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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
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.
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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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