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Eosinophilic meningitis

Author
Peter F Weller, MD, FACP
Section Editor
Daniel J Sexton, MD
Deputy Editor
Elinor L Baron, MD, DTMH

INTRODUCTION

Eosinophilic meningitis is defined as the presence of more than 10 eosinophils/mm3 in the cerebrospinal fluid (CSF) and/or eosinophils accounting for more than 10 percent of CSF leukocytes [1]. Reliable detection of eosinophils in the CSF requires examination of centrifuged cell preparations stained with Wright's, Giemsa, or other appropriate stains. Eosinophils are found in the CSF in a limited number of diseases, including certain parasitic diseases and coccidioidal meningitis (table 1) [2-4]. The etiologies of eosinophilic meningitis will be reviewed here, with emphasis on the parasitic causes of this condition.

Some of the infectious agents that cause eosinophilic meningitis are parasites that are endemic outside of North America and Europe but have a global distribution due to travel. In addition, cases of eosinophilic meningitis due to these parasites may occur among travelers to both well-known and less known endemic regions [5-11].

PARASITIC ETIOLOGIES

There are three important parasitic infections associated with eosinophilic meningitis: Angiostrongylus cantonensis, Baylisascaris procyonis, and Gnathostoma spinigerum. These are parasites for which humans are incidental hosts. Localization to nervous tissue is a typical manifestation of A. cantonensis and B. procyonis infection for both natural and incidental hosts. G. spinigerum can cause meningeal or extrameningeal infection. In general, human infection due to these organisms is self-limited because larvae do not replicate or mature to adult worms. Eosinophilic meningitis occurs as a result of larval migration within the nervous system; peripheral eosinophilia is also observed.

Angiostrongylus cantonensis — A. cantonensis is the most common parasitic cause of eosinophilic meningitis. A. cantonensis larvae are neurotropic [12].

Epidemiology — Eosinophilic meningitis due to A. cantonensis occurs principally in Southeast Asia, particularly Thailand and Malaysia, and throughout the Pacific basin, including Indonesia, the Philippines, Taiwan, China, Japan, Papua New Guinea, Hawaii, and several smaller Pacific islands. Due in part to ship-borne dissemination of infected rats, the parasite has also been found outside of this broad area in regions of Africa, Australia, Cuba, Puerto Rico, and Jamaica and has spread from New Orleans into other areas of Louisiana [13-20].

                 

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Literature review current through: Nov 2016. | This topic last updated: Thu Sep 29 00:00:00 GMT+00:00 2016.
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References
Top
  1. Lo Re V 3rd, Gluckman SJ. Eosinophilic meningitis. Am J Med 2003; 114:217.
  2. Hughes PA, Magnet AD, Fishbain JT. Eosinophilic meningitis: a case series report and review of the literature. Mil Med 2003; 168:817.
  3. Weller PF. Eosinophilic meningitis. Am J Med 1993; 95:250.
  4. Graeff-Teixeira C, da Silva AC, Yoshimura K. Update on eosinophilic meningoencephalitis and its clinical relevance. Clin Microbiol Rev 2009; 22:322.
  5. Lo Re V 3rd, Gluckman SJ. Eosinophilic meningitis due to Angiostrongylus cantonensis in a returned traveler: case report and review of the literature. Clin Infect Dis 2001; 33:e112.
  6. Bärtschi E, Bordmann G, Blum J, Rothen M. Eosinophilic meningitis due to Angiostrongylus cantonensis in Switzerland. Infection 2004; 32:116.
  7. Górgolas Md, Santos-O'Connor F, Unzú AL, et al. Cutaneous and medullar gnathostomiasis in travelers to Mexico and Thailand. J Travel Med 2003; 10:358.
  8. Ramirez-Avila L, Slome S, Schuster FL, et al. Eosinophilic meningitis due to Angiostrongylus and Gnathostoma species. Clin Infect Dis 2009; 48:322.
  9. Malvy D, Ezzedine K, Receveur MC, et al. Cluster of eosinophilic meningitis attributable to Angiostrongylus cantonensis infection in French policemen troop returning from the Pacific Islands. Travel Med Infect Dis 2008; 6:301.
  10. Luessi F, Sollors J, Torzewski M, et al. Eosinophilic meningitis due to Angiostrongylus cantonensis in Germany. J Travel Med 2009; 16:292.
  11. Herman JS, Wall EC, van-Tulleken C, et al. Gnathostomiasis acquired by British tourists in Botswana. Emerg Infect Dis 2009; 15:594.
  12. 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.
  13. Koo J, Pien F, Kliks MM. Angiostrongylus (Parastrongylus) eosinophilic meningitis. Rev Infect Dis 1988; 10:1155.
  14. Kliks MM, Palumbo NE. Eosinophilic meningitis beyond the Pacific Basin: the global dispersal of a peridomestic zoonosis caused by Angiostrongylus cantonensis, the nematode lungworm of rats. Soc Sci Med 1992; 34:199.
  15. Campbell BG, Little MD. The finding of Angiostrongylus cantonensis in rats in New Orleans. Am J Trop Med Hyg 1988; 38:568.
  16. Hochberg NS, Park SY, Blackburn BG, et al. Distribution of eosinophilic meningitis cases attributable to Angiostrongylus cantonensis, Hawaii. Emerg Infect Dis 2007; 13:1675.
  17. Slom TJ, Cortese MM, Gerber SI, et al. An outbreak of eosinophilic meningitis caused by Angiostrongylus cantonensis in travelers returning from the Caribbean. N Engl J Med 2002; 346:668.
  18. Kim DY, Stewart TB, Bauer RW, Mitchell M. Parastrongylus (=Angiostrongylus) cantonensis now endemic in Louisiana wildlife. J Parasitol 2002; 88:1024.
  19. Senanayake SN, Pryor DS, Walker J, Konecny P. First report of human angiostrongyliasis acquired in Sydney. Med J Aust 2003; 179:430.
  20. Prociv P, Carlisle MS. The spread of Angiostrongylus cantonensis in Australia. Southeast Asian J Trop Med Public Health 2001; 32 Suppl 2:126.
  21. Escargots and eosinophilic meningitis. Lancet 1988; 2:320.
  22. 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.
  23. Chau TT, Thwaites GE, Chuong LV, et al. Headache and confusion: the dangers of a raw snail supper. Lancet 2003; 361:1866.
  24. Petjom S, Chaiwun B, Settakorn J, et al. Angiostrongylus cantonensis infection mimicking a spinal cord tumor. Ann Neurol 2002; 52:99.
  25. Morton NJ, Britton P, Palasanthiran P, et al. Severe hemorrhagic meningoencephalitis due to Angiostrongylus cantonensis among young children in Sydney, Australia. Clin Infect Dis 2013; 57:1158.
  26. Martins YC, Tanowitz HB, Kazacos KR. Central nervous system manifestations of Angiostrongylus cantonensis infection. Acta Trop 2015; 141:46.
  27. Tsai HC, Liu YC, Kunin CM, et al. Eosinophilic meningitis caused by Angiostrongylus cantonensis: report of 17 cases. Am J Med 2001; 111:109.
  28. Schmutzhard E, Boongird P, Vejjajiva A. Eosinophilic meningitis and radiculomyelitis in Thailand, caused by CNS invasion of Gnathostoma spinigerum and Angiostrongylus cantonensis. J Neurol Neurosurg Psychiatry 1988; 51:80.
  29. Kuberski T, Wallace GD. Clinical manifestations of eosinophilic memingitis due to Angiostrongylus cantonensis. Neurology 1979; 29:1566.
  30. Yii CY. Clinical observations on eosinophilic meningitis and meningoencephalitis caused by Angiostrongylus cantonensis on Taiwan. Am J Trop Med Hyg 1976; 25:233.
  31. Bronstein JA, Thevenot J, Tourneux M. Eosinophilic meningitis in Tahiti: clinical study of 54 patients. N Z Med J 1978; 88:491.
  32. Podwall D, Gupta R, Furuya EY, et al. Angiostrongylus cantonensis meningitis presenting with facial nerve palsy. J Neurol 2004; 251:1280.
  33. Lindo JF, Escoffery CT, Reid B, et al. Fatal autochthonous eosinophilic meningitis in a Jamaican child caused by Angiostrongylus cantonensis. Am J Trop Med Hyg 2004; 70:425.
  34. Punyagupta S, Juttijudata P, Bunnag T. Eosinophilic meningitis in Thailand. Clinical studies of 484 typical cases probably caused by Angiostrongylus cantonensis. Am J Trop Med Hyg 1975; 24:921.
  35. Patikulsila D, Ittipunkul N, Theerakittikul B. Intravitreal angiostrongyliasis: report of 2 cases. J Med Assoc Thai 2003; 86:981.
  36. Kumar V, Kyprianou I, Keenan JM. Ocular Angiostrongyliasis: removal of a live nematode from the anterior chamber. Eye (Lond) 2005; 19:229.
  37. Kanpittaya J, Sawanyawisuth K, Intapan PM, et al. A comparative study of neuroimaging features between human neuro-gnathostomiasis and angiostrongyliasis. Neurol Sci 2012; 33:893.
  38. Tsai HC, Liu YC, Kunin CM, et al. Eosinophilic meningitis caused by Angiostrongylus cantonensis associated with eating raw snails: correlation of brain magnetic resonance imaging scans with clinical findings. Am J Trop Med Hyg 2003; 68:281.
  39. Jin E, Ma D, Liang Y, et al. MRI findings of eosinophilic myelomeningoencephalitis due to Angiostrongylus cantonensis. Clin Radiol 2005; 60:242.
  40. Eamsobhana P, Yoolek A, Kreethapon N. Blinded multi-laboratory evaluation of an in-house dot-blot ELISA kit for diagnosis of human parastrongyliasis. Southeast Asian J Trop Med Public Health 2003; 34:1.
  41. Sawanyawisuth K, Sawanyawisuth K, Intapan PM, et al. Specificity of immunoblotting analyses in eosinophilic meningitis. Mem Inst Oswaldo Cruz 2011; 106:570.
  42. Chotmongkol V, Sawanyawisuth K, Thavornpitak Y. Corticosteroid treatment of eosinophilic meningitis. Clin Infect Dis 2000; 31:660.
  43. Chotmongkol V, Sawanyawisuth K. Clinical manifestations and outcome of patients with severe eosinophilic meningoencephalitis presumably caused by Angiostrongylus cantonensis. Southeast Asian J Trop Med Public Health 2002; 33:231.
  44. Chotmongkol V, Wongjitrat C, Sawadpanit K, Sawanyawisuth K. Treatment of eosinophilic meningitis with a combination of albendazole and corticosteroid. Southeast Asian J Trop Med Public Health 2004; 35:172.
  45. Hidelaratchi MD, Riffsy MT, Wijesekera JC. A case of eosinophilic meningitis following monitor lizard meat consumption, exacerbated by anthelminthics. Ceylon Med J 2005; 50:84.
  46. 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.
  47. Sawanyawisuth K, Sawanyawisuth K. Treatment of angiostrongyliasis. Trans R Soc Trop Med Hyg 2008; 102:990.
  48. Moore DA, McCroddan J, Dekumyoy P, Chiodini PL. Gnathostomiasis: an emerging imported disease. Emerg Infect Dis 2003; 9:647.
  49. Ligon BL. Gnathostomiasis: a review of a previously localized zoonosis now crossing numerous geographical boundaries. Semin Pediatr Infect Dis 2005; 16:137.
  50. Herman JS, Chiodini PL. Gnathostomiasis, another emerging imported disease. Clin Microbiol Rev 2009; 22:484.
  51. Magnino S, Colin P, Dei-Cas E, et al. Biological risks associated with consumption of reptile products. Int J Food Microbiol 2009; 134:163.
  52. Bussaratid V, Dekumyoy P, Desakorn V, et al. Predictive factors for Gnathostoma seropositivity in patients visiting the Gnathostomiasis Clinic at the Hospital for Tropical Diseases, Thailand during 2000-2005. Southeast Asian J Trop Med Public Health 2010; 41:1316.
  53. Punyagupta S, Bunnag T, Juttijudata P. Eosinophilic meningitis in Thailand. Clinical and epidemiological characteristics of 162 patients with myeloencephalitis probably caused by Gnathostoma spinigerum. J Neurol Sci 1990; 96:241.
  54. Boongird P, Phuapradit P, Siridej N, et al. Neurological manifestations of gnathostomiasis. J Neurol Sci 1977; 31:279.
  55. Kawamura J, Kohri Y, Oka N. Eosinophilic meningoradiculomyelitis caused by Gnathostoma spinigerum. A case report. Arch Neurol 1983; 40:583.
  56. Bunnag T, Comer DS, Punyagupta S. Eosinophilic myeloencephalitis caused by gnathostoma spinigerum. Neuropathology of nine cases. J Neurol Sci 1970; 10:419.
  57. Brant-Zawadzki M, Wofsy CB, Schechter G. CT-evidence of subarachnoid hemorrhage due to presumed gnathostomiasis. West J Med 1982; 137:65.
  58. Kraivichian K, Nuchprayoon S, Sitichalernchai P, et al. Treatment of cutaneous gnathostomiasis with ivermectin. Am J Trop Med Hyg 2004; 71:623.
  59. Katchanov J, Sawanyawisuth K, Chotmongkoi V, Nawa Y. Neurognathostomiasis, a neglected parasitosis of the central nervous system. Emerg Infect Dis 2011; 17:1174.
  60. Sawanyawisuth K, Tiamkao S, Nitinavakarn B, et al. MR imaging findings in cauda equina gnathostomiasis. AJNR Am J Neuroradiol 2005; 26:39.
  61. Sawanyawisuth K, Tiamkao S, Kanpittaya J, et al. MR imaging findings in cerebrospinal gnathostomiasis. AJNR Am J Neuroradiol 2004; 25:446.
  62. Bhende M, Biswas J, Gopal L. Ultrasound biomicroscopy in the diagnosis and management of intraocular gnathostomiasis. Am J Ophthalmol 2005; 140:140.
  63. Drugs for Parasitic Infections, 3rd Ed, The Medical Letter, New Rochelle, NY 2013.
  64. Thanaviratananich S, Thanaviratananich S, Ngamjarus C. Corticosteroids for parasitic eosinophilic meningitis. Cochrane Database Syst Rev 2015; :CD009088.
  65. Nontasut P, Claesson BA, Dekumyoy P, et al. Double-dose ivermectin vs albendazole for the treatment of gnathostomiasis. Southeast Asian J Trop Med Public Health 2005; 36:650.
  66. Bussaratid V, Krudsood S, Silachamroon U, Looareesuwan S. Tolerability of ivermectin in gnathostomiasis. Southeast Asian J Trop Med Public Health 2005; 36:644.
  67. Bussaratid V, Desakorn V, Krudsood S, et al. Efficacy of ivermectin treatment of cutaneous gnathostomiasis evaluated by placebo-controlled trial. Southeast Asian J Trop Med Public Health 2006; 37:433.
  68. Strady C, Dekumyoy P, Clement-Rigolet M, et al. Long-term follow-up of imported gnathostomiasis shows frequent treatment failure. Am J Trop Med Hyg 2009; 80:33.
  69. Fox AS, Kazacos KR, Gould NS, et al. Fatal eosinophilic meningoencephalitis and visceral larva migrans caused by the raccoon ascarid Baylisascaris procyonis. N Engl J Med 1985; 312:1619.
  70. Sircar AD, Abanyie F, Blumberg D, et al. Raccoon Roundworm Infection Associated with Central Nervous System Disease and Ocular Disease - Six States, 2013-2015. MMWR Morb Mortal Wkly Rep 2016; 65:930.
  71. Roussere GP, Murray WJ, Raudenbush CB, et al. Raccoon roundworm eggs near homes and risk for larva migrans disease, California communities. Emerg Infect Dis 2003; 9:1516.
  72. Eberhard ML, Nace EK, Won KY, et al. Baylisascaris procyonis in the metropolitan Atlanta area. Emerg Infect Dis 2003; 9:1636.
  73. Bauer C. [Baylisascariosis (Baylisascaris procyonis)--a rare parasitic zoonosis in Europe]. Berl Munch Tierarztl Wochenschr 2011; 124:465.
  74. Popiołek M, Szczęsna-Staśkiewicz J, Bartoszewicz M, et al. Helminth parasites of an introduced invasive carnivore species, the raccoon ( Procyon lotor L.), from the Warta Mouth National Park (Poland). J Parasitol 2011; 97:357.
  75. Centers for Disease Control and Prevention (CDC). Raccoon roundworms in pet kinkajous--three states, 1999 and 2010. MMWR Morb Mortal Wkly Rep 2011; 60:302.
  76. Huff DS, Neafie RC, Binder MJ, et al. Case 4. The first fatal Baylisascaris infection in humans: an infant with eosinophilic meningoencephalitis. Pediatr Pathol 1984; 2:345.
  77. Cunningham CK, Kazacos KR, McMillan JA, et al. Diagnosis and management of Baylisascaris procyonis infection in an infant with nonfatal meningoencephalitis. Clin Infect Dis 1994; 18:868.
  78. Mets MB, Noble AG, Basti S, et al. Eye findings of diffuse unilateral subacute neuroretinitis and multiple choroidal infiltrates associated with neural larva migrans due to Bbaylisascaris procyonis. Am J Ophthalmol 2003; 135:888.
  79. Sorvillo F, Ash LR, Berlin OG, Morse SA. Baylisascaris procyonis: an emerging helminthic zoonosis. Emerg Infect Dis 2002; 8:355.
  80. Kelly TG, Madhavan VL, Peters JM, et al. Spinal cord involvement in a child with raccoon roundworm (Baylisascaris procyonis) meningoencephalitis. Pediatr Radiol 2012; 42:369.
  81. Wise ME, Sorvillo FJ, Shafir SC, et al. Severe and fatal central nervous system disease in humans caused by Baylisascaris procyonis, the common roundworm of raccoons: a review of current literature. Microbes Infect 2005; 7:317.
  82. Dangoudoubiyam S, Vemulapalli R, Ndao M, Kazacos KR. Recombinant antigen-based enzyme-linked immunosorbent assay for diagnosis of Baylisascaris procyonis larva migrans. Clin Vaccine Immunol 2011; 18:1650.
  83. Murray WJ, Kazacos KR. Raccoon roundworm encephalitis. Clin Infect Dis 2004; 39:1484.
  84. Gavin PJ, Kazacos KR, Shulman ST. Baylisascariasis. Clin Microbiol Rev 2005; 18:703.
  85. Robinson A, Tannier C, Magnaval JF. [Toxocara canis meningoradiculitis]. Rev Neurol (Paris) 2002; 158:351.
  86. Bottieau E, David P, Dewitte O, Jacobs F. Eosinophilic meningitis following incomplete resection of a meningeal hydatid cyst. Scand J Infect Dis 2003; 35:898.
  87. Weller PF, Liu LX. Eosinophilic meningitis. Semin Neurol 1993; 13:161.
  88. Xia Y, Ju Y, Chen J, You C. Cerebral paragonimiasis: a retrospective analysis of 27 cases. J Neurosurg Pediatr 2015; 15:101.
  89. Niggemann B, Bauer A, Jendroska K, Wahn U. Latex allergy as a cause of eosinophilia in cerebrospinal fluid in a child with a ventricular shunt. J Allergy Clin Immunol 1997; 100:849.
  90. Moore PM, Harley JB, Fauci AS. Neurologic dysfunction in the idiopathic hypereosinophilic syndrome. Ann Intern Med 1985; 102:109.
  91. Quinn JP, Weinstein RA, Caplan LR. Eosinophilic meningitis and ibuprofen therapy. Neurology 1984; 34:108.
  92. Asperilla MO, Smego RA Jr. Eosinophilic meningitis associated with ciprofloxacin. Am J Med 1989; 87:589.
  93. Patey O, Lacheheb A, Dellion S, et al. A rare case of cotrimoxazole-induced eosinophilic aseptic meningitis in an HIV-infected patient. Scand J Infect Dis 1998; 30:530.
  94. Grabb PA, Albright AL. Intraventricular vancomycin-induced cerebrospinal fluid eosinophilia: report of two patients. Neurosurgery 1992; 30:630.
  95. Mine S, Sato A, Yamaura A, et al. Eosinophilia of the cerebrospinal fluid in a case of shunt infection: case report. Neurosurgery 1986; 19:835.
  96. Traynelis VC, Powell RG, Koss W, et al. Cerebrospinal fluid eosinophilia and sterile shunt malfunction. Neurosurgery 1988; 23:645.
  97. Kennedy CR, Singer HS. Eosinophilia of the cerebrospinal fluid: late reaction to a silastic shunt. Dev Med Child Neurol 1988; 30:386.
  98. Tung H, Raffel C, McComb JG. Ventricular cerebrospinal fluid eosinophilia in children with ventriculoperitoneal shunts. J Neurosurg 1991; 75:541.
  99. Scott TF. A new cause of cerebrospinal fluid eosinophilia: neurosarcoidosis. Am J Med 1988; 84:973.
  100. Sivalingam S, Corkill G, Ellis WG, Claiche JR. Focal eosinophilic granuloma of the temporal lobe. Case report. J Neurosurg 1977; 47:941.