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Meesing A, Khamsai S, Sawanyawisuth K, Tiamkao S, Maleewong W, Limpawattana P, Sawunyavisuth B, Ngamjarus C, Boonsawat W. Transmission sources and severe rat lung worm diseases in travelers: a scoping review. Trop Dis Travel Med Vaccines 2023; 9:2. [PMID: 36759878 PMCID: PMC9912548 DOI: 10.1186/s40794-022-00184-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 11/18/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Rat lung worm disease (RLWD) has several clinical forms including eosinophilic meningitis (EOM) and two severe forms, eosinophilic meningoencephalitis (EOME) and eosinophilic radiculomyelitis (EORM). It remains unclear whether transmission sources are associated with severe forms of RLWD. This study aimed to evaluate if transmission factors are related to the severity of RLWD among travelers by using a scoping review of case reports. METHODS This was a review using five databases to retrieve case reports and case series of travelers with RLWD. Clinical data and transmission sources of reported cases diagnosed as RLWD were retrieved. The outcome of the study was occurrence of severe forms of RLWD defined as EOME, EORM, and combined EOME/EORM. RESULTS We retrieved 1,326 articles from five databases and 31 articles were included in the analysis. There were 84 cases eligible from 15 countries. Four cases were excluded. Seventy cases were in EOM group and 10 cases had EOME or EORM. Compared with the EOM group, the EOME, EORM, and combination EOME/EORM group had similar age, sex, and risk factors of consumptions of apple snails, shrimp and prawn, and salad/vegetables. The EOME group had higher proportion of consumption of African snails than the EOM group (60% vs 13.8%). However, only one study reported the consumption of African snails and the heterogeneity between studies and the small sample size impeded direct comparisons between groups. CONCLUSIONS RLWD in travelers can be found in most continents and mostly get infected from endemic countries of RLWD. Further studies are required to evaluate the association between transmission vectors and severity of RLWD.
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Affiliation(s)
- Atibordee Meesing
- grid.9786.00000 0004 0470 0856Department of Medicine, Faculty of Medicine, Khon Kaen University, 123 Mitraparp Road, Khon Kaen, Thailand 40002
| | - Sittichai Khamsai
- Department of Medicine, Faculty of Medicine, Khon Kaen University, 123 Mitraparp Road, Khon Kaen, Thailand, 40002.
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, 123 Mitraparp Road, Khon Kaen, Thailand, 40002.
| | - Somsak Tiamkao
- grid.9786.00000 0004 0470 0856Department of Medicine, Faculty of Medicine, Khon Kaen University, 123 Mitraparp Road, Khon Kaen, Thailand 40002
| | - Wanchai Maleewong
- grid.9786.00000 0004 0470 0856Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand 40002
| | - Panita Limpawattana
- grid.9786.00000 0004 0470 0856Department of Medicine, Faculty of Medicine, Khon Kaen University, 123 Mitraparp Road, Khon Kaen, Thailand 40002
| | - Bundit Sawunyavisuth
- grid.9786.00000 0004 0470 0856Department of Marketing, Faculty of Business Administration and Accountancy, Khon Kaen University, Khon Kaen, Thailand 40002
| | - Chetta Ngamjarus
- grid.9786.00000 0004 0470 0856Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand 40002
| | - Watchara Boonsawat
- grid.9786.00000 0004 0470 0856Department of Medicine, Faculty of Medicine, Khon Kaen University, 123 Mitraparp Road, Khon Kaen, Thailand 40002
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Cowie RH, Ansdell V, Panosian Dunavan C, Rollins RL. Neuroangiostrongyliasis: Global Spread of an Emerging Tropical Disease. Am J Trop Med Hyg 2022; 107:1166-1172. [PMID: 36343594 PMCID: PMC9768254 DOI: 10.4269/ajtmh.22-0360] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/18/2022] [Indexed: 11/09/2022] Open
Abstract
Neuroangiostrongyliasis (NAS) is an emerging parasitic disease caused by the neurotropic nematode Angiostrongylus cantonensis. Since it was first discovered, in rats in southern China in the 1930s, this tropical to subtropical parasite has spread to much of Southeast Asia, the Pacific Islands (including Hawaii), Australia, Japan, South America, the southeastern United States, the Caribbean, Africa, the Canary Islands, and the Balearic Islands. The parasite completes its natural life cycle in snails and slugs (intermediate hosts), and rats (definitive hosts). Humans become accidental hosts after ingesting infective third-stage larvae contained within uncooked or undercooked intermediate or paratenic hosts, an event that sometimes results in NAS, also known as rat lungworm disease. Although A. cantonensis larvae cannot complete their life cycle in humans, their migration into the brain and spinal cord combined with a powerful inflammatory reaction often leads to eosinophilic meningitis and can, in rare instances, lead to coma, paralysis, and death or, in other cases, chronic, disabling neurologic sequelae. Symptoms of NAS are diverse, which often makes it difficult to diagnose. Treatment may include administration of analgesics, corticosteroids, anthelminthics, and repeat lumbar punctures to reduce intracranial pressure. Unfortunately, few medical providers, even in endemic areas, are familiar with A. cantonensis or its epidemiology, diagnosis, and treatment. As the parasite continues to spread and NAS affects more people, medical practitioners, as well as the general public, must become more aware of this emerging zoonosis and the potentially devastating harm it can cause.
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Affiliation(s)
- Robert H. Cowie
- Pacific Biosciences Research Center, University of Hawaii, Honolulu, Hawaii;,Address correspondence to Robert H. Cowie, Pacific Biosciences Research Center, University of Hawaii, 3050 Maile Way, Gilmore 408, Honolulu, HI 96822. E-mail:
| | - Vernon Ansdell
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | | | - Randi L. Rollins
- Pacific Biosciences Research Center, University of Hawaii, Honolulu, Hawaii;,School of Life Sciences, University of Hawaii, Honolulu, Hawaii
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Phan HT, Tran KH, Nguyen HS. Eosinophilic Meningitis due to Angiostrongylus cantonensis in Children. Case Rep Neurol 2021; 13:184-189. [PMID: 33976654 PMCID: PMC8077498 DOI: 10.1159/000512809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/05/2020] [Indexed: 11/19/2022] Open
Abstract
Meningoencephalitis is not a rare disease in children. However, eosinophilic meningitis due to Angiostrongylus cantonensis is unusual in the pediatric population. We describe the case of a 12-year-old girl from the central area of Vietnam with eosinophilic meningitis due to A. cantonensis. The patient lived in a rural area, where farming is widespread, and presented with fever and headache. Laboratory results showed peripheral eosinophilia, a cerebrospinal fluid white blood cell count of 730/mm3 with 65% eosinophils. Cerebrospinal fluid ELISA was positive for A. cantonensis, and blood ELISA was positive for A. cantonensis. The presentation was consistent with a diagnosis of A. cantonensis eosinophilic meningitis. The patient recovered fully after administration of albendazole (200 mg/day for 2 weeks), as well as intravenous dexamethasone (0.6 mg/kg/day every 8 h) and mannitol (1.5 g/kg/day every 8 h) for the first 3 days, followed by 5 days of oral prednisolone (2 mg/kg/day).
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Affiliation(s)
- Hai Thanh Phan
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue, Vietnam
| | - Kiem Hao Tran
- Pediatric Center, Hue Central Hospital, Hue, Vietnam
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Abstract
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.
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Angiostrongylus cantonensis in travelers: clinical manifestations, diagnosis, and treatment. Curr Opin Infect Dis 2019; 31:399-408. [PMID: 30138142 DOI: 10.1097/qco.0000000000000481] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Angiostrongylus cantonensis eosinophilic meningitis is a neglected, yet important emerging disease, which has been increasingly recognized in travelers. In this review, we describe the occurrence of the disease in travelers, sources of infection, clinical manifestations, diagnosis, and currently recommended treatment. RECENT FINDINGS Various intermediate hosts and/or paratenic hosts can be the source of infection in humans. Serological tests for antibody may be negative early in the course of the disease but PCR for antigen detection in the CSF has recently been developed and may help to make the diagnosis at an earlier stage. High-dose corticosteroids (e.g. prednisolone 60 mg per day for at least 1-2 weeks) are currently the recommended treatment. Efficacy and safety of antihelminthic drugs for treatment remains controversial because of theoretical concerns that they may worsen the inflammatory response to dead and dying worms. Previous clinical trials were conducted with small numbers of participants and were underpowered. Further well designed clinical trials are urgently needed. SUMMARY Awareness about increasing numbers of A. cantonensis eosinophilic meningitis in travelers is very important. Travelers should be advised about possible sources of infection. Diagnosis should be confirmed by antigen or antibody detection in blood or CSF. High-dose corticosteroids are the recommended treatment. The efficacy of various antihelminthic drugs is unproven. A large-scale, double-blind, randomized, controlled trial of antihelminthic drug involving antihelminthic drugs such as albendazole is necessary to prove the efficacy before formally advocating their use on a regular basis.
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Wang H, Lu L, She D, Wen Z, Mo Z, Li J, Li H. Eating Centipedes Can Result in Angiostrongylus cantonensis Infection: Two Case Reports and Pathogen Investigation. Am J Trop Med Hyg 2018; 99:743-748. [PMID: 30062990 DOI: 10.4269/ajtmh.18-0151] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Angiostrongyliasis is a food-borne parasitic disease caused by the nematode Angiostrongylus cantonensis that can lead to eosinophilic meningitis (EM) or meningoencephalitis in humans. Angiostrongylus cantonensis is prevalent in the Pacific Islands. In recent years, a large number of outbreaks and severe cases have occurred. Several species of mollusk, such as snails and slugs, act as intermediate and paratenic hosts of A. cantonensis. In this study, two cases of EM were found to have been caused by infection with A. cantonensis due to consumption of raw centipedes. To survey the A. cantonensis infections acquired through centipedes that the patients had bought at a vegetable market, we performed etiological examinations and polymerase chain reaction amplification of A. cantonensis genes. Third-instar larvae of A. cantonensis were detected in the centipedes, and specific genes from A. cantonensis were detected in all the specimens. This indicates that the centipede may act as a competent host for the transmission of A. cantonensis. To our knowledge, this is the first report of A. cantonensis infection through the consumption of centipedes.
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Affiliation(s)
- Huijie Wang
- Department of Pathogen Biology and Experimental Teaching Centre of Preventive Medicine, Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, Key Laboratory for Tropical Disease Research of Guangdong Province, School of Public Health, Southern Medical University, Guangzhou, China
| | - Lingli Lu
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Dan She
- Department of Pathogen Biology and Experimental Teaching Centre of Preventive Medicine, Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, Key Laboratory for Tropical Disease Research of Guangdong Province, School of Public Health, Southern Medical University, Guangzhou, China
| | - Zhibo Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zexun Mo
- Department of Pathogen Biology and Experimental Teaching Centre of Preventive Medicine, Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, Key Laboratory for Tropical Disease Research of Guangdong Province, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jun Li
- Department of Pathogen Biology and Experimental Teaching Centre of Preventive Medicine, Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, Key Laboratory for Tropical Disease Research of Guangdong Province, School of Public Health, Southern Medical University, Guangzhou, China
| | - Hua Li
- Department of Pathogen Biology and Experimental Teaching Centre of Preventive Medicine, Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, Key Laboratory for Tropical Disease Research of Guangdong Province, School of Public Health, Southern Medical University, Guangzhou, China
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Angiostrongylus cantonensis: a review of its distribution, molecular biology and clinical significance as a human pathogen. Parasitology 2016; 143:1087-118. [PMID: 27225800 DOI: 10.1017/s0031182016000652] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Angiostrongylus cantonensis is a metastrongyloid nematode found widely in the Asia-Pacific region, and the aetiological agent of angiostrongyliasis; a disease characterized by eosinophilic meningitis. Rattus rats are definitive hosts of A. cantonensis, while intermediate hosts include terrestrial and aquatic molluscs. Humans are dead-end hosts that usually become infected upon ingestion of infected molluscs. A presumptive diagnosis is often made based on clinical features, a history of mollusc consumption, eosinophilic pleocytosis in cerebral spinal fluid, and advanced imaging such as computed tomography. Serological tests are available for angiostrongyliasis, though many tests are still under development. While there is no treatment consensus, therapy often includes a combination of anthelmintics and corticosteroids. Angiostrongyliasis is relatively rare, but is often associated with morbidity and sometimes mortality. Recent reports suggest the parasites' range is increasing, leading to fatalities in regions previously considered Angiostrongylus-free, and sometimes, delayed diagnosis in newly invaded regions. Increased awareness of angiostrongyliasis would facilitate rapid diagnosis and improved clinical outcomes. This paper summarizes knowledge on the parasites' life cycle, clinical aspects and epidemiology. The molecular biology of Angiostrongylus spp. is also discussed. Attention is paid to the significance of angiostrongyliasis in Australia, given the recent severe cases reported from the Sydney region.
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Morassutti AL, Thiengo SC, Fernandez M, Sawanyawisuth K, Graeff-Teixeira C. Eosinophilic meningitis caused by Angiostrongylus cantonensis: an emergent disease in Brazil. Mem Inst Oswaldo Cruz 2015; 109:399-407. [PMID: 25075779 PMCID: PMC4155839 DOI: 10.1590/0074-0276140023] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 05/28/2014] [Indexed: 11/21/2022] Open
Abstract
Eosinophilic meningitis (EoM) is an acute disease that affects the central nervous
system. It is primarily caused by infection with the nematode Angiostrongylus
cantonensis. This infection was previously restricted to certain Asian
countries and the Pacific Islands, but it was first reported in Brazil in 2007. Since
then, intermediate and definitive hosts infected with A. cantonensis
have been identified within the urban areas of many states in Brazil,
including those in the northern, northeastern, southeastern and southern regions. The
goals of this review are to draw the attention of the medical community and health
centres to the emergence of EoM in Brazil, to compile information about several
aspects of the human infection and mode of transmission and to provide a short
protocol of procedures for the diagnosis of this disease.
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Affiliation(s)
- Alessandra Loureiro Morassutti
- Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifícia Universidade do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Monica Fernandez
- Laboratório de Malacologia, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, RJ, Brasil
| | - Kittisak Sawanyawisuth
- Department of Medicine, Center for Emerging Infectious Diseases, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Carlos Graeff-Teixeira
- Laboratório de Biologia Parasitária, Faculdade de Biociências, Pontifícia Universidade do Rio Grande do Sul, Porto Alegre, RS, Brasil
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Chang SH, Tang P, Lai CH, Kuo ML, Wang LC. Identification and characterisation of microRNAs in young adults of Angiostrongylus cantonensis via a deep-sequencing approach. Mem Inst Oswaldo Cruz 2014; 108:699-706. [PMID: 24037191 PMCID: PMC3970689 DOI: 10.1590/0074-0276108062013005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 06/13/2013] [Indexed: 01/21/2023] Open
Abstract
Angiostrongylus cantonensis is an important causative agent of
eosinophilic meningitis and eosinophilic meningoencephalitis in humans.
MicroRNAs (miRNAs) are small non-coding RNAs that participate in a wide range of
biological processes. This study employed a deep-sequencing approach to study
miRNAs from young adults of A. cantonensis. Based on 16,880,456
high-quality reads, 252 conserved mature miRNAs including 10 antisense miRNAs
that belonging to 90 families, together with 10 antisense miRNAs were identified
and characterised. Among these sequences, 53 miRNAs from 25 families displayed
50 or more reads. The conserved miRNA families were divided into four groups
according to their phylogenetic distribution and a total of nine families
without any members showing homology to other nematodes or adult worms were
identified. Stem-loop real-time polymerase chain reaction analysis of
aca-miR-1-1 and aca-miR-71-1 demonstrated that their level of expression
increased dramatically from infective larvae to young adults and then decreased
in adult worms, with the male worms exhibiting significantly higher levels of
expression than female worms. These findings provide information related to the
regulation of gene expression during the growth, development and pathogenesis of
young adults of A. cantonensis.
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Affiliation(s)
- Shih-Hsin Chang
- Institute of Biomedical Sciences, College of Medicine, Chang Gung University, TaoyuanCounty, Taiwan
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Vitta A, Polseela R, Nateeworanart S, Tattiyapong M. Survey of Angiostrongylus cantonensis in rats and giant African land snails in Phitsanulok province, Thailand. ASIAN PAC J TROP MED 2012; 4:597-9. [PMID: 21914534 DOI: 10.1016/s1995-7645(11)60154-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 05/11/2011] [Accepted: 06/15/2011] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To survey the Angiostrongylus cantonensis (A. cantonensis) or the rat lungworm in a rat, definitive host, and in a giant African land snail (Achatina fulica), the intermediate host, in Phitsanulok, Thailand. METHODS Rats and giant African land snails were captured from Tha Pho sub-district, Phitsanulok, Thailand. Rats were killed and examined for adult A. cantonensis. The artificial digestion method following Baermann technique were used for isolation third stage larvae of A. cantonensis. RESULTS Sixty-two rats were captured and they were identified as Rattus argentiventer, Rattus rattus (R. rattus), Bandicota savilei, and Bandicota indica but only one animal (R. rattus) of 62 rats (1.61%) was positive with adult worm of A. cantonensis. The third stage larvae of A. cantonensis were examined on 307 Angiostrongylus fulica snails. It was found that the overall infection rate was 12.38% (38 infected out of 307 Achatina snails). CONCLUSIONS This study demonstrates that A. cantonensis is available in the natural hosts of Phitsanulok. This suggests that the transmissions of this parasite to human may occur in this region.
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Affiliation(s)
- Apichat Vitta
- Department of Microbiology & Parasitology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand.
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Liu J, Gao J, Zhou C. A case report on eosinophilic meningitis caused by Angiostrongylus cantonensis. Int J Med Sci 2011; 8:510-3. [PMID: 21897764 PMCID: PMC3167100 DOI: 10.7150/ijms.8.510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 08/11/2011] [Indexed: 11/05/2022] Open
Abstract
Angiostrongylus cantonensis is the most common cause of eosinophilic meningitis in humans. It is usually caused by ingestion of raw or inadequately cooked intermediate hosts or food contaminated with infective third-stage larvae. We describe a case of eosinophilic meningitis caused by A. cantonensis in a male Chinese patient. The patient had a history of eating raw fish and snail. We describe the clinical features of the patient, the diagnostic process and treatments. We also provide a brief update for physicians on the characteristics, diagnosis and treatment of eosinophilic meningitis caused by A. cantonensis, with particular emphasis on the update of prevalence and treatment of the disease in China.
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Affiliation(s)
- Jingyao Liu
- Department of Neurology, Jilin University First Hospital, Changchun 130031, China
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