Microbiology
Helminth (not to be confused with Hellmouth, where Sunnydale High located) aka roundworm includes A. cantonensis and A. costaricensis.
Epidemiologic Risks
Worldwide distribution; where there are rats and slugs/snails there is Angiostrongylus.
Humans are accidental hosts.
Angiostrongylus cantonensis (rat lungworm) is transmitted between rats and mollusks (slugs or snails). Other animals can become infected such as freshwater shrimp, land crabs, frogs, and planarians of the genus Platydemus that are transport hosts transmitting the infection to humans if eaten raw or undercooked. So avoid slug sushi, although on occasion there are chopped slugs in that lettuce melange on your sandwich.
In SE Asia associated with eating undercooked crabs, shellfish and snails. And raw, yes raw, frogs (PubMed). And raw, wait for it, centipedes (PubMed).
A. costaricensis cycles between rats and slugs.
There have been cases in both France, Tennessee, Texas, and Hawaii (Pubmed). Nice to know these parts of the world have something in common. I remember when my son was 2 he found a slug and et it before I could react.
In the US, besides eating slugs, eating fresh from the garden vegetables, and with it slugs, is a risk (PubMed).
40% of rats in New Orleans have it (PubMed), so be careful with that rat jambalaya.
Syndromes
A. cantonensis: eosinophilic meningitis (Review) and ocular disease. A big problem in SE Asia and the Carribean.
No serology and rare to get organisms on a smear, so a clinical diagnosis risks and LP findings, so consider other causes of eosinophilic meningitis.
A. costaricensis: eosinophilic gastroenteritis.
Treatment
A. cantonensis: mebendazole 100 mg po bid x 5 d or, perhaps best, albendazole 20 mg/kg PLUS dexamethasone 3 mg daily for 7 days (PubMed).
A. costaricensis: mebendazole 200-400 mg po tid x 10 d or thiabendazole 75 mg/kg divided tid x 3 d.
Steroids are perhaps more helpful than antibiotics.
Notes
Last update: 12/28/19