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Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam
BACKGROUND: Eosinophilic meningitis (EM) is a rare clinical syndrome caused by both infectious and noninfectious diseases. In tropical pacific countries, Angiostrongylus cantonensis is the most common cause. However, the EM definition varies in the literature, and its relation to parasitic meningiti...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810332/ https://www.ncbi.nlm.nih.gov/pubmed/33351806 http://dx.doi.org/10.1371/journal.pntd.0008937 |
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author | Hiraoka, Tomoko Cuong, Ngo Chi Hamaguchi, Sugihiro Kikuchi, Mihoko Katoh, Shungo Anh, Le Kim Anh, Nguyen Thi Hien Anh, Dang Duc Smith, Chris Maruyama, Haruhiko Yoshida, Lay-Myint Cuong, Do Duy Thuy, Pham Thanh Ariyoshi, Koya |
author_facet | Hiraoka, Tomoko Cuong, Ngo Chi Hamaguchi, Sugihiro Kikuchi, Mihoko Katoh, Shungo Anh, Le Kim Anh, Nguyen Thi Hien Anh, Dang Duc Smith, Chris Maruyama, Haruhiko Yoshida, Lay-Myint Cuong, Do Duy Thuy, Pham Thanh Ariyoshi, Koya |
author_sort | Hiraoka, Tomoko |
collection | PubMed |
description | BACKGROUND: Eosinophilic meningitis (EM) is a rare clinical syndrome caused by both infectious and noninfectious diseases. In tropical pacific countries, Angiostrongylus cantonensis is the most common cause. However, the EM definition varies in the literature, and its relation to parasitic meningitis (PM) remains unclear. METHODOLOGY/PRINCIPAL FINDINGS: Adult and adolescent patients of 13 years old or above with suspected central nervous system (CNS) infections with abnormal CSF findings were prospectively enrolled at a tertiary referral hospital in Hanoi, Vietnam from June 2012 to May 2014. Patients with EM or suspected PM (EM/PM) were defined by the presence of either ≥10% eosinophils or an absolute eosinophil cell counts of ≥10/mm(3) in the CSF or blood eosinophilia (>16% of WBCs) without CSF eosinophils. In total 679 patients were enrolled: 7 (1.03%) had ≥10% CSF eosinophilia, 20 (2.95%) had ≥10/mm(3) CSF eosinophilia, and 7 (1.03%) had >16% blood eosinophilia. The patients with ≥10% CSF eosinophilia were significantly younger (p = 0.017), had a lower body temperature (p = 0.036) than patients with ≥10/mm(3) CSF eosinophilia among whom bacterial pathogens were detected in 72.2% (13/18) of those who were tested by culture and/or PCR. In contrast, the characteristics of the patients with >16% blood eosinophilia resembled those of patients with ≥10% CSF eosinophilia. We further conducted serological tests and real-time PCR to identify A. cantonensis. Serology or real-time PCR was positive in 3 (42.8%) patients with ≥10% CSF eosinophilia and 6 (85.7%) patients with >16% blood eosinophilia without CSF eosinophils but none of patients with ≥10/mm(3) CSF eosinophilia. CONCLUSIONS: The etiology of PM in northern Vietnam is A. cantonensis. The eosinophil percentage is a more reliable predictor of parasitic EM than absolute eosinophil count in the CSF. Patients with PM may present with a high percentage of eosinophils in the peripheral blood but not in the CSF. |
format | Online Article Text |
id | pubmed-7810332 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-78103322021-01-27 Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam Hiraoka, Tomoko Cuong, Ngo Chi Hamaguchi, Sugihiro Kikuchi, Mihoko Katoh, Shungo Anh, Le Kim Anh, Nguyen Thi Hien Anh, Dang Duc Smith, Chris Maruyama, Haruhiko Yoshida, Lay-Myint Cuong, Do Duy Thuy, Pham Thanh Ariyoshi, Koya PLoS Negl Trop Dis Research Article BACKGROUND: Eosinophilic meningitis (EM) is a rare clinical syndrome caused by both infectious and noninfectious diseases. In tropical pacific countries, Angiostrongylus cantonensis is the most common cause. However, the EM definition varies in the literature, and its relation to parasitic meningitis (PM) remains unclear. METHODOLOGY/PRINCIPAL FINDINGS: Adult and adolescent patients of 13 years old or above with suspected central nervous system (CNS) infections with abnormal CSF findings were prospectively enrolled at a tertiary referral hospital in Hanoi, Vietnam from June 2012 to May 2014. Patients with EM or suspected PM (EM/PM) were defined by the presence of either ≥10% eosinophils or an absolute eosinophil cell counts of ≥10/mm(3) in the CSF or blood eosinophilia (>16% of WBCs) without CSF eosinophils. In total 679 patients were enrolled: 7 (1.03%) had ≥10% CSF eosinophilia, 20 (2.95%) had ≥10/mm(3) CSF eosinophilia, and 7 (1.03%) had >16% blood eosinophilia. The patients with ≥10% CSF eosinophilia were significantly younger (p = 0.017), had a lower body temperature (p = 0.036) than patients with ≥10/mm(3) CSF eosinophilia among whom bacterial pathogens were detected in 72.2% (13/18) of those who were tested by culture and/or PCR. In contrast, the characteristics of the patients with >16% blood eosinophilia resembled those of patients with ≥10% CSF eosinophilia. We further conducted serological tests and real-time PCR to identify A. cantonensis. Serology or real-time PCR was positive in 3 (42.8%) patients with ≥10% CSF eosinophilia and 6 (85.7%) patients with >16% blood eosinophilia without CSF eosinophils but none of patients with ≥10/mm(3) CSF eosinophilia. CONCLUSIONS: The etiology of PM in northern Vietnam is A. cantonensis. The eosinophil percentage is a more reliable predictor of parasitic EM than absolute eosinophil count in the CSF. Patients with PM may present with a high percentage of eosinophils in the peripheral blood but not in the CSF. Public Library of Science 2020-12-22 /pmc/articles/PMC7810332/ /pubmed/33351806 http://dx.doi.org/10.1371/journal.pntd.0008937 Text en © 2020 Hiraoka et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Hiraoka, Tomoko Cuong, Ngo Chi Hamaguchi, Sugihiro Kikuchi, Mihoko Katoh, Shungo Anh, Le Kim Anh, Nguyen Thi Hien Anh, Dang Duc Smith, Chris Maruyama, Haruhiko Yoshida, Lay-Myint Cuong, Do Duy Thuy, Pham Thanh Ariyoshi, Koya Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam |
title | Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam |
title_full | Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam |
title_fullStr | Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam |
title_full_unstemmed | Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam |
title_short | Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam |
title_sort | meningitis patients with angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern vietnam |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810332/ https://www.ncbi.nlm.nih.gov/pubmed/33351806 http://dx.doi.org/10.1371/journal.pntd.0008937 |
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