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Parastrongyliasis (angiostrongyliasis) 

Parastrongyliasis (angiostrongyliasis)

Chapter:
Parastrongyliasis (angiostrongyliasis)
Author(s):

Richard Knight

DOI:
10.1093/med/9780199204854.003.070906_update_001

Update:

Epidemiology—recent epidemics of Parastrongylus cantonensis in China and South-East Asia; changes in geographic distribution.

Treatment—prednisolone alone now often the recommended treatment.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 28 March 2017

Parastrongylus cantonensis

The rat lungworm causes outbreaks of eosinophilic meningitis in parts of South-East Asia, East Asia, Oceania, and the Caribbean. Elsewhere the condition is usually seen in travellers. Human infections follow ingestion of uncooked molluscs, the primary intermediate hosts, or one of several paratenic hosts. Clinical manifestations include headache, meningism, vomiting, cranial nerve lesions, and (less commonly) other neurological features such as seizures. Ocular lesions are quite common. Diagnosis is made by lumbar puncture revealing eosinophilic meningitis, with larval or immature adult worms sometimes seen. Treatment is with albendazole together with prednisolone, or with prednisolone alone. Mortality is usually below 2%. Prevention is by avoidance of raw high-risk dietary items and unwashed salads.

Parastrongylus costaricensis

The cotton rat is the principal reservoir host. Unwitting ingestion of slugs, the intermediate hosts, in salads or fruit leads to human infections, especially in Costa Rica, Nicaragua, Guatemala, and Honduras. The organism causes granulomatous lesions of the right colon and sometimes the liver: most patients present with right-sided or right iliac fossa pain, with tenderness and sometimes a palpable mass. Diagnosis is usually made histologically on resected material. Surgery may be necessary, but the value of anthelminthics is uncertain. Preventive measures include washing and careful inspection of vegetables, and hand washing before meals by children and those preparing salads.

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