precipitation reaction, passive erythrocyte agglutination, latex agglutination, absorption immunity) have been studied. enamel binding, radioimmune immunity, dual gel diffusion, ..



..)
Among them, the enzyme-absorbing immunity technique (ELISA) proved to be more suitable in the diagnosis of routine parasites in laboratories (due to the low cost of biological products, chemicals, simple manipulation and can self automation).
In addition, this technique can detect antibodies (Ab-ELISA) and circulating antigens (Ag-ELISA).
In order to contribute to the diagnosis of human infection with Angiostrongylus cantonensis, many ELISA kits have been developed to detect antibodies specific to A. cantonensis antigen (specific Ab-Ag), yeast-absorbing immunity technology. (ELISA) has been studied to diagnose many parasitic diseases, including A. cantonensis disease in humans.
A. cantonensis antigen at a concentration of 3 ng / ml binds to the antibody present in control serum (+) to form an antigen-antibody complex (Ag-Ab).



This complex was detected by the human IgG rabbit anti-IgG conjugate conjugated peroxydase in the presence of the substrate.
When severe can poke CSF fluid in cerebrospinal fluid, sometimes opaque, aseptic, albumin increased, 400-500 cells / mm3 of which 40-50% are calculated leukocytes. Very rarely see young worms in the cerebrospinal fluid.
- Endodontic response to Angiostrongylus antigen may be helpful in many cases.
Treatment of meningitis caused by Angiostrongylus cantonensis
- Symptomatic treatment: analgesic, aspirating cerebrospinal fluid to relieve pressure; anti-inflammatory drugs ... may be used in some cases
Prophylaxis of meningitis caused by Angiostrongylus cantonensis
- Avoid eating snails, shrimp, crabs, leeches in the live form.
- Eating habits sometimes make it difficult for people to follow the advice of a physician.



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Medical Group Anh Nga Parasitic Clinic
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SAI GON KST SPECIALIST SURVICE
SPECIALIST IN PREVENTION AND SPRING
Address: 402 An Duong Vuong, Ward 4, District 5, TP. HCM
TEL. 028.

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