Intravitreal Angiostrongylus cantonensis: first case report in South America

Population dynamics of Achatina fulica in a peri-urban area adjacent to the Fiocruz Atlantic Forest Biological Station (EFMA), in Rio de Janeiro, Brazil, with report on Angiostrongylus cantonensis infection

Achatina fulica is a species native to East Africa, considered one of the 100 worst invasive alien species in the world. The present study investigated the population of the snail, A. fulica, in a peri-urban area adjacent to the Fiocruz Atlantic Forest Biological Station (EFMA), in Jacarepaguá, Rio de Janeiro state, Brazil, focusing on population dynamics and the nematodes associated with this species. To this end, specimens were collected during four climatic seasons of the years 2021 and 2022 in three fixed 20 m × 10 m plots. The abundance of A. fulica in these areas was evaluated in relation to a set of environmental variables (temperature, relative humidity air, and soil pH and calcium). The abundance of snails infected by nematodes was also evaluated in relation to the season and body size of the specimens. The molluscs were found by active search, and standardized (15 minutes/three collections). Nematode larvae were extracted from the specimens by artificial digestion and identified by their external morphology and the sequencing of molecular markers. A total of 280 specimens of A. fulica were collected, with the highest abundances being recorded in the autumn and summer, although no significant relationship was found between the number of specimens collected and the environmental variables. Overall, 192 snails were infected by nematodes: Angiostrongylus cantonensis, Cruzia tentaculata and free-living nematodes, including Caenorhabditis briggsae. These findings demonstrate the epidemiological importance of the study area and the need to implement educational measures in the community, with the aim of controlling the local A. fulica population, thereby minimizing the risk of parasitic infection in the local human population.

Identification and genetic characterization of Angiostrongylus cantonensis isolated from the human eye

Angiostrongylus cantonensis, or the rat lungworm, is the causative agent of human angiostrongyliasis associated with eosinophilic meningitis or meningoencephalitis. Additionally, this nematode can cause ocular angiostrongyliasis, though this is rare. The worm can cause permanent damage to the affected eye and sometimes even blindness. Genetic characterization of the worm from clinical samples is limited. In the present study, we investigated the genetics of A. cantonensis recovered from a patient's eye in Thailand. We sequenced two mitochondrial genes (cytochrome c oxidase subunit I, or COI, and cytochrome b, or cytb) and nuclear gene regions (66-kDa protein and internal transcribed spacer 2, or ITS2) from a fifth-stage larva of Angiostrongylus sample that was surgically removed from the human eye. All sequences of the selected nucleotide regions were highly similar (98-100%) to the sequences of A. cantonensis in the GenBank database. The maximum likelihood and neighbor-joining trees of the COI gene indicated that A. cantonensis was closely related to the AC4 haplotype, whereas the cytb and 66-kDa protein genes were closely clustered with the AC6 and Ac66-1 haplotypes, respectively. In addition, the phylogeny of the concatenated nucleotide datasets of the COI and cytb revealed that the worm was closely related to the Thai strain and strains from other countries. This study confirms the identification and genetic variation of the fifth-stage larvae of A. cantonensis recovered from a patient's eye in Thailand. Our findings are important for future research on the genetic variation of A. cantonensis that causes human angiostrongyliasis.

Comparative biology of parasitic nematodes in the genus Angiostrongylus and related genera

The rise to prominence of some Angiostrongylus species through associated emerging disease in humans and dogs has stimulated calls for a renewed focus on the biology of this genus and three related genera. Although significant research efforts have been made in recent years these have tended to focus on individual species and specific aspects such as diagnosis and treatment of disease or new records of occurrence and hosts. This comprehensive review takes a comparative approach, seeking commonalities and differences among species and asking such questions as: Which species belong to this and to closely related genera and how are they related? Why do only some species appear to be spreading geographically and what factors might underlie range expansion? Which animal species are involved in the life cycles as definitive, intermediate, paratenic and accidental hosts? How do parasite larvae find, infect and develop within these hosts? What are the consequences of infection for host health? How will climate change affect future spread and global health? Appreciating how species resemble and differ from each other shines a spotlight on knowledge gaps and provides provisional guidance on key species characteristics warranting detailed study. Similarities exist among species, including the basic life cycle and transmission processes, but important details such as host range, climatic requirements, migration patterns within hosts and disease mechanisms differ, with much more information available for A. cantonensis and A. vasorum than for other species. Nonetheless, comparison across Angiostrongylus reveals some common patterns. Historically narrow definitive host ranges are expanding with new knowledge, combining with very broad ranges of intermediate gastropod hosts and vertebrate and invertebrate paratenic and accidental hosts to provide the backdrop to complex interactions among climate, ecology and transmission that remain only partly understood, even for the species of dominant concern. Key outstanding questions concern larval dynamics and the potential for transmission outside trophic relations, relations between infection and disease severity in different hosts, and how global change is altering transmission beyond immediate impacts on development rate in gastropods. The concept of encounter and compatibility filters could help to explain differences in the relative importance of different gastropod species as intermediate hosts and determine the importance of host community composition and related environmental factors to transmission and range. Across the group, it remains unclear what, physiologically, immunologically or taxonomically, delimits definitive, accidental and paratenic hosts. Impacts of infection on definitive host fitness and consequences for population dynamics and transmission remain mostly unexplored across the genus. Continual updating and cross-referencing across species of Angiostrongylus and related genera is important to synthesise rapid advances in understanding of key traits and behaviours, especially in important Angiostrongylus species that are emerging causative agents of disease in humans and other animals.

Epidemiological, clinical and laboratory aspects of Angiostrongylus cantonensis infection: an integrative review

This integrative literature review study analyzes the findings of the last 5 years of the parasite Angiostrongylus cantonensis. It is known that this nematode is found in the pulmonary arteries of rats, where it remains as a definitive host. From mice, the cycle spreads to animals, such as snails, which in contact with humans can trigger the disease. In humans, the parasite causes several neurological, abdominal manifestations and mainly meningitis. Based on the review of studies, its epidemiology shows worldwide distribution, although there are endemic cases for this parasite, such as asian countries. Laboratory findings generally showed altered CSF with turbidity, increased protein and eosinophilia, which generated meningeal signs in the patient, moreover MRI exams showed multiple alterations. Rare findings of the nematode in the eyeball, lung and signs of peritoneal inflammation were reported, which requires further studies to understand the whole pathophysiology. Finally, conservative treatment based on anthelmintics and anti-inflammatories brought good responses, although there are reports of deaths, which demonstrates the importance in the prevention and therapy of this disease.

Subretinal Angiostrongyliasis: A Case Report

Purpose

To report the patient with subretinal Angiostrongylus larva.

Methods

Retrospective, observational case report.

Results

A 47-year-old Thai woman had eosinophilic meningitis. One week after the onset of a headache, blurred vision developed in her right eye. Ocular examination of the right eye showed Angiostrongylus larva in the subretinal space in the inferotemporal quadrant and macular edema. Although serum analysis for Angiostrongylus was negative, the larva can be identified by its characteristic appearance. Blood eosinophilia and cerebrospinal fluid eosinophilia were presented. Focal laser photocoagulation was applied to the retina, and the patient also received anti-helminthic and oral corticosteroid drugs. The vision did not recover. Ultimately, the retina became atrophic. The dead larva remained at the same site at which it was observed. No further larval migration occurred after treatment.

Conclusion

Angiostrongylus larva can damage the retinal layer despite its eradication and no further migration. After its death, the inflammation persisted either as the result of toxin secretion or an immune responsiveness. Administration of local anti-inflammatory drugs such as corticosteroids or any anti-vascular endothelial growth factor injection should be considered.

Clinical Efficacy and Safety of Albendazole and Other Benzimidazole Anthelmintics for Rat Lungworm Disease (Neuroangiostrongyliasis): A Systematic Analysis of Clinical Reports and Animal Studies

The safety and efficacy of benzimidazole anthelmintics for the treatment of rat lungworm disease (neuroangiostrongyliasis) have been questioned regardless of numerous experimental animal studies and clinical reports. In this review, 40 of these experimental animal studies and 104 clinical reports are compiled with a focus on albendazole. Among the 144 articles involving an estimated 1034 patients and 2561 animals, 4.1% were inconclusive or vague regarding the use of benzimidazoles. Of the remaining 138 articles, 90.5% found benzimidazoles to be safe and effective (885 patients, 2530 animals), 4.3% as safe but ineffective (73 patients, 3 animals), and 5.0% caused adverse reactions (7 patients, 28 animals). Among those clinical reports that described a confirmed diagnosis of neuroangiostrongyliasis in which albendazole monotherapy was used, 100% reported high efficacy (743 patients, 479 animals). In those where albendazole-corticosteroid co-therapy was used, 97.87% reported it to be effective (323 patients, 130 animals).

Two Ocular Angiostrongyliasis Cases in Thailand with Molecular Identification of Causative Parasite Species

Human angiostrongyliasis is an important foodborne helminthic zoonosis caused by the nematodes of the genus Angiostrongylus. We describe two parasitologically confirmed cases of ocular angiostrongyliasis, presenting at a tertiary care hospital in Thailand between 2012 and 2018. Parasites were surgically recovered from patients' eyes and morphologically identified as Angiostrongylus species. DNA analysis allowed identification of Angiostrongylus cantonensis. Polymerase chain reaction was used to amplify all or part of the small nuclear ribosomal subunit, the second internal transcribed spacer region, and cytochrome c oxidase subunit 1. The sequences subsequently obtained were highly similar to those of A. cantonensis (97-100%). This is the first molecular confirmation that A. cantonensis is a causative agent of human angiostrongyliasis in Thailand.

Case Report: Management of Dead Intraocular Helminth Parasites in Asymptomatic Patients

We report four asymptomatic patients from Nepal with an incidental finding of a dead intraocular helminth parasite on ophthalmological routine examination. Because the patients were asymptomatic and the intraocular helminth parasites dead without noted pathology present, it was decided to abstain from surgical removal and pursue a watch-and-wait strategy. The clinical follow-up of the four patients over two years was uneventful and showed no complications. We conclude that dead intraocular helminth parasites in asymptomatic patients without apparent pathology do not require surgical removal.

Magnetic resonance imaging findings and clinical manifestations in cerebral angiostrongyliasis from Dali, China

PURPOSE

To analyze magnetic resonance imaging (MRI) findings and clinical diagnosis and treatment data relating to Angiostrongylus cantonensis infection to gain insight into the disease.

MATERIALS AND METHODS

We retrospectively analyzed the epidemiology, clinical manifestations, diagnosis and treatment data, imaging manifestations, and outcomes of 27 patients who were clinically diagnosed with angiostrongyliasis and who underwent contrast-enhanced brain MRI.

RESULTS

Patients with A. cantonensis infection had a history of eating raw mollusks in the endemic area, and they mainly presented with dizziness and headache of varying degrees and vomiting (n = 7). Laboratory examinations revealed increased peripheral blood and cerebrospinal fluid (CSF) eosinophils, as well as increased CSF protein levels. Brain MRI findings mainly included eosinophilic meningitis, whereas linear or nodular enhancement of the pia mater was observed in enhanced T1-weighted and fluid-attenuated inversion recovery images, accompanied by encephalitis or vasculitis. Meningitis manifested as multiple, thickened flow voids around the meninges, and contrast-enhanced scans showed substantial enhancement in intracranial dilated and hyperplastic blood vessels.

CONCLUSION

The possibility of A. cantonensis infection should be considered in the effective use of albendazole or mebendazole as a treatment. Combining clinical history with laboratory examination is helpful in diagnosing A. cantonensis infection. A final definite diagnosis can be confirmed by detecting larvae in the CSF. The administration of corticosteroids during pathogen therapy can substantially reduce the therapeutic response.