Early migration and pathogenicity of Angiostrongylus cantonensis in laboratory rats

Host transmission dynamics of first- and third-stage Angiostrongylus cantonensis larvae in Bullastra lessoni

Given the importance of angiostrongyliasis as an emerging infectious disease of humans, companion animals, and wildlife, the current study focused on the transmission dynamics of first- and third-stage larvae of the parasitic nematode, Angiostrongylus cantonensis. The migration of infective larvae and their subsequent distribution within the Lymnaeidae snail, Bullastra lessoni, were investigated over time using microscopic examination of histological sections and fresh tissue. Snails were divided into four anatomical regions: (i) anterior and (ii) posterior cephalopedal masses, (iii) mantle skirt and (iv) visceral mass. The viability of free-swimming third-stage larvae, after their release from snail tissues, was evaluated in vitro by propidium iodide staining and infectivity by in vivo infection of Wistar rats. Snails were sequentially dissected over time to assess the number and anatomical distribution of larvae within each snail and hence infer their migration pathway. Herein, ongoing larval migratory activity was detected over 28 days post-infection. A comparison of infection rates and the larval distribution within the four designated snail regions demonstrated a significant relationship between anatomical region and density of infective larvae, with larvae mostly distributed in the anterior cephalopedal mass (43.6 ± 10.8%) and the mantle skirt (33.0 ± 8.8%). Propidium iodide staining showed that free-swimming third-stage larvae retained viability for between 4 and 8 weeks when stored under laboratory conditions. In contrast to viability, larval infectivity in rats remained for up to 2 weeks only. Knowledge gained from the current work could provide information on the development of new approaches to controlling the transmission of this parasite.

Guidelines for the diagnosis and treatment of neuroangiostrongyliasis: updated recommendations

A subcommittee of the Hawaii Governor's Joint Task Force on Rat Lungworm Disease developed preliminary guidelines for the diagnosis and treatment of neuroangiostrongyliasis (NAS) in 2018 (Guidelines, 2018). This paper reviews the main points of those guidelines and provides updates in areas where our understanding of the disease has increased. The diagnosis of NAS is described, including confirmation of infection by real-time polymerase chain reaction (RTi-PCR) to detect parasite DNA in the central nervous system (CNS). The treatment literature is reviewed with recommendations for the use of corticosteroids and the anthelminthic drug albendazole. Long-term sequelae of NAS are discussed and recommendations for future research are proposed.

Role of Gastropod Mucus in the Transmission of Angiostrongylus cantonensis, a Potentially Serious Neurological Infection

Angiostrongylus cantonensis, the rat lungworm, is endemic to Hawaii. A recent increase in the number of cases has drawn intense local and national media attention. As a result there is an increased fear of acquiring the disease from local produce, which has the potential to adversely affect the income of local farmers. The most common means of transmission is by the ingestion of an infected intermediate host. Other modes of transmission have been suggested including infectious larvae being released into the mucus trail of gastropods. This literature review indicates that mucus trails from infected gastropods poses a minimal risk to humans.

Species of Angiostrongylus (Nematoda: Metastrongyloidea) in wildlife: A review

Twenty-one species of Angiostrongylus plus Angiostrongylus sp. (Nematoda: Metastrongyloidea) are known currently in wildlife. These occur naturally in rodents, tupaiids, mephitids, mustelids, procyonids, felids, and canids, and aberrantly in a range of avian, marsupial and eutherian hosts including humans. Adults inhabit the pulmonary arteries and right atrium, ventricle and vena cava, bronchioles of the lung or arteries of the caecum and mesentery. All species pass first-stage larvae in the faeces of the host and all utilise slugs and/or aquatic or terrestrial snails as intermediate hosts. Gastropods are infected by ingestion or penetration of first-stage larvae; definitive hosts by ingestion of gastropods or gastropod slime. Transmission of at least one species may involve ingestion of paratenic hosts. Five developmental pathways are identified in these life cycles. Thirteen species, including Angiostrongylus sp., are known primarily from the original descriptions suggesting limited geographic distributions. The remaining species are widespread either globally or regionally, and are continuing to spread. Small experimental doses of infective larvae (ca. 20) given to normal or aberrant hosts are tolerated, although generally eliciting a granulomatous histopathological response; large doses (100-500 larvae) often result in clinical signs and/or death. Two species, A. cantonensis and A. costaricensis, are established zoonoses causing neurological and abdominal angiostrongliasis respectively. The zoonotic potential of A. mackerrasae, A. malaysiensis and A. siamensis particularly warrant investigation. Angiostrongylus cantonensis occurs in domestic animals, mammalian and avian wildlife and humans in the metropolitan areas of Brisbane and Sydney, Australia, where it has been suggested that tawny frogmouths and brushtail possums may serve as biosentinels. A major conservation issue is the devastating role A. cantonensis may play around zoos and fauna parks where captive rearing of endangered species programmes may exist and where Rattus spp. are invariably a problem.

Twenty two cases of canine neural angiostrongylosis in eastern Australia (2002-2005) and a review of the literature

Cases of canine neural angiostrongylosis (NA) with cerebrospinal fluid (CSF) evaluations in the peer-reviewed literature were tabulated. All cases were from Australia. A retrospective cohort of 59 dogs was contrasted with a series of 22 new cases where NA was diagnosed by the presence of both eosinophilic pleocytosis and anti-Angiostrongylus cantonensis immunloglobulins (IgG) in CSF, determined by ELISA or Western blot. Both cohorts were drawn from south east Queensland and Sydney. The retrospective cohort comprised mostly pups presented for hind limb weakness with hyperaesthesia, a mixture of upper motor neurone (UMN) and lower motor neurone (LMN) signs in the hind limbs and urinary incontinence. Signs were attributed to larval migration through peripheral nerves, nerve roots, spinal cord and brain associated with an ascending eosinophilic meningo-encephomyelitis. The contemporary cohort consisted of a mixture of pups, young adult and mature dogs, with a wider range of signs including (i) paraparesis/proprioceptive ataxia (ii) lumbar and tail base hyperaesthesia, (iii) multi-focal central nervous system dysfunction, or (iv) focal disease with neck pain, cranial neuropathy and altered mentation. Cases were seen throughout the year, most between April and July (inclusive). There was a preponderance of large breeds. Often littermates, or multiple animals from the same kennel, were affected simultaneously or sequentially. A presumptive diagnosis was based on consistent signs, proximity to rats, ingestion/chewing of slugs or snails and eosinophilic pleocytosis. NA was diagnosed by demonstrating anti-A. cantonensis IgG in CSF. Detecting anti-A. cantonensis IgG in serum was unhelpful because many normal dogs (20/21 pound dogs; 8/22 of a hospital population) had such antibodies, often at substantial titres. Most NA cases in the contemporary series (19/22) and many pups (16/38) in the retrospective cohort were managed successfully using high doses of prednisolone and opioids. Treatment often included antibiotics administered in case protozoan encephalomyelitis or translocated bacterial meningitis was present. Supportive measures included bladder care and physiotherapy. Several dogs were left with permanent neural deficits. Dogs are an important sentinel species for NA. Human cases and numerous cases in tawny frogmouths were reported from the same regions as affected dogs over the study period.

Trichobilharzia regenti: host immune response in the pathogenesis of neuroinfection in mice

Besides their natural bird hosts, Trichobilharzia regenti cercariae are able to penetrate skin of mammals, including humans. Experimental infections of mice showed that schistosomula of this species are able to avoid the immune response in skin of their non-specific mammalian host and escape the skin to migrate to the CNS. Schistosomula do not mature in mammals, but can survive in nervous tissue for several days post infection. Neuroinfections of specific bird hosts as well as accidental mammalian hosts can lead to neuromotor effects, for example, leg paralysis and thus this parasite serves as a model of parasite invasion of the CNS. Here, we show by histological and immunohistochemical investigation of CNS invasion of immunocompetent (BALB/c) and immunodeficient (SCID) mice by T. regenti schistosomula that the presence of parasites in the nervous tissue initiated an influx of immune cells, activation of microglia, astrocytes and development of inflammatory lesions. Schistosomula elimination in the tissue depended on the host immune status. In the absence of CD3+ T-cells in immunodeficient SCID mice, parasite destruction was slower than that in immunocompetent BALB/c mice. Axon injury and subsequent secondary demyelination in the CNS were associated with mechanical damage due to migration of schistosomula through the nervous tissue, and not by host immune processes. Immunoreactivity of the parasite intestinal content for specific antigens of oligodendrocytes/myelin and neurofilaments showed for the first time that schistosomula ingest the nervous tissue components during their migration.

Larvicidal activities of ginger (Zingiber officinale) against Angiostrongylus cantonensis

In this study, we investigated the anthelmintic activity of [6]-gingerol, [10]-shogaol, [10]-gingerol, [6]-shogaol and hexahydrocurcumin, a constituent isolate from the roots of ginger (Zingiber officinale), for the parasite Angiostrongylus cantonensis. This study found that the above constituents killed A. cantonensis larvae or reduced their spontaneous movements in a time- and dose-dependent manner. The larvicidal effect or ability to halt spontaneous parasite movement of [10]-shogaol, [6]-gingerol, [10]-gingerol, [6]-shogaol and hexahydrocurcumin at various concentrations was reached from 24 to 72 h, respectively. Further investigation to determine minimal effective doses of [10]-gingerol and hexahydrocurcumin revealed [10]-gingerol to have a greater maximum larvicidal effect and loss of spontaneous movements than hexahydrocurcumin, mebendazole and albendazole. These constituents of ginger showed effects against DPPH and peroxyl radical under larvicidal effect. Together, these findings suggest that these constituents of ginger might be used as larvicidal agents against A. cantonensis.

Matrix metalloproteinase-2 and -9 in the granulomatous fibrosis of rats infected with Angiostrongylus cantonensis

The histomorphology of granuloma formation and gelatinase production were investigated in the brains, hearts, lungs and livers of Sprague-Dawley rats infected with Angiostrongylus cantonensis. The relationships between two gelatinases and granulomatous fibrosis were explored, following infection of each rat with 60 infective larvae of the nematode. Worm recovery from the brain was maximal on day 15 post-inoculation whereas peak recovery from the lungs was maximal 75 days later, on day 90. The granulomatous reactions and fibrosis were marked in the lungs but only mild, if present at all, in the brain, heart and liver. Gelatin zymography revealed that matrix metalloproteinase2 (MMP-2) was present, at all time-points, in the heart and lungs, although only in the lungs was there partial conversion of the 72-kDa pro-enzyme to the 64-kDa active form during granulomatous fibrosis. The activity of the MMP-9 pro-enzyme was significantly higher at the time-points when granuloma formation was observed than at other times. Immuno-histochemistry revealed MMP-2 and MMP-9 within the lung granulomas, around infiltrating leucocytes and the epithelial cells of the alveoli. As the granulomatous fibrosis appeared to be strongly associated with MMP-2 and MMP-9, these enzymes may be useful markers in the lungs of rats infected with A. cantonensis.

Association of matrix metalloproteinase-9 and Purkinje cell degeneration in mouse cerebellum caused by Angiostrongylus cantonensis

Angiostrongylosis is a neurological disorder caused by invasion of the central nervous system by developing larvae of Angiostrongylus cantonensis. Purkinje cells in infected mouse cerebellums are small and irregular with degenerative atrophy or partial loss. Ultrastructural changes in degenerative cells included enlarged vacuolar structures and swollen mitochondria within the cytoplasm. The matrix metalloproteinase-9 mRNA which is low in normal cerebellums was expressed in A. cantonensis-infected mice cerebellum prior to Purkinje cell degeneration. Matrix metalloproteinase-9 protein level and enzyme activity increased when the Purkinje cells appeared degenerated. Using immunohistochemistry, matrix metalloproteinase-9 was localised within degenerative Purkinje cells. In addition, when the specific matrix metalloproteinase inhibitor, GM6001, was added, matrix metalloproteinase-9 enzyme activity was reduced by 41.6%. The numbers of degenerative Purkinje cells increased significantly upon establishment of infection but subsided upon inhibition. These results suggested that the expression of matrix metalloproteinase-9 may be associated with degeneration of Purkinje cells in mouse cerebellum infected by A. cantonensis.

Neural angiostrongylosis in three captive rufous bettongs (Aepyprymnus rufescens)

Neurological disease attributed to migration of the rat lungworm (Angiostrongylus cantonensis), is described in three captive rufous bettongs (Aepyprymnus rufescens). Clinical signs, including ascending paralysis and multifocal neurological deficits, were similar to those seen in other species. Histologically, the severity of meningoencephalomyelitis ranged from mild to moderate. In one animal cerebrospinal fluid contained a high percentage of eosinophils but peripheral blood cell counts were within normal limits. Treatment with dexamethasone, diazepam and vitamin E was unsuccessful. The prognosis for bettongs with this disease is poor. The susceptibility of this species to this disease has implications for enclosure design.

Antigen dependent release of interleukin 5 in vitro from spleen cells of mice infected with Angiostrongylus cantonensis

The kinetics of eosinophil growth and/or survival stimulating factors (Eo-stimulating factors) released by spleen cells from A. cantonensis-infected mice were assessed by in vitro marrow cultures. When spleen cells from C57BL/6 mice 8 to 20 days p.i. were cultured with young adult A. cantonensis worm antigen or Con A, almost equal amounts of Eo-stimulating factors were detected in the conditioned media obtained from both stimulations. No Eo-stimulating factor activity was detected in cultures from spleen cells without stimulation or from normal spleen cells with stimulation. Production of Eo-stimulating factors was inhibited by the pretreatment of the spleen cells with anti-Thy1.2 or anti-L3T4 antibodies plus complement but not with anti-Lyt2.2 antibody. In the presence of anti-mouse IL-5 monoclonal antibody, the activity of Eo-stimulating factors was inhibited by up to 99%. IL-5, therefore, appears to play a principal role in induction of eosinophilia in mice infected with A. cantonensis.

Experimental infection routes of Angiostrongylus cantonensis in mice

Stomach intubation is the most common method used in the experimental infection of animals with Angiostrongylus cantonensis. In order to compare the effectiveness of other possible transmission methods, groups of BALB/c mice were given infective third-stage larvae of A. cantonensis by different routes including intraperitoneal or subcutaneous injections, and penetration of anal mucosa, vaginal mucosa, conjunctival mucosa, lacerated skin, unabraded skin, foot pad and tail skin, while stomach intubation was used as control. Recovery of fifth-stage larvae was higher in mice inoculated with third-stage larvae subcutaneously. Successful infections were established through all experimental transmission routes except tail skin penetration. This study suggests that oral infection may not be the only route for the transmission of human angiostrongyliasis, and subcutaneous infection may be a better method for experimental infection.

Pathogenic factors in the later pulmonary phase of Angiostrongylus cantonensis-infected rats

In rats infected with different worm burdens of Angiostrongylus cantonensis, the loss of body weight was proportional to the increasing dose of infection. Body weight was correlated inversely with female worm burden (r = -0.669), the sum of mean numbers of larvae per gram of faeces (LPG) (r = -0.527) and lung weight (r = -0.761). Lung weight was positively correlated with female worm burden (r = 0.785) and the sum of mean numbers of LPG (r = 0.685). On the other hand, in rats infected with larvae developed from gamma-irradiated first-stage larvae (Experiment B) or infected rats treated with the drug ivermectin (Experiment C), body weight was inversely correlated with the sum of mean numbers of LPG (r = -0.798, Experiment B; r = -0.670, Experiment C) and lung weight (r = -0.862, Experiment B; r = -0.812, Experiment C), but not with female worm burden. Furthermore, lung weight was positively correlated with the sum of mean numbers of LPG (r = -0.783, Experiment B; r = 0.899, Experiment C), but not with the female worm burden. From these results, it is concluded that in the later pulmonary phase of infection in rats the pathogenic effects may be closely related to the increasing number of first-stage larvae produced by female worms.

Immunological regulation of Angiostrongylus cantonensis infections in rats: modulation of population density and enhanced parasite growth following one or two superimposed infections

Rats acquired a degree of protective immunity to reinfection with Angiostrongylus cantonensis after a single infection with 50 infective larvae. Infected rats resisted the establishment of most challenging larvae and protective immunity increased with subsequent reinfections. Part of the primary infection was lost after a superimposed second and also following a superimposed third infection, but the total size of the concurrent adult worm populations remained the same as that from a primary infection. Worms surviving from the primary infection showed enhanced growth after each reinfection but their fecundity was impaired.

The course of Angiostrongylus cantonensis infection in athymic nude and neonatally thymectomized mice

BALB/c athymic nude and thymus-reconstituted nude mice and neonatally thymectomized BALB/c mice were infected with stage 3 larvae of Angiostrongylus cantonensis and the worm burdens of the mice were determined at various times after infection. When the nude and thymectomized mice were exposed to the parasite, some worms were found to migrate from the brain to lungs but died there without reaching maturity. This pulmonary arterial migration of the worms in the nude did not occur following thymic reconstitution. These data suggest that the inability of murine intracranial worms to migrate to the lungs is at least in part due to thymus-dependent mechanisms, and also that the failure of worm maturation in mouse lungs might be due to thymus-independent immune mechanisms and/or nonimmunological mechanisms.

Phospholipase B in the brains and meninges of nonsensitized and sensitized rats after challenge with Angiostrongylus cantonensis

After a primary infection with 100 Angiostrongylus cantonensis larvae, infected rats showed elevated phospholipase B activity in meningeal and brain homogenates beginning with the first week and continuing through the first month of infection. The rise in phospholipase B values through the first 4 weeks, with a prolonged peak spanning days 30 to 31, coincided with the invasion and maturation of the parasites in the brain, and the ensuing sharp decline in phospholipase B levels, shown by the readings on day 45, coincided in turn with the known migration of the worms from the brain to the lungs, which begins about 5 weeks after infection. In the meninges, the pattern of enzyme elevation was generally similar to that in the brain samples except that the highest activity was seen earlier at days 8 to 9, followed by a gradual decline by days 30 to 31 and a sharper drop by day 45. Rats challenged with 100 larvae 53 days after the primary infection exhibited an almost immediate rise of phospholipase B activity in both the brain and meninges; the peaks of activity occurred at day 1 for the meninges and day 25 for the brain, and levels above control values were still present at day 50. Comparison of the total enzymatic content of the cerebral tissue and meninges revealed that a remarkably high proportion of the phospholipase B activity was contained in the meninges. The inference that elevated levels of this enzyme in the cerebral tissue of A. cantonensis-infected rats are due to inflammatory reactions within the meningeal envelopes was confirmed by histochemical demonstration of specific sites of enzymatic activity limited to the meninges. It is of interest that 80% of the cells positive for the enzyme were clearly identifiable as eosinophils since an association of bone marrow eosinophilia and high phospholipase B levels in rats infected with A. cantonensis was shown in our earlier study of rats infected with this parasite.

Host-parasite relationship of Angiostrongylus cantonensis. 2. Angiotropic behaviour and abnormal site development

Migratory young fifth-stage Angiostrongylus cantonensis transplanted intracranially into recipient rats were found to reach the lungs 3-4 days later by randomly entering cerebral veins. However, worms which were transplanted close to extracranial veins such as the jugular and femoral veins, or into the pleural and peritoneal cavities failed to enter these blood vessels. Third-stage larvae were capable of infecting rats via skin wounds. Protease activity was not detected around young fifth and third-stage larvae incubated on gelatin films. The migratory young fifth-stage worms underwent a significant growth and completed development of their reproductive system during the first week after transplantation into pleural and peritoneal cavities and subcutaneous tissues where some survived for as long as 60 days. Oviposition also occurred in the pleural cavity.

Angiostrongylus cantonensis: phospholipase in nonsensitized and sensitized rats after challenge

Rats given an initial infection with Angiostrongylus cantonensis had moderately elevated phospholipase B activity in the lungs at 8 and 15 days after challenge, and greatly elevated levels were evident at 35, 43, and 49 days. In the brain, the values were elevated at 15 through 35 days. These periods of increased activity in the lungs and brain coincided with the migration patterns of the third stage larvae and the adult worms in this host. The elevated enzyme levels also were were correlated with increased numbers of eosinophils in the bone marrow at 8 and 15 days and again at 36, 43, and 49 days after infection. Similarly infected rats exhibited leukocytosis at 1 through 10 weeks of observation after challenge, and striking eosinophilia at 1, 7, 8, and 9 weeks. Rats reinfected after removal of the worms of the initial infection by thiabendazole treatment showed an anamnestic response characterized by (i) elevated enzyme values in both the lungs and brain at 1 day after reinfection and (ii) eosinophilia in the bone marrow by day 4. These accelerated responses were accompanied by a significant reduction in the worm burden of the rats. The results, which support our hypothesis that inflammation, elevated phospholipase B activity, and reduction in worm burden are causally related, are discussed in light of similar findings reported earlier from our studies with Trichinella spiralis and Nippostrongylus brasiliensis.